Recurrent Scapular Dislocation

A 45-year-old male presented to the emergency department (ED) with atraumatic left shoulder deformity. The patient reported that he woke up from sleep with the deformity. His arm felt more numb than usual with decreased range of motion of the left shoulder, however, intact range of motion of the elbow, wrist, and fingers. This was not an unusual occurrence for this patient. The patient reported chronic left scapular-thoracic dislocation stemming from an injury suffered in military service about 10 years earlier, in 2001. The patient reported that he sustained several gunshots to a metal plate containing body armor vest from an angle. The bullets caused the vest to shift and the metal plate to push the inferior angle of his scapula upward and lift the body off his thorax. Additionally, he suffered a gunshot wound to his lateral thorax resulting in a pneumothorax, requiring a chest tube upon return to the military ship. The patient reported no injury to the scapula, however, he did have extensive damage to the long thoracic nerve and the trapezius muscle, causing laxity of the scapula as well as baseline numbness of the left arm. Since the initial injury, he suffers from chronic scapular dislocation several times a week that requires medical intervention and reduction. Normally, the scapula is held against the thoracic cavity by the action of the serratus anterior muscle that attaches the medial edge of the scapula to the rib cage