Winged Scapula: A Comprehensive Review of Surgical Treatment (original) (raw)
Related papers
Syndrome of fascial incarceration of the long thoracic nerve: winged scapula
Revista brasileira de ortopedia
To analyze the results from early intervention surgery in patients with the syndrome of fascial incarceration of the long thoracic nerve and consequent winged scapula. Six patients with a syndrome of nerve trapping without specific nerve strain limitations were followed up. The patients achieved improvement of their symptoms 6-20 months after the procedure. The motor symptoms completely disappeared, without any persistent pain. The medial deformity of the winged scapula improved in all cases, without any residual esthetic disorders. The approach of early surgical release seems to be a better predictor for recovery from non-traumatic paralysis of the anterior serratus muscle.
Orthopaedics & Traumatology: Surgery & Research, 2013
Scapular winging secondary to serratus anterior muscle palsy is a rare pathology. It is usually due to a lesion in the thoracic part of the long thoracic nerve following violent upper-limb stretching with compression on the nerve by the anterior branch of thoracodorsal artery at the ''crow's foot landmark'' where the artery crosses in front of the nerve. Scapular winging causes upper-limb pain, fatigability or impotence. Diagnosis is clinical and management initially conservative. When functional treatment by physiotherapy fails to bring recovery within 6 months and electromyography (EMG) shows increased distal latencies, neurolysis may be suggested. Muscle transfer and scapula-thoracic arthrodesis are considered as palliative treatments. We report a single-surgeon experience of nine open neurolyses of the thoracic part of the long thoracic nerve in eight patients. At 6 months' follow-up, no patients showed continuing signs of winged scapula. Control EMG showed significant reduction in distal latency; Constant scores showed improvement, and VAS-assessed pain was considerably reduced. Neurolysis would thus seem to be the first-line surgical attitude of choice in case of compression confirmed on EMG. The present results would need to be confirmed in larger studies with longer follow-up, but this is made difficult by the rarity of this pathology. Level of evidence: III.
Cureus, 2017
There are very few surgical options available for treating a patient with winged scapula caused by a long thoracic nerve (LTN) injury. Therefore, we devised a novel technique based on a cadaveric dissection whereby regional intercostal nerves (ICN) were harvested and transposed to the adjacent LTN in 10 embalmed cadavers (20 sides). The LTN was identified along the lateral border of the serratus anterior and ICNs were identified at the mid-axillary line inferior to the lower edge of the pectoralis major muscle. Along the mid-clavicular line, each ICN was transected and transposed to the adjacent LTN. The length and diameter of each ICN available for mobilization to the LTN were measured. All measurements were made with microcalipers. Within the operative site, the mean proximal and distal diameters of the LTN were 1.6 and 1.1 mm, respectively. The adjacent ICN had a mean diameter of 1.3 mm. On all sides, the ICN branches were easily transposed to the adjacent LTN without any tension...
Voluntary winging of the scapula: Proposed diagnostic criteria
Muscle & Nerve, 2020
Introduction: We report a series of 10 patients with unilateral, dynamic, winged scapula (WS), without cause, that was diagnosed as voluntary winging of the scapula (VWS). Methods: We compared clinical, electrodiagnostic, and other examination data for 10 patients with VWS and 146 with dynamic WS-related neuromuscular disorders, to establish a detailed pattern of the VWS subtype. Results: In VWS, electrodiagnostic and other examinations did not reveal any neuromuscular or orthopedic cause. Winging was dynamic, obvious, neither medial nor lateral, and mainly involved the inferior angle of the scapula, in young patients. VWS never appeared during floor push-ups. Patients could produce WS at will with the index and healthy shoulder, between 25° and 65° of anterior elevation, or with shoulder internal rotation. Discussion: VWS is a benign disorder that can be distinguished from neuromuscular WS by normal electrodiagnostic results for muscles and nerves of both shoulders and two specific clinical tests.
Winging of Scapula due to a Sinister Etiology
Case Reports in Neurological Medicine
Background. Scapular winging is a rare but disabling deformity, which is commonly caused by lesions of the long thoracic and spinal accessory nerves that innervate the serratus anterior and trapezius muscles, respectively. Across the literature, traumatic injury to the nerves account for the majority of cases. Less common, nontraumatic causes include viral illness, neuroinflammatory conditions, toxins, compressive lesions, and C7 radiculopathy. We present a case where an apical lung malignancy causes winging of scapula by infiltrating C5–C7 roots of brachial plexus, which has been reported only once in the literature. Case. A 54-year-old male presented with recent onset painful difficulty in raising his right arm. He had no respiratory or constitutional symptoms. On examination, winging of scapula on the right side was noted with wasting and fasciculation involving the ipsilateral shoulder girdle. Proximal muscle power of the right upper limb was of 3/5 with preserved distal muscle ...
Fixation of Winged Scapula in Facioscapulohumeral Muscular Dystrophy
Clinical Medicine & Research, 2007
To verify if stabilizing the scapulothoracic joint without arthrodesis could lead to functional improvement of shoulder range of motion and clinical improvement of winged scapula, we incorporated four additional patients into our previous analysis to determine if the results obtained were long lasting, and to compare this fixation with the other techniques described in the literature, balancing the benefits with the complications.
Muscle & Nerve, 2018
Introduction: We report a large series of patients with unilateral winged scapula (WS), with special attention to long thoracic nerve (LTN) palsy. Methods: Clinical and electrodiagnostic data were collected for 128 patients over a 25-year period. Results: Causes of unilateral WS were LTN palsy (n=70), spinal accessory nerve (SAN) palsy (n=39), both LTN and SAN palsy (n=5), facioscapulohumeral dystrophy (FSH) (n=5), orthopedic causes (n=11), voluntary WS (n=6), and no definite cause (n=2). LTN palsy was related to neuralgic amyotrophy (NA) in 61 patients and involved the right side in 62. Discussion: Clinical data allow for identifying 2 main clinical patterns for LTN and SAN palsy. Electrodiagnostic examination should consider bilateral nerve conduction studies of the LTN and SAN, and needle electromyography of their target muscles. LTN palsy is the most frequent cause of unilateral WS and is usually related to NA. Voluntary WS and FSH must be considered in young patients.
Arthroscopy Techniques, 2017
Symptomatic scapular winging resulting in scapular dyskinesia leads to a wide spectrum of clinical complaints, most notably periscapular pain. The malpositioning of the scapula, termed through use of the acronym SICK (scapular malposition, inferior-medial border prominence, coracoid pain and malposition, and dyskinesia of scapular movement), is due to the irregular activity of one or more of the periscapular muscles. In particular, the serratus anterior, innervated by the long thoracic nerve, is a key muscle that stabilizes the scapula and provides coordinated scapulohumeral rhythm. If the long thoracic nerve is injured, this results in significant shoulder dysfunction and scapular winging that may require surgical intervention. The purpose of this Technical Note is to present our preferred technique to treat symptomatic scapular winging due to long thoracic nerve palsy through transfer of the pectoralis major with its bone insertion to the inferior edge of the scapula.
An unusual cause of scapular winging following trauma in an army personnel
Journal of Shoulder and Elbow Surgery, 2010
Winging of the scapula is more commonly associated with long thoracic nerve palsy. Scapular winging following trauma has been reported and this can be secondary to a scapular fracture associated with nerve injury, usually signifying high energy direct trauma. 7 Indirect trauma resulting in avulsion scapular fractures has been described in such sportspersons as cricketers and baseball pitchers; but, these do not result in winging. 4-6 Other unusual patterns of direct and indirect scapular injury have been described without winging as a cosequence. 1,3,9 Hayes and Zehr 8 reported a post traumatic winging of scapula leading to weakness and easy tiring of the shoulder because of detachment of serratus anterior muscle from the border of the scapula. We describe a case of persistent, painful winging of the scapula caused by traumatic fracture of the inferior angle of the scapula without co-existent nerve injury. The anatomical reason for this presentation and the need to recognize and treat this pattern of injury early is explained. We obtained consent from the patient to submit data and images concerning the case for publication.