Scapulothoracic Dislocation after Transthoracic Esophagectomy

Abstract

A 64-year-old man presented with an acute onset of severe pain of the right shoulder and inability to move it. Three months earlier he had undergone a right-sided posterolateral thoracotomy for an esophageal carcinoma that appeared irresectable because of ingrowth into the trachea. Postoperatively the patient was treated with concurrent radiotherapy (total 52.2 Gy) and chemotherapy. Two months after the thoracotomy, lesions of two ribs at the right side were diagnosed, and were suspect for metastases. Physical examination of the right shoulder revealed a thoracotomy scar without signs of infection, but an obvious deformity consisting of a vanishing right scapula: the scapula seemed “locked” in the chest (A). Shoulder movements were painful and impaired.There were no signs of vascular or neural compromise. Plain x-rays of the shoulder revealed an intrathoracic scapular entrapment in which the inferior scapular angle was traumatically inserted between two fractured ribs (B, redarrows).Theintercostalspace(B,whitearrow)between the fourth and fifth rib was significantly widened. These fractureswerehighlysuspiciousforbonemetastasis.Closed reduction of the scapula was easily accomplished. Control x-ray showed an anatomic position of the shoulder and no signs of hemato- or pneumothorax. To prevent redislocation, a collar and cuff sling was applied. The next day the pain had markedly improved and there was a normal functional range of motion of the shoulder without signs of redislocation. Nine months later no redislocation had occurred. Weakness of the shoulder girdle is a common complication after posterolateral thoracotomy. Scapulothoracic dislocation is a rarity, 1,2 but it should be considered in a patient with complaints of the shoulder after ipsilateral thoracotomy.