title: Scapular dyskinesis following displaced fractures of the middle clavicle.
abstract: OBJECTIVE
  To evaluate the rate of scapular dyskinesis and resulting patient outcomes after treatment of displaced midshaft clavicle fractures.
  
  
  METHODS
  Skeletally mature patients with isolated, displaced midshaft clavicle fractures treated with or without surgery over a 16-month period were recruited. The minimum length of follow-up at study examination was 12 months. Patient outcomes were documented using the SICK (scapular malposition, inferomedial border prominence, coracoid pain and malposition, and dyskinesis of scapular movement) Scapula Rating Scale, the Simple Shoulder Test, 3 visual analog scales (VAS) for pain, and shoulder range-of-motion and strength measurements. Of the 32 eligible patients, 24 (75%) were successfully recruited.
  
  
  RESULTS
  The mean participant age was 46 ± 17 years, with a mean length of follow-up at study evaluation of 1.7 ± 1 years. Surgical fixation was performed in 12 patients (50%). Scapular dyskinesis was present in 37.5% of patients (n = 9). Patients with scapular dyskinesis had worse SICK scapula scores (5.8 ± 2.2 vs 3.1 ± 2.4, P = .01), worse Simple Shoulder Test scores (10.5 ± 1.6 vs 11.7 ± 0.8, P = .029), higher maximum VAS pain scores (4.1 ± 3.1 vs 0.97 ± 1.2, P = .002), and worse average VAS pain scores in the week before the examination (2.7 ± 2.5 vs 0.2 ± 0.4, P < .001) compared with patients without scapular dyskinesis. Range of motion and abduction strength were similar between the groups. Scapular dyskinesis developed in 1 patient treated with surgery (8% [1 of 12]) compared with 8 patients treated nonoperatively (67% [8 of 12]) (P = .009).
  
  
  CONCLUSIONS
  Scapular dyskinesis is common after displaced middle-third clavicle fractures, and these patients have more pain and worse functional outcomes compared with patients without scapular dyskinesis. Surgical treatment may reduce a patient's risk of scapular dyskinesis developing and improve short-term outcomes.
authors.affiliation: Department of Orthopaedics and Rehabilitation, University of Rochester, Rochester, NY, USA.
authors.forename: Edward
authors.initials: E
authors.lastname: Shields
authors.affiliation: Department of Orthopaedics and Rehabilitation, University of Rochester, Rochester, NY, USA.
authors.forename: Caleb
authors.initials: C
authors.lastname: Behrend
authors.affiliation: Department of Orthopaedics and Rehabilitation, University of Rochester, Rochester, NY, USA.
authors.forename: Tanya
authors.initials: T
authors.lastname: Beiswenger
authors.affiliation: Department of Orthopaedics and Rehabilitation, University of Rochester, Rochester, NY, USA.
authors.forename: Benjamin
authors.initials: B
authors.lastname: Strong
authors.affiliation: Department of Orthopaedics and Rehabilitation, University of Rochester, Rochester, NY, USA.
authors.forename: Christopher
authors.initials: C
authors.lastname: English
authors.affiliation: Department of Orthopaedics and Rehabilitation, University of Rochester, Rochester, NY, USA.
authors.forename: Michael
authors.initials: M
authors.lastname: Maloney
authors.affiliation: Department of Orthopaedics and Rehabilitation, University of Rochester, Rochester, NY, USA. Electronic address: Ilya_Voloshin@urmc.rochester.edu.
authors.forename: Ilya
authors.initials: I
authors.lastname: Voloshin
mesh_terms: D000173:Acromioclavicular Joint / Q000503:physiopathology*; D000328:Adult; D000368:Aged; D002968:Clavicle / Q000293:injuries* / Q000601:surgery; D015331:Cohort Studies; D020820:Dyskinesias / Q000209:etiology* / Q000503:physiopathology; D005260:Female; D005500:Follow-Up Studies; D005592:Fracture Fixation; D050723:Fractures, Bone / Q000628:therapy*; D006801:Humans; D007103:Immobilization; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D064232:Visual Analog Scale
keywords: Clavicle fracture; SICK scapula syndrome; scapular dyskinesis