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
Cardiac/Vascular
- Cardiac injury
  - Blunt cardiac injury
    - Cardiac contusion
    - Commotio cordis
  - Penetrating cardiac injury
  - Cardiac tamponade
- Traumatic aortic transection
Musculoskeletal
Other

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

Disposition

See Also

External Links

References

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