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PubMed · 9796713

Scapulothoracic dissociation.

L Lee·T T Miller·E Schultz·B Toledano
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Abstract

Scapulothoracic dissociation is an uncommon and devastating traumatic injury. A review of 72 cases in the English literature shows that a broad range of musculoskeletal and neurovascular injuries resulting from blunt trauma have been classified as scapulothoracic dissociation since the term was first used in 1984. A review of the current clinical signs and radiographic findings that define scapulothoracic dissociation, as well as a brief description of treatment options and outcomes, is presented.

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Acromioclavicular JointAmputation, SurgicalArthrodesisHumansJoint DislocationsPrognosisScapulaSternoclavicular JointTreatment OutcomeWounds, NonpenetratingJournal ArticleReview

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L Lee, T T Miller, E Schultz, B Toledano. 1998. Scapulothoracic dissociation.. https://pubmed.ncbi.nlm.nih.gov/9796713/

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PubMed2004

Functional outcome following scapulothoracic dissociation.

BACKGROUND: Scapulothoracic dissociation is an infrequent injury that is often accompanied by neurovascular injuries with a potentially devastating outcome. The aim of this study was to evaluate the functional outcome following scapulothoracic dissociation. METHODS: During a twenty-four-year period, we treated twenty-five patients with a scapulothoracic dissociation. The average age was 32.5 years. The average Injury Severity Score was 22 points. Nine patients had a complete brachial plexus avulsion, and ten had an incomplete brachial plexus avulsion. Three patients died from their associated injuries, and six patients required an above-the-elbow amputation. The outcome was assessed with use of the Short-Form 36-Item Health Survey, and the shoulder function of the patients who had not had an amputation was evaluated with use of the Subjective Shoulder Rating System. The degree of initial scapular lateralization was quantified with the scapula index. RESULTS: The average duration of follow-up was 12.6 years. The physical and mental component summary scores and the scores on the role-physical, general health, vitality, and mental health subscales of the Short-Form 36-Item Health Survey were significantly lower for patients with a complete brachial plexus avulsion (p < 0.05). The Subjective Shoulder Rating System score was also significantly lower in patients with a complete brachial plexus avulsion (33.8 points compared with 72.5 points for the patients with no or an incomplete avulsion, p = 0.046). The average scapula index was 1.29 +/- 0.19. The scores on the Short-Form 36-Item Health Survey scales and the Subjective Shoulder Rating System score did not correlate with the initial scapula index (p > 0.05). CONCLUSIONS: The presence of a complete brachial plexus avulsion is predictive of a poor functional outcome in a patient with a scapulothoracic dissociation. Therefore, we suggest a modification of the classification of the severity of this injury, with complete brachial plexus avulsion considered to be the most severe injury type. LEVEL OF EVIDENCE: Prognostic study, Level II-1 (retrospective cohort study). See Instructions to Authors for a complete description of levels of evidence.

Acromioclavicular Joint↗
PubMed2003

Coracoclavicular joints. Reflections upon incidence, pathophysiology and etiology of the different forms.

Since the first description of the coracoclavicular joint in 1861, many papers have been published reporting its occurrence, anatomical description, and geographical distribution. However, there are as yet no published articles with a convincing explanation for the rather variable forms of this variant. In this study, we investigated the occurrence of the coracoclavicular joint in the current and medieval population of Toulouse city and propose, through biometric measures, an explanation for the different forms of this anatomical variant. A total of 2192 chest X-rays taken for various conditions at a receiving hospital and 392 specimens (784 scapulae and an equal number of clavicles) of the L'Isle-Jourdain Series were examined with this aim. When present in the osteologic collection, the sizes of the articular conoid process as well as the height of the corresponding coracoid and acromial processes were noted. A coracoclavicular joint was noted in 0.82% and in 1.78% of the individuals examined in the radiological and osteologic series, respectively. The conoid process varied in size and correlated with the disposition of each correspondent coracoacromial arch. Osteoarthritis was noted in some of these joints when there was discordance between the conoid process size and the architecture of the correspondent coracoacromial arch, suggesting impingement. Our findings support a genetic origin for this variant, and suggest that its occurrence is also probably influenced by environmental factors. Osteoarthritis of this joint may be responsible for shoulder pain.

Acromioclavicular Joint↗