Refractory disorders of the scapulothoracic articulation have been reported to result in debilitating pain and dysfunction that may require surgical management (1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22). The most common clinical presentation, scapular winging (23), was first reported in the published literature in 1723, and several etiologies for scapular winging have been subsequently documented. Soft tissue operations (such as pectoralis major tendon transfer) have had reported success in stabilizing the dyskinetic scapula in the appropriate patient population (24, 25, 26, 27, 28, 29, 30).

However, despite these successful clinical outcomes, there exists a population of patients who experience recurrent symptomatic scapular winging even after pectoralis major transfer (23,25). Several authors (7,23,25,31) report that arthrodesis is the treatment of choice for these failed muscle transfers. For failed pectoralis transfer or significant (irreducible) fixed winging, scapulothoracic arthrodesis can be a successful salvage operation for these patients (12).

Unfortunately, the incidence of postoperative complications after scapulothoracic arthrodesis is significant, occurring in 33% to 48% of patients (12). The vast majority of complications can be grouped into four major categories:

Although a detailed description of the technique for scapulothoracic arthrodesis can be found elsewhere (12), a brief review assists in the understanding of potential complications.

The patient is intubated with a double-lumen endotracheal tube (to allow for selective deflation of the ipsilateral lung during wire placement) and positioned prone. The entire involved arm, scapula, and ipsilateral posterior iliac crest are prepped and draped to the midline of the spine. The incision is placed along the medial border of the scapula from just superior to the scapular spine to the inferior angle. The superficial fascia is incised and the trapezius muscle is identified and retracted medially. The rhomboid muscles are incised off the medial edge of the scapula to allow for reattachment prior to closure.