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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
  • 10% overall mortality
  • 90% will have neurologic injury: often complete and permanent brachial plexopathy,
  • Frequent limb-threatening vascular injury.

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 axillary views. Films demonstrate posterolateral displacement of the scapula relative to the rib cage. Nonrotated chest xray shows scapula displaced laterally as compared to normal side. Displacement measured by the distance from the sternal notch or spinous process of the vertebrae to the coracoid, glenoid, or medial scapular border.  Often also have widening of the acromioclavicular joint.
  • 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 with complete vascular and neurologic injury: consider amputation.

Scapulothoracic Dissociation Associated Injuries / Differential Diagnosis

  • Brachial 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

  • Clements RH, Reisser JR. Scapulothoracic dissociation: a devastating injury. J Trauma. 1996 Jan;40(1):146-9.

 

 

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