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Lukelahood/Scapulothoracic fusion | |
---|---|
Specialty | Orthopaedic |
Frequency | Rare |
Scapulothoracic fusion, also known as scapulodesis, scapulothoracic arthrodesis, and scapular fusion, is an orthopedic procedure to immobilize the scapula by achieving bony fusion between the scapula and the ribs, most commonly for the treatment of facioscapulohumeral muscular dystrophy (FSHD). Note that this procedure is distinct from the scapulopexy, versions of which can achieve similar results without bony fusion.
FSHD, the most common indication for scapulothoracic fusion, is a progressive muscle disease that affects the muscles around the scapula (periscapular muscles), namely the trapezius and serratus anterior. FSHD more often spares the rotator cuff muscles and deltoid muscle.
Serratus anterior muscle palsy (long thoracic nerve palsy) is the most common cause of scapular winging. [1] Trapezius muscle palsy (spinal accessory nerve palsy) is another cause of scapular winging. First line therapy for both cases is observation or nerve repair. In cases of failed nerve repair, a pectoralis major transfer or Eden-Lange procedure, respectively, is indicated. Finally, scapulothoracic fusion is considered alternative treatment or salvage treatment for failed muscle transfers. [2]
Clavicular insufficiency is a condition in which the clavicle is unable serve its anatomical role as a strut during scapular movement, usually a result of trauma or surgery. When it is accompanied with pain, scapular winging emerges, secondary to the clavicular pain. When claviculectomy is unlikely to be beneficial, scapulothoracic fusion has served as a salvage procedure to alleviate severe pain. [3]
Stroke causing flail arm with scapular instability has rarely been treated with scapulothoracic fusion. [4]
In general, most of the risks are in the short term, after surgery.
Overall, outcomes are good, even many years after the procedure.
In most cases, shoulder fatigue, shoulder pain, and scapular winging is eliminated. The neck and shoulder contours are also restored. Active shoulder abduction and flexion significantly increases, although passive range of motion decreases (loss of ability to "throw" the arm up 180 degrees overhead). [7] In some cases of FSHD, gains in shoulder abduction and flexion diminishes in the long term as the deltoid muscle undergoes dystrophy. [5]
![]() | This is not a Wikipedia article: It is an individual user's work-in-progress page, and may be incomplete and/or unreliable. For guidance on developing this draft, see
Wikipedia:So you made a userspace draft. Find sources:
Google (
books ·
news ·
scholar ·
free images ·
WP refs) ·
FENS ·
JSTOR ·
TWL |
Lukelahood/Scapulothoracic fusion | |
---|---|
Specialty | Orthopaedic |
Frequency | Rare |
Scapulothoracic fusion, also known as scapulodesis, scapulothoracic arthrodesis, and scapular fusion, is an orthopedic procedure to immobilize the scapula by achieving bony fusion between the scapula and the ribs, most commonly for the treatment of facioscapulohumeral muscular dystrophy (FSHD). Note that this procedure is distinct from the scapulopexy, versions of which can achieve similar results without bony fusion.
FSHD, the most common indication for scapulothoracic fusion, is a progressive muscle disease that affects the muscles around the scapula (periscapular muscles), namely the trapezius and serratus anterior. FSHD more often spares the rotator cuff muscles and deltoid muscle.
Serratus anterior muscle palsy (long thoracic nerve palsy) is the most common cause of scapular winging. [1] Trapezius muscle palsy (spinal accessory nerve palsy) is another cause of scapular winging. First line therapy for both cases is observation or nerve repair. In cases of failed nerve repair, a pectoralis major transfer or Eden-Lange procedure, respectively, is indicated. Finally, scapulothoracic fusion is considered alternative treatment or salvage treatment for failed muscle transfers. [2]
Clavicular insufficiency is a condition in which the clavicle is unable serve its anatomical role as a strut during scapular movement, usually a result of trauma or surgery. When it is accompanied with pain, scapular winging emerges, secondary to the clavicular pain. When claviculectomy is unlikely to be beneficial, scapulothoracic fusion has served as a salvage procedure to alleviate severe pain. [3]
Stroke causing flail arm with scapular instability has rarely been treated with scapulothoracic fusion. [4]
In general, most of the risks are in the short term, after surgery.
Overall, outcomes are good, even many years after the procedure.
In most cases, shoulder fatigue, shoulder pain, and scapular winging is eliminated. The neck and shoulder contours are also restored. Active shoulder abduction and flexion significantly increases, although passive range of motion decreases (loss of ability to "throw" the arm up 180 degrees overhead). [7] In some cases of FSHD, gains in shoulder abduction and flexion diminishes in the long term as the deltoid muscle undergoes dystrophy. [5]