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

Differential Diagnosis

Thoracic 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

References

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