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Scapulothoracic Dissociation: Evaluation and Management
- Source :
- The Journal of the American Academy of Orthopaedic Surgeons. 25(5)
- Publication Year :
- 2017
-
Abstract
- Scapulothoracic dissociation is a rare, potentially limb- and life-threatening injury of the shoulder girdle. The injury is characterized by lateral displacement of the scapula resulting from traumatic disruption of the scapulothoracic articulation. The typical physical examination findings consist of substantial swelling of the shoulder girdle, along with weakness, numbness, and pulselessness in the ipsilateral upper extremity. Radiographic evaluation includes measurement of the scapular index on a nonrotated chest radiograph and assessment for either a distracted clavicle fracture or a disrupted acromioclavicular or sternoclavicular joint. Although vascular injury occurs in most patients, emergent surgery is performed only in patients with either limb-threatening ischemia or active arterial hemorrhage. Management of neurologic injury can be delayed if necessary. The location and severity of neurologic injury determine whether observation, nerve grafting, nerve transfer, or above-elbow amputation is performed. Skeletal stabilization procedures include plate fixation of clavicle fractures and reduction of distracted acromioclavicular or sternoclavicular joints. The extent of neurologic injury determines clinical outcomes. Medical Outcomes Study 36-Item Short Form scores are significantly lower in patients with complete brachial plexus avulsion injury than in patients with postganglionic injury.
- Subjects :
- medicine.medical_specialty
medicine.medical_treatment
Sternoclavicular joint
Joint Dislocations
Physical examination
03 medical and health sciences
Fractures, Bone
0302 clinical medicine
Scapula
medicine
Humans
Orthopedics and Sports Medicine
Reduction (orthopedic surgery)
030222 orthopedics
medicine.diagnostic_test
business.industry
030208 emergency & critical care medicine
Clavicle
Sternoclavicular Joint
Surgery
medicine.anatomical_structure
Amputation
Acromioclavicular Joint
Shoulder girdle
business
Chest radiograph
Subjects
Details
- ISSN :
- 19405480
- Volume :
- 25
- Issue :
- 5
- Database :
- OpenAIRE
- Journal :
- The Journal of the American Academy of Orthopaedic Surgeons
- Accession number :
- edsair.doi.dedup.....7fa94e2f060374b2e0d2c331f64d9f4c