A neurovascular complication after scapulothoracic arthrodesis.

Facioscapulohumeral muscular dystrophy is a progressive disorder characterized by weakness in the muscles of the face, shoulder girdle and upper limbs, and variable lower extremity weakness. The muscles that stabilize the scapula are significantly weak, although the deltoid usually is preserved. With attempted shoulder abduction, the unstable scapula protrudes, elevates, and internally rotates. Scapulothoracic arthrodesis stabilizes the scapula and improves active range of motion and function of the shoulder. Appropriate scapular positioning on the chest wall has been described previously. The current authors review a neurovascular complication after scapulothoracic arthrodesis in which the scapula was positioned as described in the literature. Immediate repositioning resulted in an excellent long-term outcome. Previous recommendations as to scapular position must be taken simply as guidelines. Intraoperative monitoring of neurovascular function in the upper extremity should prevent this complication.