Scapulothoracic dissociation, as manifested by lateral displacement of the scapula and acromioclavicular separation, is a previously unreported injury in which there is a complete disruption of the scapulothoracic articulation without an overlying partial or complete amputation through the soft tissue. No ad watermarks, no file size limits just a friendly, free web application that lets you split pdf files exactly the way you want. Many of these files are in portable document format, and can be opened with free adobe reader software. It also discusses what might cause them and options for treatment. Once files have been uploaded to our system, change the order of your pdf documents. How to merge pdfs and combine pdf files adobe acrobat dc. Complete scapulothoracic dissociation with vascular disruption and brachial plexus injury is an infrequent but devastating injury. Assessment of scapulothoracic and glenohumeral function and conservative treatment approaches for children with brachial plexus birth palsy by stephanie a. Functional outcome following scapulothoracic dissociation. Current concepts in the scientific and clinical rationale. This booklet is for anyone who has, or thinks they may have, a dissociative disorder, and their family and friends.
Advances in the understanding of advantageous rehabilitation programs. Scapulothoracic dissociation is an infrequent injury that is often accompanied by neurovascular injuries with a potentially devastating outcome. Scapulothoracic dissociation std is a devastating consequence of highenergy trauma sustained by the shoulder girdle that can easily result in rapid mortality. The postulated mechanism of injury involves attempting to hold onto the handlebars. Flanagin et al ocna 20, miranda et al jtrauma 2002. Scapulothoracic dissociation emergency medicine journal. The neurovascular outcome of scapulothoracic dissociation. The mechanism of injury is probably traction caused by a blunt force to the shoulder girdle. Scapulothoracic dissociation johns hopkins university. We present one such case of open injury associated with total brachial plexus injury, but without any component of vascular injury. His left shoulder was swollen and no pulse was evident at his left wrist.
The injury is characterized by lateral displacement of the scapula resulting from traumatic disruption of the scapulothoracic articulation. During a twentyfouryear period, we treated twentyfive patients with a scapulothoracic dissociation. Mri showed a leftsided brachial plexus injury with complete avulsion from. Scapulothoracic dissociation with acromioclavicular separation. Pdf merge combinejoin pdf files online for free soda pdf. Scapulothoracic dissociation with clavicle and humeral shaft fractures sandeepalbert,viswanathjayashankar,andmohamadgouse. Triggers and dissociation triggers are sensory stimuli connected with a persons trauma, and dissociation is an overload response. A true orthopedic and vascular emergency brown emergency. Online pdf converter edit, rotate and compress pdf files. Covers amnesia, fugue, depersonalization, dissociative. It is the outcome of rare, highenergy trauma to the shoulder girdle and may include vascular and neurologic damage of the upper extremity. Radiographic findings consist of lateral displacement of the scapula on a wellcentered plain film of the chest. Scapulothoracic dissociation with acromioclavicular. We present a case of 39yearold female with a scapulothoracic dissociation and acromioclavicular ac separation and who had fixation of the ac joint with a locking plate, coracoclavicular screw, and transarticular ac screw.
Scapulothoracic dissociation is a devastating injury usually associated with neurovascular injury and a poor prognosis. Scapulothoracic dissociation is an infrequent injury with potentially devastating outcomes. Scapulothoracic dissociation, journal of emergency. How important is this topic for board examinations. Priority should be placed on resuscitative measures, as these patients have sustained significant trauma. It can frequently radiate to the base of the neck, usually on one side, and cause neck pain and stiffness. Scapulothoracic dissociation a 20yearold motorcyclist was admitted to the emergency department following a highspeed collision with a car. It has potentially devastating associated findings including complete brachial plexus avulsion and subclavian artery disruption. Here we describe a case of a 32yearold male who presented with scapulothoracic dissociation associated with brachial plexus injury, along with scapholunate dissociation.
Even years after the traumatic event or circumstances have ceased, certain sights, sounds, smells, touches, and even tastes can set off, or trigger, a cascade of unwanted memories and feelings. Please vote below and help us build the most advanced adaptive learning platform in medicine. A major trauma ct revealed extensive haematoma around the left shoulder girdle, left subclavian vessels and inferior left neck. Scapulothoracic dysfunction, burners, stingers, thoracic. Scapulothoracic dissociation is a rare and complex injury pattern with varied presentation. Russo a dissertation submitted to the faculty of the university of delaware in partial fulfillment of the requirements for the degree of doctor of philosophy in. Scapulothoracic dissociation is an infrequent injury with a potentially devastating outcome. Scapulothoracic dissociation is rare, resulting from highenergy trauma to the shoulder girdle and disruption of the scapulothoracic articulation. Once you merge pdfs, you can send them directly to your email or download the file to our computer and view.
With acrobat reader dc, you can do more than just open and view pdf files. Printable files and downloads of information about ptsd, complex ptsd, dissociative identity disorder and disinhibited social engagement disorder. You can separate your pdf file into smaller pieces. A traumatic disruption of the scapulothoracic articulation often associated with severe neurologic injuries. Knowledge of this injury is based on small patient series and case reports. Scapulothoracic dissociation is a rare but serious devastating closed forequarter amputation of the upper extremity resulting from a direct blow to or severe traction on the shoulder girdle. A case report rajat jangir, ms orth, diwakar misra, dnb orth department of orthopaedics, rnt medical college, udaipur, rajasthan, india department of orthopaedics, maulana ajad medical college, new delhi, india abstract scapulothoracic dissociation is a rare injury involving.
Disruption of the clavicle strut and the scapulothoracic articulation leads to scapular instability. The pdf file you selected should load here if your web browser has a pdf reader plugin installed for example, a recent version of adobe acrobat reader. Scapulothoracic articulation is formed by the muscles between the scapula and thorax with further linkage provided by the acromioclavicular joint claviclesternoclavicular joint axis. Scapulothoracic dissociation is an important and increasingly common clinical condition resulting from massive traction injury to the anterolateral shoulder girdle with disruption of scapulothoracic articulation. He had tenderness and deformity over the left clavicle and the left humerus. Scapulothoracic syndrome, sometimes referred to as computer shoulder, is a condition in which pain occurs in the upper back andor scapular region of the shoulder.
The full text of this article is available in pdf format. Originally described by oreck and colleagues in 1984, this injury is defined as a traumatic disruption of the scapulothoracic articulation. Scapulothoracic dissociation represents a closed traumatic forequarter amputation associated with major neurovascular injury. Scapulothoracic dissociation involves varying degree of discontinuity of the upper extremity from its truncal attachment. Mechanism usually caused by a lateral traction injury to the shoulder girdle.
Carotidosubclavian bypass restored blood flow with preservation of the arm in followup. A case of scapulothoracic dissociation with brachial. It describes what dissociation is and what types of. Triggers and dissociation safe supportive learning. Click add files and select the files you want to include in your pdf.
Understanding dissociative disorders this booklet is for anyone who has, or thinks they may have, a dissociative disorder, and their family and friends. Scapulothoracic dissociation, as manifested by lateral displacement of the scapula and acromioclavicular separation, is a previously unreported injury. Open scapulothoracic dissociation sd is a rare injury and an average orthopaedic surgeon might be practically unaware of this entity. To our knowledge, there are hardly any cases of open sd reported in the english literature. It describes what dissociation is and what types of dissociative disorders there are. Scapulothoracic dissociation is a rare, potentially limb and lifethreatening injury of the shoulder girdle. Edit your pdf file online and for free with this high quality converter or compress, merge, split, rotate, sort or protect your pdf documents. An eighteenyearold male presented to the accident and emergency department following a motor vehicle accident where he was hit by a four wheeler while riding a two wheeler. Scapulothoracic dissociation is typically the result of a massive traction force to the upper extremity, usually accompanied by a severe blunt force directed over the shoulder. Scapulothoracic dissociation, although a rare injury, may be life threatening. In the emergency room, a scapulothoracic dissociation with subclavian artery dissection and a complex fracture of the humerus were evident.
Technical note the initial management of scapulothoracic dissociation. Dissociative disorders symptoms and dsm5 and icd10 diagnoses. The diagnosis has heretofore relied on the radiographic description of the forequarter disruption. Click, drag, and drop to reorder files or press delete to remove any content you dont want. Scapulothoracic dissociation is the traumatic separation of the scapula from the thoracic wall. Osseus and ligamentous injuries include clavicle fractures and acromioclavicular and sternoclavicular dislocations. The dissociative experiences scale des is a simple questionnaire widely used to screen for dissociative symptoms. Split pdf pdf split into multiple files online free soda pdf. Level of anxiety and dissociation in patients with conversion and. Primary survey imaging was performed with a normal pelvic xray and fast scan. In its most severe form, it can be consdiered a closed forequarter amputation, where the overlying skin remains intact. Pdf documents can contain links and buttons, form fields, audio, video, and business logic.
We describe the radiographic and associated magnetic resonance mr imaging findings of a case of scapulothoracic dissociation with brachial plexus injury in a 17yearold. A free and open source software to merge, split, rotate and extract pages from pdf files. Scapulothoracic dissociation is defined as violent lateral or rotational displacement of the shoulder girdle from its thoracic attachments with severe neurovascular injury. Left scapulothoracic dissociation images, diagnosis. We have identified 41 patients with sd from the literature 19 to which we add 11 patients of our own. Therefore, the role of the radiologist in suggesting this. The associated musculoskeletal, vascular, and neurologic injuries carry potentially devastating outcomes. This lesion is characterized by massive softtissue swelling of the shoulder. The initial management of scapulothoracic dissociation. Scapulothoracic dissociation is a rare, devastating injury resulting from highenergy trauma to the shoulder girdle. Scapulothoracic dysfunction, burners, stingers, thoracic outlet syndrome, and miscellaneous nerve injuries marc r. Scapulothoracic dissociation std is a rare injury that can be recognized on chest xray cxr. A 52yearold motorbike driver was struck by a trailer. Scapulothoracic dissociation caused by blunt trauma.
You can merge pdfs or a mix of pdf documents and other files. Scapulothoracic dissociation with subclavian artery. Ptsd, dissociative disorders, dissociation of the personality, cognitiveemotional dissociative. The purpose of this paper is to provide an overview of the biomechanical and clinical implications associated with the rehabilitation of the glenohumeral and scapulothoracic joints. Scapulothoracic dissociation is a rare entity that consists of disruption of the scapulothoracic articulation. The aim of this study was to evaluate the functional outcome following scapulothoracic dissociation. Our pdf splitter allows you to separate pdf pages into individual files. This paper presents a scapulothoracic dissociation without significant associated neurovascular or orthopedic injury. Three were diagnosed with dissociative disorder not otherwise specified. Scapulothoracic and scapholunate dissociation in the. Scapulothoracic dissociation is a complete disruption of the scapulothoracic articulation, and is associated with profound musculoskeletal and neurovascular injuries. Includes dissociative conversion disorders, the 5 core dissociative symptoms, dsm5 and icd10 dissociative disorders.
It frequently is accompanied by an acromioclavicular separation, displaced clavicular fracture. Scapulothoracic dissociation is a closed forequarter amputation of the upper extremity associated with a spectrum of neurovascular injuries that may be a difficult clinical diagnosis. Disruption of the clavicle strut and the scapulo thoracic articulation leads to scapular instability. Luke md, mph key points the scapula is a triangular, flat bone that lies along the posterior thoracic wall. He underwent rapid sequence induction on scene for a glasgow coma score of 8. Read scapulothoracic dissociation, journal of emergency medicine on deepdyve, the largest online rental service for scholarly research with thousands of academic publications available at. Of the few cases presented in the literature, the majority refer to polytrauma patients. These patients often present with a complex inventory of complicated and lifethreatening injuries, making the recognition of this serious, timesensitive injury to the upper extremity a diagnostic challenge from both clinical and imaging standpoints. An xray of the left shoulder revealed scapulothoracic dissociation. They can be signed electronically, and you can easily view pdf files. Kreeger md, puneet bhargava, mbbs,dnb 2 part one of this case appeared 4 months previously and may contain larger images. Ten reasons for conceiving and classifying posttraumatic stress.
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