Locked scapula syndrome (or scapular dislocation). A rare condition of scapula "dislocation"

This case represents an extremely rare condition described in the literature as "scapular dislocation" or locking scapular syndrome. A patient who is in his 40s presented in the ER with deformity to the R shoulder and inability to lift his arm at the shoulder. There was deformity to the shoulder and pain. He reported multiple prior dislocations of his scapula in the past, the first one due to trauma in a battlefield from an explosion. He had no scars and no gunshot wounds to his shoulder. His exam demonstrated no motor or sensory deficits to the involved extremity.

Scapular Y XR prior to reduction

AP of the shoulder prior to reduction

Reduced scapula - AP Xray

A reduction maneuver was performed in the ER in the following manner without sedation.
1. Longitudinal traction of the arm with the shoulder flexed at 90
2. Direct pressure over the inferior corner of the scapula with the force direction applied caudal (attempt to make the superior dislocation worse!)

The force was applied in that direction because most of the time the inferior corner of the scapula is "entrapped" in the thoracic cage between the ribs.

Most cases are the result of thoracic surgery that result in defects in the thoracic wall. In our case such history did not exist.

A few reports exist in the literature. Examples are shown below:

Locked scapula. A case report. W G Ward ; J P Weaver ; W E Garrett Jr

J Bone Joint Surg Am, 1989 Dec; 71 (10): 1558 -1559 

Intrathoracic dislocation of the inferior pole of the scapula following thoracotomy. Lee RS1, Dooley JF. Am J Orthop (Belle Mead NJ). 2013 Jan;42(1):E1-4.

Recurrent low-energy intrathoracic dislocation of the scapula. Fowler TT1, Taylor BC, Fankhauser RA.

Scapular dislocation. Am J Emerg Med. 1998 Nov;16(7):690-1. Muñiz AE1