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Scapulothoracic Dissociation: Evaluation and Management

Choo, Andrew M. MD; Schottel, Patrick C. MD; Burgess, Andrew R. MD

JAAOS - Journal of the American Academy of Orthopaedic Surgeons: May 2017 - Volume 25 - Issue 5 - p 339–347
doi: 10.5435/JAAOS-D-15-00509
Review Article

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.

From the Department of Orthopaedic Surgery, University of Texas Health Science Center, Houston, TX (Dr. Choo and Dr. Burgess), and the Department of Orthopaedics and Rehabilitation, University of Vermont Medical Center, Burlington, VT (Dr. Schottel).

Dr. Burgess or an immediate family member serves as a paid consultant to or is an employee of Cardinal Health and Stryker and has stock or stock options held in Stryker. Neither of the following authors nor any immediate family member has received anything of value from or has stock or stock options held in a commercial company or institution related directly or indirectly to the subject of this article: Dr. Choo and Dr. Schottel.

Received September 20, 2015

Received in revised form March 26, 2016

Accepted May 12, 2016

© 2017 by American Academy of Orthopaedic Surgeons
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