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Musculoskeletal trauma
Published in Ian Greaves, Keith Porter, Chris Wright, Trauma Care Pre-Hospital Manual, 2018
Ian Greaves, Keith Porter, Chris Wright
The scapula articulates with the ribs, the clavicle (via the acromioclavicular joint) and the humerus, via the glenoid cavity. Numerous muscular attachments keep the scapula in position and its position on the posterior thoracic wall offers it a fair degree of protection. Consequently, scapular fractures are relatively rare. When they do occur, it is usually a result of direct and severe force applied to the back. Confident pre-hospital diagnosis of scapular fracture is difficult and its main significance is as a marker of significant force applied to the thorax which is likely to produce other injuries. Patients usually present with lateral back pain, made worse on movement of the arm, particularly anterior movement at the shoulder. Analgesia is the mainstay of pre-hospital management.
Scapular fractures
Published in Charles M Court-Brown, Margaret M McQueen, Marc F Swiontkowski, David Ring, Susan M Friedman, Andrew D Duckworth, Musculoskeletal Trauma in the Elderly, 2016
The diagnostic procedure in patients with scapular injuries depends on their general condition. In polytrauma patients, the priority is to save life. The treatment of a scapular fracture, even if detected during primary examination, may be postponed to a later time, except for an open scapular fracture. In a number of polytrauma patients, scapular fractures are often found coincidentally, for example, on a radiograph of lungs or a CT scan of chest.
Upper limb symptoms and signs
Published in Kevin G Burnand, John Black, Steven A Corbett, William EG Thomas, Norman L Browse, Browse’s Introduction to the Symptoms & Signs of Surgical Disease, 2014
Kevin G Burnand, John Black, Steven A Corbett, William EG Thomas, Norman L Browse
Considerable direct force (such as a blow on the back of the shoulder from a fall) is required to cause a scapular fracture as the bulky surrounding muscles protect the bone. Additional injuries to the ribs and chest are common.
Anatomical feasibility study of the infraspinatus muscle neurotization by lower subscapular nerve
Published in Neurological Research, 2023
Aneta Krajcová, Michal Makel, Gautham Ullas, Veronika Němcová, Radek Kaiser
This study is limited to an anatomical feasibility of surgical technique. Furthermore, we did not assess the axonal counts at the level of transection; however, due to the diameters of both stumps being similar, the axonal counts should be comparable. The classical SAN to SSN neurotization provides high levels of reinnervation; therefore, it follows that LSN to IB-SSN reconstruction should allow comparable results in restoring infraspinatus muscle function. The dissections were performed on specimens with the intact anatomical fields. However, the anatomy of both nerves may be disrupted after the trauma leading to a scapular fracture. Therefore, this study does need substantiation with a clinical study.
Anatomical aspects of the selective infraspinatus muscle neurotization by spinal accessory nerve
Published in Journal of Plastic Surgery and Hand Surgery, 2021
Radek Kaiser, Aneta Krajcová, Michal Makel, Gautham Ullas, Veronika Němcová
The idea of direct IB-SSN neurotization in selected brachial plexus injury cases has been proposed by some authors. Sommarhem et al. analyzed eight patients with brachial plexus birth injuries who underwent neurotization of IB-SSN by SAN. At the one-year follow-up, the mean improvement in active external rotation was 47° (20° to 85°) regarding adduction and 49° (5° to 85°) regarding abduction [5]. Tavares et al. performed IB-SSN neurotization by the radial nervés branch for the medial head of the triceps muscle. They stated that, although anatomically feasible, this transfer results in poor clinical outcomes [20]. Unfortunately, the management of IB-SSN palsy associated with scapular fractures is often neglected in clinical practice [21]. In the acute stage, it is often difficult to distinguish between nerve palsy that is due to the original injury and those that occur as a complication of surgery. The preoperative examination can be limited by pain due to scapular fracture and concomitant injuries [21]. However, every nerve palsy persisting more than three months after the trauma without signs of reinnervation on electromyography study deserves surgical revision. Generally, lesions in continuity with positive neurograms are managed by simple external neurolysis. Neuromas with negative neurogram or lacerated nerves with preserved proximal and distal stumps can be reconstructed by using nerve grafts. Very proximal lesions or complex injuries with inaccessible proximal stumps are good candidates for nerve transfer. In cases of very complicated scapular fractures with persistent IB-SSN palsy, it can be extremely risky to dissect the whole nerve within scar tissue. Furthermore, nerve reconstruction in the area of the spinoglenoid notch can be surgically challenging [22]. Therefore, SAN to IB-SNN transfer might be useful in these cases.
Current concepts review: peripheral neuropathies of the shoulder in the young athlete
Published in The Physician and Sportsmedicine, 2020
Tamara S. John, Felicity Fishman, Melinda S. Sharkey, Cordelia W. Carter
Electrodiagnostic studies can be utilized to confirm the diagnosis, evaluate severity of nerve injury and monitor recovery. Electrodiagnostic evaluation may be especially useful for isolating long thoracic nerve injury as a cause for scapular winging as opposed to a secondary winging from another cause, such as traumatic avulsion of the serratus anterior or a displaced inferior pole scapula fracture [19].