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Scapular winging: anatomical review, diagnosis, and treatments.

Martin RM, Fish DE - Curr Rev Musculoskelet Med (2008)

Bottom Line: Diagnosis is easily made upon visible inspection of the scapula, with serratus anterior paralysis resulting in medial winging of the scapula.Most cases of serratus anterior paralysis spontaneously resolve within 24 months, while conservative treatment of trapezius paralysis is less effective.To allow time for spontaneous recovery, a 6-24 month course of conservative treatment is often recommended, after which if there is no recovery, patients become candidates for corrective surgery.

View Article: PubMed Central - PubMed

Affiliation: Department of Orthopaedics, Physical Medicine and Rehabilitation, David Geffen School of Medicine at UCLA, 1250, 16th St, 7th Floor, Tower Bld, Rm 745, Santa Monica, CA, 90404, USA.

ABSTRACT
Scapular winging is a rare debilitating condition that leads to limited functional activity of the upper extremity. It is the result of numerous causes, including traumatic, iatrogenic, and idiopathic processes that most often result in nerve injury and paralysis of either the serratus anterior, trapezius, or rhomboid muscles. Diagnosis is easily made upon visible inspection of the scapula, with serratus anterior paralysis resulting in medial winging of the scapula. This is in contrast to the lateral winging generated by trapezius and rhomboid paralysis. Most cases of serratus anterior paralysis spontaneously resolve within 24 months, while conservative treatment of trapezius paralysis is less effective. A conservative course of treatment is usually followed for rhomboid paralysis. To allow time for spontaneous recovery, a 6-24 month course of conservative treatment is often recommended, after which if there is no recovery, patients become candidates for corrective surgery.

No MeSH data available.


Related in: MedlinePlus

A patient with pronounced winging of the left scapula during active external rotation against resistance, typical of trapezius palsy. Note the lateral displacement of the scapula with the superior angle more lateral to the midline than the inferior angle [64, Fig. 4A]
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Fig4: A patient with pronounced winging of the left scapula during active external rotation against resistance, typical of trapezius palsy. Note the lateral displacement of the scapula with the superior angle more lateral to the midline than the inferior angle [64, Fig. 4A]

Mentions: Physical examination elicits an asymmetrical neckline with drooping of the effected shoulder. This may be accompanied with lateral displacement and winging of the scapula [12, 15, 16]. Typically, winging is minimal and is accentuated during arm abduction, with the scapula moving upwards with the superior angle more lateral to the midline than the inferior angle [5]. Winging may disappear during forward flexion of the arm due to the action of the serratus anterior muscle [5]. Difficulty in abducting the arm is a consistent finding, and in one series of patients, the majority could only abduct to 80–90° [16]. Chan et al. [64] suggest an additional test for accessory nerve palsy, requiring the patient to externally rotate the shoulder against a force provided by the examiner’s hand. Any medial winging of the scapula is indicative of accessory nerve palsy (Fig. 4).Fig. 4


Scapular winging: anatomical review, diagnosis, and treatments.

Martin RM, Fish DE - Curr Rev Musculoskelet Med (2008)

A patient with pronounced winging of the left scapula during active external rotation against resistance, typical of trapezius palsy. Note the lateral displacement of the scapula with the superior angle more lateral to the midline than the inferior angle [64, Fig. 4A]
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC2684151&req=5

Fig4: A patient with pronounced winging of the left scapula during active external rotation against resistance, typical of trapezius palsy. Note the lateral displacement of the scapula with the superior angle more lateral to the midline than the inferior angle [64, Fig. 4A]
Mentions: Physical examination elicits an asymmetrical neckline with drooping of the effected shoulder. This may be accompanied with lateral displacement and winging of the scapula [12, 15, 16]. Typically, winging is minimal and is accentuated during arm abduction, with the scapula moving upwards with the superior angle more lateral to the midline than the inferior angle [5]. Winging may disappear during forward flexion of the arm due to the action of the serratus anterior muscle [5]. Difficulty in abducting the arm is a consistent finding, and in one series of patients, the majority could only abduct to 80–90° [16]. Chan et al. [64] suggest an additional test for accessory nerve palsy, requiring the patient to externally rotate the shoulder against a force provided by the examiner’s hand. Any medial winging of the scapula is indicative of accessory nerve palsy (Fig. 4).Fig. 4

Bottom Line: Diagnosis is easily made upon visible inspection of the scapula, with serratus anterior paralysis resulting in medial winging of the scapula.Most cases of serratus anterior paralysis spontaneously resolve within 24 months, while conservative treatment of trapezius paralysis is less effective.To allow time for spontaneous recovery, a 6-24 month course of conservative treatment is often recommended, after which if there is no recovery, patients become candidates for corrective surgery.

View Article: PubMed Central - PubMed

Affiliation: Department of Orthopaedics, Physical Medicine and Rehabilitation, David Geffen School of Medicine at UCLA, 1250, 16th St, 7th Floor, Tower Bld, Rm 745, Santa Monica, CA, 90404, USA.

ABSTRACT
Scapular winging is a rare debilitating condition that leads to limited functional activity of the upper extremity. It is the result of numerous causes, including traumatic, iatrogenic, and idiopathic processes that most often result in nerve injury and paralysis of either the serratus anterior, trapezius, or rhomboid muscles. Diagnosis is easily made upon visible inspection of the scapula, with serratus anterior paralysis resulting in medial winging of the scapula. This is in contrast to the lateral winging generated by trapezius and rhomboid paralysis. Most cases of serratus anterior paralysis spontaneously resolve within 24 months, while conservative treatment of trapezius paralysis is less effective. A conservative course of treatment is usually followed for rhomboid paralysis. To allow time for spontaneous recovery, a 6-24 month course of conservative treatment is often recommended, after which if there is no recovery, patients become candidates for corrective surgery.

No MeSH data available.


Related in: MedlinePlus