Shoulder Girdle
Symptomatic Clavicular Insufficiency after Multiple Surgeries
August 31, 2020
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This is a 44-year old female patient with right shoulder pain who fell on ice in 2013. She sustained a type I ACJ separation and labrum tear. She underwent multiple surgeries and has presented for further treatment. What are her options?
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Case Responses
Scapula Tethering Solution for STAM (Scapulo-Thoracic Abnormal Motion)
June 8, 2020
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Question posed by Dr. Wayne Burkhead:
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Would anyone do a pec major transfer rather than a scapulothoracic fusion for FSH if the pec is still functioning and the patient is 34 or so?
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Response by Dr. Bassem Elhassan:
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To answer your question about FSHD and pect transfer; I would say it depends on the patient age, function of the trapezius and expectations.
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If the patient is younger and has good functional upper trapezius, then yes it is possible to do pect transfer to stabilize the scapula as long as the patient knows that the longevity of the outcome is very unpredictable. If his disease didn’t progress quick and his upper trapezius and pectoralis remain functional for years, then patient may do well during those years.
However if the trapezius muscle is already significantly affected (which is mostly the case in FSHD) then unfortunately I don’t believe pect transfer is a good idea.
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An alternative to ST fusion is right to left scapula tethering. Attaching the right to left scapula with Achilles tendon allograft in retracted position can maintain better position of the scapulae on the chest wall and better function. This has been my approach in symptomatic very young patients with FSHD. I also have done it in young patients who refused ST fusion
Why this approach especially in very young? Because in patients younger than 12 yo we can't do fusion since most of the scapula and ribs are still made of cartilage.
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The patients I have done this procedure on have done very well and I’m in the process of collecting data on these patients and hopefully publish about them.
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