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

• Airway/Pulmonary
  • Bronchial injury
  • Diaphragmatic trauma
  • Hemothorax
  • Pneumomediastinum
  • Pulmonary contusion
  • Tracheal injury
  • Trachobronchial injury
  • Traumatic pneumothorax
    • Tension pneumothorax
• Cardiac/Vascular
  • Cardiac injury
    • Blunt cardiac injury
      • Cardiac contusion
      • Commotio cordis
    • Penetrating cardiac injury
    • Cardiac tamponade
  • Traumatic aortic transection
• Musculoskeletal
  • Clavicle fracture
    • Clavicle fracture (peds)
  • Rib fracture
    • Flail chest
  • Scapular fracture
  • Scapulothoracic dissociation
  • Sternoclavicular dislocation
  • Sternum fracture
  • Thoracic and lumbar fractures and dislocations
• Other
  • Esophageal injury or Perforation
  • Pneumomediastinum
  • Pneumopericardium
  • Traumatic asphyxia

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