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Scapulothoracic dissociation
From WikEM
Contents
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
- Musculoskeletal
- Clavicle fracture
- Flail chest
- Rib fracture
- Scapula fracture
- Scapulothoracic dissociation
- Sternoclavicular dislocation
- Sternum fracture
- 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
- Clavicle fracture
- Sternoclavicular dislocation
- Scapula fracture
- Brachial plexus injury
- Vascular injury
