Scapulothoracic Dissociation Research Articles

Open Scapulothoracic Dissociation

Scapulothoracic dissociation refers to the traumatic separation of the shoulder from the chest wall. This most commonly occurs as a closed injury. We present a case of open scapulothoracic dissociation and emphasize clinical features unique to this injury. In both closed and open scapulothoracic dissociation, the force necessary to shear the scapula from its thoracic attachments results in vascular disruption and neurologic injury to the upper extremity. As a consequence, patients have a pulseless, flail upper extremity with a significant chest wall hematoma (closed) or active bleeding (open). The first priority is to resuscitate and address life-threatening injuries. If the patient has active bleeding, immediate vascular control to prevent exsanguination is essential. Patients with ischemia and an incomplete injury or unreliable neurologic examination need revascularization. Outcome is based on the extent of brachial plexus or cervical nerve root avulsion. Patients with loss of neurologic function ultimately benefit from amputation at the appropriate level.

BRACHIAL PLEXUS INJURIES IN SCAPULOTHORACIC DISSOCIATION

The rare condition of scapulothoracic dissociation (STD) is characterized by a lateral displacement of the scapula from the thoracic cage following severe trauma to the scapular girdle. This study presents an analysis of five STDs. There were three supraclavicular brachial plexus palsies and two retro- and infraclavicular palsies. Recovery of elbow flexion was obtained in only two cases. Nerve damage dominates the prognosis and nerve recovery only rarely occurs. Nerve surgery should attempt to reestablish elbow flexion

Shoulder and humerus trauma.

Three bones and two joints comprise the pectoral girdle. These are the clavicle, scapula, proximal humerus, acromioclavicular joint, and shoulder joint. The pectoral girdle binds the upper extremity to the torso. Thus, injury to any of the pectoral girdle's components can impact the function of the entire extremity. The spectrum of pectoral girdle injuries ranges from a simple acromioclavicular joint sprain to scapulothoracic dissociation. Whereas the former is a painful but self-limiting injury with minimal sequelae, the latter is life threatening. However, the severity of most pectoral girdle injuries lies between these two extremes. Fractures and dislocations are common in this region throughout life, and a clear understanding of the patterns of injury and their radiographic spectrum is essential for all radiologists who deal with trauma.

Scapulothoracic dissociation: A "missed injury"?

The scapulothoracic dissociation (SD) is a complex injury of the shoulder girdle, mostly associated with polytraumatized critically ill patients. This case report of 3 patients shows the variety of possible injuries combined with SD. Diagnosis and therapy in such a rare trauma, which is most likely seen in specialized trauma centres are being described. The 3 patients are presented from trauma to management, with remarks to various possibilities in treatment. Reports of other groups include multicenter studies with small numbers of patients, making it different to look for homogenity or defining standards, whereas current guidelines are being mentioned, including remarks on the management of these mostly polytraumatized and vitally endangered patients.

A case of sternoclavicular dislocation with scapulothoracic dissociation.

A case of sternoclavicular dislocation with scapulothoracic dissociation.

Scapulothoracic dissociation: Report of five cases and review of the literature

Scapulothoracic dissociation is a closed forequarter amputation of the upper extremity associated with a spectrum of neurovascular injuries that may be a difficult clinical diagnosis. Classic radiographic features are discussed, and the literature is reviewed.

The neurovascular outcome of scapulothoracic dissociation

Purpose: The purpose of this study was to define the role of acute revascularization in the management of scapulothoracic dissociation (SD), a rare injury of the upper extremity in which severe traction to the shoulder girdle results in combined arterial, brachial plexus, and musculoskeletal injury.Methods: The results of a retrospective study of 11 patients with SD who were compared with 41 patients from the literature are presented.Results: All 11 patients were involved in high-speed accidents. All patients had chest wall hematoma, absent radial pulse, and complete brachial plexus palsy. All patients had subclavian or axillary occlusion shown by angiography; one patient with simultaneous brachial artery injury had limb-threatening ischemia. No patient had active bleeding from the injured artery. Six limbs were revascularized, five were not. All five non-revascularized limbs remained viable. No patient had delayed hemorrhage. No patient had significant neurologic recovery; all limbs remained insensate and functionless. Two viable arms underwent late amputation because of neurologic dysfunction.Conclusion: The infrequent occurrence of delayed hemorrhage and limb-threatening ischemia and the dismal functional outcome of the brachial plexus injury suggest a conservative policy toward revascularization for the arterial injury in SD.

Traumatic Scapulothoracic Dissociation

A 23-year-old man suffered traumatic scapulothoracic dissociation (TSD) in a car-vs.-bicyclist accident. TSD is a devastating forequarter injury characterized by brachial plexus damage, major upper extremity musculoskeletal disruption, and exsanguinating hemorrhage: our patient survived a hematocrit of 7. Prompt recognition and aggressive management of TSD's multiple injuries are crucial.

Scapulothoracic dissociation.

Scapulothoracic dissociation is a rare entity that consists of disruption of the scapulothoracic articulation. The mechanism of injury is probably traction caused by a blunt force to the shoulder girdle. This lesion is characterized by massive soft-tissue swelling of the shoulder; lateral displacement of the scapula, measured radiographically; an injury to bone (an acromioclavicular separation, a displaced fracture of the clavicle, or a sternoclavicular disruption); a severe neurovascular injury; and a variety of upper and lower-extremity fractures. We treated fifteen patients who had this lesion, most of whom had several associated injuries. Three patients died: two from exsanguination and one from a cardiac arrest. In most patients, the damaged artery was repaired and the brachial plexus was explored. All of the twelve patients who had a complete brachial-plexus injury were left with a flail upper extremity. Most patients refused amputation.

Scapulothoracic Dissociation

A 26-year-old man sustained a scapulothoracic dissociation (STD) as a result of severe shoulder girdle trauma. In this recently described syndrome, multiple fractures of the upper extremity and closed disruption of the scapula from the thorax are combined with damage to the local neurovascular structures. The occurrence of blunt subclavian arterial injury and STD indicates the possibility of severe brachial plexus lesions.

Traumatic lateral displacement of the scapula

Scapulothoracic dissociation, as manifested by lateral displacement of the scapula and acromioclavicular separation, is a previously unreported injury in which there is a complete disruption of the scapulothoracic articulation without an overlying partial or complete amputation through the soft tissue. Associated with the disruption of the scapulothoracic articulation are injuries to the brachial plexus and the subclavian artery and vein; multiple open and closed fractures of the ipsilateral upper extremity are often present also. In the patient with severe multiple injuries, scapulothoracic dissociation may not be recognized immediately, with potentially fatal consequences. In this paper we present the cases of three patients with radiographic and pathological evidence of scapulothoracic dissociation and review the literature on related injuries.