Scapulothoracic dissociation is an uncommon injury resulting from high-energy trauma with potentially disabling and deadly outcomes. It occurs as a result of severe lateral traction to the upper extremity. In addition to the obvious musculoskeletal injuries, devastating vascular disruption and brachial plexus avulsions can lead to death and poor functional outcomes, respectively. These patients often present with a complex inventory of complicated and life-threatening injuries, making the recognition of this serious, time-sensitive injury to the upper extremity a diagnostic challenge from both clinical and imaging standpoints. Therefore, the role of the radiologist in suggesting this uncommon and potentially devastating injury is critical.