ePoster #2402 - 2013 ISAKOS Biennial Congress

Scapular Dyskinesis Following Treatment of Displaced Fractures of the Midshaft Clavicle

Caleb Behrend, MD, Rochester, NY, USA
Tanya Beiswenger, BS, Rochester, NY, USA
Christopher English, MD, Rochester, NY, USA
Edward Shields, MD, Rochester, NY, USA
Michael D. Maloney, Rochester, NY, USA
Ilya Voloshin, MD, Rochester, NY, USA
University of Rochester, Rochester, NY, USA

FDA Status Not Applicable

Summary: This study evaluated rates of scapular dyskinesis and SICK scapula syndrome in patients following treatment of displaced midshaft clavicle fractures. Following treatment 37.5% of patients develop scapular dyskinesis at 2 years follow up. These patients reported a clinically meaningful increase in pain with decreased scores on patient reported outcomes for functional and quality of life measures.

Abstract:
Objective:
This study evaluated rates of scapular dyskinesis and SICK scapula syndrome in patients following treatment of displaced midshaft clavicle fractures.

Methods:
Scapulothoracic motion was evaluated for 24 patients with displaced, shortened, comminuted midshaft clavicle fractures with a mean follow up of 24 months. Patients reported outcomes were documented using the SICK(Scapular malposition, Inferior medial border prominence, Coracoid pain and malposition, and
dyskinesis of scapular movement) Scapula Rating Scale, Simple Shoulder Test, SF36, and three VAS pain scales . Radiographic and clinical nonunion was documented as well as operative or non operative treatments provided to each patient. During the physical exam objective measures included assessment of scapular malposition, shoulder range of motion, and strength measurements using a hand dynamometer. Statistical analysis was performed using SPSS® Statistics 20 (IBM® Chicago, Illinois) software for descriptive statistics, and multivariate statistical analysis. Post hoc analysis was performed when appropriate.

Results:
Of the 24 patients, 9 (37.5%) had scapular dyskinesis with the arms at rest. For these patients the mean SICK Scapula Rating Scale score was 7.1 points compared to 2.2 for those without scapular dyskinesis (P<0.001). Patients with observed scapular dyskinesis reported increased pain with VAS pain scales with worst pain of 3.6 compared with 1.2 for patients with no observed dyskinesis (P=0.02). SF36 composite and subscales were decreased for patients with observed scapular dyskinesis (p<.05). These differences were clinically significant for pain and quality of life measures. Objective measures included decreased strength (P=0.02) and range of motion(P=0.03) on physical exam for external rotation. Differences in simple shoulder test were observed but did not reach clinical significance.

Conclusions:
Following treatment for displaced midshaft clavicle fractures 37.5% of patients develop scapular dyskinesis at 2 years follow up. These patients reported a clinically meaningful increase in pain with decreased scores on patient reported outcomes for functional and quality of life measures.