Pure Intrathoracic Scapular Dislocation
Scapular dislocation, also known as locked scapula or scapulothoracic dislocation, is a rare entity that can be identified as extrathoracic or intrathoracic dislocation, depending on the penetration of the scapula into the thoracic cavity.
The 3 reported cases of intrathoracic scapular dislocations in the literature are associated with a preexisting condition, such as sternoclavicular separation, prior rib fracture, thoracotomy for a lung transplant procedure, or surgical resection of superior ribs during breast or pulmonary tumor excisions. There are also 3 published cases of intrathoracic scapular impaction, involving comminuted scapular fractures with intrathoracic impaction of the inferior fragment through intercostal space. We report an intrathoracic scapular dislocation that was not associated with fracture of the scapula or predisposing factors. To our knowledge, this is the first case of pure intrathoracic dislocation.
In the treatment of our patient, relying on the unique dislocation mechanism without any fracture of the scapula or ribs, we started early active shoulder movement after 1 week of immobilization in a shoulder sling, which prevented recurrence of dislocation. In addition to presenting the first pure intrathoracic scapular dislocation, this case demonstrated satisfactory clinical results with short-term immobilization and early rehabilitation.
Conclusion
Contrary to the literature, the possibility of intrathoracic scapular dislocation should be considered in the differential diagnosis even in patients with a negative anamnesis for predisposing factors, such as lung or chest surgery, and when no fractures are detected. Shoulder or thorax computed tomography, especially 3D reconstructions, are helpful in diagnosing the condition and in guiding treatment. Closed reduction under sedation followed by early rehabilitation is an appropriate treatment method, which resulted in a full return of function in 1 month in our patient.
