Scapula Muscle Injuries / Detachment
The term ‘scapula muscle detachment’ was coined by Dr Ben Kibler in the USA following his experience and research into complex scapula disorders and seeing patients referred to him from other surgeons around the USA with the history and clinical findings consistent with a scapula muscle injury.
He published his experience and results of surgery for this condition in the Journal of Shoulder and Elbow Surgery in 2014 [Kibler et al, JSES, 2014]. However, he is not the first to describe this rare injury. The first reference dates to 1922 by Joseph P Replogle, where he terms the condition a “sprain” of the rhomboid muscles [Replogle, 1922]. In 1981, Hayes and Zehr published in the Journal of Bone Surgery a typical case consistent with a scapula muscle avulsion. Another case report was published in 2006 by Lee et al, including a description of the surgical repair, with very similar findings to those of Dr Kibler’s patients.
Other articles publishing on scapula muscle injuries include Otoshi, Journal of Shoulder and Elbow Surgery 2007, Sing and Vargaonkar, Chinese Journal of Traumatology 2014, and Fichet in the New England Journal of Medicine in October 1930.
More advanced degrees of scapula muscle injury have been published as a ‘scapulothoracic dissociation’, where there is a more extensive muscle detachment with higher levels of trauma (Brucker et al, Injury, 2005). The scapula muscle detachment of the rhomboid and trapezius as described by Dr Kibler is probably a slightly lesser version of the classic scapulothoracic dissociation.
The typical injury is a wrenching of the shoulder blade forward, such as traction injuries to the arm with the arm being pulled away from the body, and motor vehicle accidents when the body is twisted whilst the arm is being pulled. There follows a very classical, clinical presentation after the trauma of severe unremitting pain and scapula muscle weakness. A defect in the muscle may be palpable at it's attachment to the scapula, with extreme localised tenderness. Patients often present late and complex pain patterns and overlay may have developed by this stage. This injury is rare and not commonly seen, even by specialist shoulder surgeons.
Imaging in chronic cases may not be able to demonstrate the injury as it is not a true detachment and thus the use of the word ‘detachment’ can be a misnomer. The rhomboid and trapezius muscle do not attach to the bone with a strong, definite tendon such as with the pectoralis major muscle. They have more broadly based muscular attachments. The muscle therefore does not detach or tear via a tendon but there is most likely an “extensive” stretch/strain of the scapula attachment of these muscles. In acute cases with fat suppression sequences on MRI scan, inflammation can be seen at the scapula attachments, but these patients very rarely get this type of imaging in the acute situation as this is not a routine imaging process in most centres for acute injuries.
This injury is rare and in chronic cases can be a 'diagnosis of exclusion'. It does not account for all patients with scapula winging and scapula pain, and it is essential to exclude other possible diagnoses before considering interventional surgery as many patients may improve without requiring surgical intervention. The surgery has been well described by Kibler & Sciascia. Outcomes are generally good, particularly in the less chronic cases. It is important to recognise the injury as soon as possible after the initial trauma to avoid long term chronic symptoms.
- Patient Information (Dr Kibler)