Scapulothoracic Dissociation: Evaluation and Management

Abstract

Scapulothoracic dissociation is a rare, potentially limb- and life-threatening injury of the shoulder girdle. The injury is characterized by lateral displacement of the scapula resulting from traumatic disruption of the scapulothoracic articulation. The typical physical examination findings consist of substantial swelling of the shoulder girdle, along with weakness, numbness, and pulselessness in the ipsilateral upper extremity. Radiographic evaluation includes measurement of the scapular index on a nonrotated chest radiograph and assessment for either a distracted clavicle fracture or a disrupted acromioclavicular or sternoclavicular joint. Although vascular injury occurs in most patients, emergent surgery is performed only in patients with either limb-threatening ischemia or active arterial hemorrhage. Management of neurologic injury can be delayed if necessary. The location and severity of neurologic injury determine whether observation, nerve grafting, nerve transfer, or above-elbow amputation is performed. Skeletal stabilization procedures include plate fixation of clavicle fractures and reduction of distracted acromioclavicular or sternoclavicular joints. The extent of neurologic injury determines clinical outcomes. Medical Outcomes Study 36-Item Short Form scores are significantly lower in patients with complete brachial plexus avulsion injury than in patients with postganglionic injury.

Disociación escapulo-torácica y trauma cerrado de arteria vertebral: reporte de un caso.

“…These injuries have unpredictable responses and treatment options, including amputation 2 which must be individualized according to the type of injury. Post-ganglionic injuries are associated with a greater regenerative capacity when compared to pre-ganglionic injuries, which have a poor prognosis 1,3,10,14 . Compromise to the brachial plexus in a scapulo-thoracic dissociation has a negative influence in limb prognosis 1 .…”

“…Post-ganglionic injuries are associated with a greater regenerative capacity when compared to pre-ganglionic injuries, which have a poor prognosis 1,3,10,14 . Compromise to the brachial plexus in a scapulo-thoracic dissociation has a negative influence in limb prognosis 1 . However, the partial effective response after reconstructive surgery and its rehabilitation, determined in this case report and according to the patient's course presented thus far, warrants consideration of a more distal level of amputation in the patient's arm.…”

“…The scapulothoracic joint is made up of the acromio-clavicular joint, glenohumeral joint, clavicle, scapula, and sternoclavicular joint. This type of injury can cause subclavian and axillary vascular injuries, partial or complete avulsion of the brachial plexus, and edema to the surrounding soft tissues 1 . It is an uncommon injury with a mortality rate up to 10% and caused by motor vehicle accidents in 44% of cases.…”

“…It is an uncommon injury with a mortality rate up to 10% and caused by motor vehicle accidents in 44% of cases. Above the elbow amputation has been noted to be in around 20% of cases due to low potential for neurological recovery [1][2][3] .…”

“…The mechanism of injury is explained by the application of high energy traumatic forces, usually caused by high velocity mechanisms. Its management is challenging in all phases of care for the compromised patient 1 .…”