Scapulothoracic Dissociation

synonyms: closed forequarter amputation, scapulothoracic dissociation

Scapulothoracic Dissociation ICD-9

• 726.2 (other affections of the shoulder region, not elsewhere classified)

Scapulothoracic Dissociation Etiology / Epidemiology / Natural History

• Results from high-energy trauma with severe associated injuries

Scapulothoracic Dissociation Anatomy

Scapulothoracic Dissociation Clinical Evaluation

• C/O shoulder pain after trauma.
• Massive swelling of the shoulder girdle.
• Document axillary, median, ulnar, radial nerve function and radial pulse. EMG can be performed 3 weeks after injury is neurologic injury is found or suspected.

Scapulothoracic Dissociation Xray / Diagnositc Tests

• Chest xray, AP, scapular lateral and axillaryviews. Films demonstrate posterolateral displacement of the scapula relative to the rib cage. Nonrotated chest xray shows scapula displaced laterally as compared to normal side. Displaced measured by the distance from the sternal notch or spinous process of the vertebrae to the coracoid, glenoid, or medial scapular border.
• CT scan generally indicated to fully assess fracture.
• Angiogram indicated if vascular injury is suspected.
• EMG can be performed 3 weeks after injury if neurologic injury is found or suspected.

Scapulothoracic Dissociation Classification / Treatment

Scapulothoracic Dissociation Associated Injuries / Differential DiagnosisBrachial Plexus palsy:common

• Clavicle Fracture: common
• Subclavian, brachial, or axillary artery injury: common
• Brachial plexus palsy: uncommon
• Rib fractures, pulmonary contusions, pneumothorax, pulmonary contusion, spinal cord injury
• Proximal Humerus Fracture
• Glenoid Fracture
• Acromioclavicular dislocation
• Sternoclavicular dislocation
• Scapulthoracic dissociation
• Coracoid Fracture
• Glenohumeral instability

Scapulothoracic Dissociation Complications

Scapulothoracic Dissociation Follow-up Care

Scapulothoracic Dissociation Review References