Scapulothoracic dissociation

Background

• Traumatic dislocation of scapula from thoracic wall
• Mechanism: massive traction force to ipsilateral upper extremity/shoulder girdle
• Associated with vascular injury to subclavian or axillary artery and brachial plexus injury

Clinical Features

• Upper extremity pain
• Upper extremity numbness/tingling, weakness
• Swelling, ecchymosis to shoulder
• Injury to subclavian or axillary arteries: hematoma, pulse deficit
• Severe mechanism --> often associated with chest trauma

Evaluation

• CXR
  • Laterally displaced scapula
  • Associated with distracted clavicle fracture, AC spearation, sternoclavicular dislocation
• CT Chest
  • To identify intrathoracic injuries
• CT Angio
  • To detect vascular injuries

Management

• Any evidence of neuro or vascular damage, hemodynamic instability--> surgery
• Normal neuro exam, no vascular injury: immobilization, supportive care

See Also

• Clavicle fracture
• Sternoclavicular dislocation
• Scapula fracture
• Brachial plexus injury
• Vascular injury