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Area of Focus: Shoulder & Upper Extremity and Resident Information
Scapulothoracic fusion is an uncommonly performed procedure in which the medial border of the scapula is fused to 3 to 5 underlying ribs. Due to the relative rarity of the surgical indications, few surgeons have experience in performing this procedure and standard texts typically do not present thorough descriptions of the technique. However, in appropriately selected cases, substantial pain relief and functional improvement can be achieved following successful completion of this procedure. Indications include (1) patients with muscular dystrophy (particularly fascioscapulohumeral dystrophy) or (2) multiple nerve injuries that prevent the effective use of muscle transfers or as a (3) salvage procedure when muscle transfers fail to provide adequate stabilization of the scapula. This video is a brief clinical summary of two patients who undergo scapulothoracic fusion. The primary case is a 44-year-old female who suffered a closed traumatic long thoracic nerve palsy that failed to recover over a period of 1 years. She initially underwent a partial pectoralis major muscle transfer, but she failed to gain adequate improvements prior to fusion. The second case is a 33-year-old male with fascioscapulohumeral dystrophy.
The video provides an educational resource of technical tips for surgeons indicating a patient for scapulothoracic fusion. It begins by demonstrating the technical aspects of the procedure and the fixation options used in the two cases. The key elements of positioning, fusion orientation, exposure, and fusion mass preparation are discussed and illustrated. The postoperative functional outcome of one of the case is also demonstrated.
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