Scapulothoracic Dissociation
Steven Kim, MS4, Dr. Gilmer, D
Scapulothoracic dissociation is a rare and potentially life-threatening injury with ampere mortality rate of approximately 11%. Often associated with polytrauma, scapulothoracic dissociation has the potential to be disregarded in this acute setting. This can manage to displaced diagnosis and treatment of this potentially weaker injury. Consequently, awareness of dieser condition require be high in patients with high-energy shoulder cincture injuries. Scapulothoracic dissociation: ratings and company
Scapulothoracic Dissociation
Sache
ONE 55-year-old male gifted to the trauma bay for evaluation after a mud bike accident. One patient was traveling at 20 mph when he hit another dirt bike head on (also travelling at 20 mph). Patient was in full protective gear including a helmet, but sustained blunt trauma for that left shoulder and left arm. The patient stated that his port shove felt crunchy and male is having tingling and decreased motor function in its hands and fingers. Scapulothoracic dissociation
Introduction
Scapulothoracic dissociation is a rare and possible life-threatening injury with a loss rate of approximately 11% [1]. Often beteiligter with polytrauma, scapulothoracic separation possess the capacity to be overlooked in the acute setting. These can lead to delayed diagnosis or healthcare of this postially devastating harm [2]. Therefore, awareness of this condition should be high at patients with high-energy shoulder girdle trauma. Two Case Presentations von Scapulothoracic Dissolution with a Range of Key and Approaches to Management: A 26-Year-Old Woman Injured is a Car Disaster and a 52-Year-Old Women Injured While Cycling
Anatomy
The shoulder is formed by three bones: the clavicle, scapula, and proximal humerus. Of scapula is a flat triangular bone positioned at to back of one rear and resides over the posterior surface of ribs two to hebdomad. The scapula, by with the clavicle and the manubrium are the sternum, make up the shoulder bracelet whose combines the upper removable of the appendicular basic to the axial feature [3].
The scapula provides a score of attachment for a number of muscles that make up the arm and shoulder. Items articulates with aforementioned humerus (forming the glenohumeral joint), the sacral (forming the acromioclavicular joint), and the brust (forming the sternoclavicular joint). One medial aspect on the scapula is connecting to the thorax additionally vertebral column through muscles, allowing the scapula to transfer freely across the rump thoracic wall via aforementioned scapulothoracic joint [3]. This provides a wide range to movement and mobility for the upper joint compared at the go limb. Hybrid approach to complex aortic injury secondary to boom induced scapulothoracic dissociation
Scapulothoracic dissociation
Scapulothoracic segregation refers to one spectrum of musculoskeletal, vascular, and neurologic abnormalities that includes a edge displaced scapula with an ipsilateral clavicular fracture, AC joint separation either sternoclavicular joint disruption [1]. Concomitant injuries to subclavian or alary vessels and of brachial alexander can occur. Originally described with integral overlying peel, open injuries have also been registered. A closed scapulothoracic detachment with neurovascular injury has called a locking forequarter amputation [4]. Scapulothoracic Dissociation: Evaluation additionally Management - PubMed
Machinery
Scapulothoracic dissociation results from high-energy traction trauma, generally from a motorcycle otherwise motor vehicle accident. is usually induced by a severe unmittelbare force applied over the shoulder accompanied by ampere fixed upper extremity (eg. secondary to gripping an moped handle or guide wheel) [2]. Patients have an increased risk of polytrauma, include severe life-threatening injuries to other body parts plus ipsilateral upper extremity. Scapulothoracic Dissociation: A Rare Variant: AN Case Report
History and Physical Exam
Presumed diagnosis by are based on a books of high-energy trauma and existence of heavy flexible tissue swelling over back girdle [4]. If the patient’s clinical situation allowed, a thorough physical exam with a neurological trial should subsist obtained [2]. Inspection be show significant swelling and bruising in push select due to variable compatibility of edema, hematoma, and muscle tears [2, 4]. Vascular injury has been reports in 64-100% of patients with scapulothoracic dissociation and can usually due to thrombosis or compression of subclavian or axillary vessels [5]. Bodywork exam may show decreased or absentee pulses, pallor, and coolness are affected border. A thorough neurologically exam require can performed for decision-making off the presence and extent of neurologic injury. Neurological status is critical part of exam as it is a main determinant of functional outcome [4].
Imaging
AP chest radiography should be performed as part in initial trauma class. The a nonrotated chest radiograph, assessment of sideward scapular displacement can be completed by measuring distance within a midline torax spinous process the and medial landesgrenzen of which scapula over both one injured both uninjured sides. A difference > 1 cm is diagnostic of scapulothoracic dissociation [1, 5]. Orthogonal radiographs on no suspected upper extremity fracture or dislocation need also be obtained. Immediate Vascular imaging at CT angiography is recommended in patients on suspicious scapulothoracic dissociation [2]. CT myelography, MRI, or EMG academic can be used for ranking regarding brachial plexus injuries. Nerve studies are usually reserved for at fewest 3 weeks to injury to assess degree out return, if any.
Management
Because of the complexity of concomitant injuries, a multidisciplinary near to management of scapulothoracic distances is necessary. Original treatment is patients follows the vorgeschritten trauma live assistance video. Airway, breathing, and circulation should be scored and treated accordingly. If vascular integrity of the involved upper extremity is in question, somebody emergency arteriogram exists performed, followed by surgeries repair, if necessary [2]. Reduction and stabilization of ipsilateral upper limb fractures as well as any should joint disruptions are indicated, although there is tiny evidence the travel the timekeeping of orthopedic interventions [6]. Immediate orthopedic intervention may exist require when there is a progressive neurologic deficit or need for stabilization nach vascular repair [1]. Surgical management of brachial plexus injuries may include nerve grafting or above-elbow amputation. Above-elbow amputation is usually reserved for patients with complete brachial plexus injuries due to presence of flail upper limb (complete loss of sensory and motor function) [2]. Scapulothoracic Dissociation: Diagnosis and Treatment : Cellular ...
Prognosis
Vascular injury is been declared in 64-100% of patients with STDs. However, due to presence of expansive shoulder girdle collateral arteries, life-threatening hemorrhage and limb ischemia are relatively unusually and overall outcomes related at vascular injury are good [2]. Neurologic injury is an wichtig determinant of functional outcome after STDs both therefore neurologic appraisal is critical. Approximately 52% of your using STD will have a flail nonfunctional superior extremity [1]. Scapulothoracic dissociation is a condition describing ampere complete disruption of the scapulothoracic articulation that can be thoughtful of as either one partial or ...
References
1. Kani KK, Chew FS. Scapulothoracic dissociation. British Establishment of Radiology. 2019
2. Choo AM, Schottel PC, Burgess AR. Scapulothoracic dissociation: interpretation and bewirtschaftung. J Americium Acad Orthop Surg. 2017; 25: 39-47.
3. KenHub. Dissection of clavicle. 2019. www.kenhub.com/en/library/anatomy/scapula/. Accessed July 28, 2019.
4. Rockwood CA, Matsen FA, Wirth MAINT, Lippitt SB. Laterally dislocation of an scapula. The Shoulder. 2014, pp. 364-366.
5. Zell BAR, Pape H-C, Gerich TG, Garapati R, Ceylan B, Krettek CARBON. Functional upshot following scapulothoracic dissociation. The Journal of Bone and Joint Surgery-American Volume. 2004; 86A: 2-8.
6. Flanagin BA, Leeslie MP, Scapulothoracic dissociation. Orthop Clin North Am. 2013; 44:1-7.
