Scapular Winging

Abstract

This review explores the causes of scapula winging, with overview of the relevant anatomy, proposed aetiology and treatment. Particular focus is given to lesions of the long thoracic nerve, which is reported to be the most common aetiological factor. INTRODUCTIONScapular winging is painful and incapacitating [1,2]. The composite movements of the scapula in rotation, abduction and tilting are essential for normal shoulder function and, if this anchored gliding of the scapula (against the posterior chest wall) is lost, then shoulder abduction can be limited to 90• C or less and the ability

Unilateral winged scapula: Clinical and electrodiagnostic experience with 128 cases, with special attention to long thoracic nerve palsy

“…This large series has considered clinical and EDX data for each type of pathology, Our findings confirm that LTN and SAN palsies are the most frequent causes of unilateral WS. This series found similar causes for LTN palsy and the unexplained high frequency of right upper limb involvement, and confirmed the utility of the Fidiann classification to establish an accurate etiological diagnosis with unilateral WS, especially with no diagnosis of LTN or SAN palsy. The utility of EDX examination is evidenced by several findings: (1) 100% of FSH cases, 94% of medical SAN palsy cases, and 39% of LTN palsy cases were not diagnosed before EDX was performed; (2) 30% of SAN palsies were diagnosed as LTN lesions before EDX was performed; and (3) in 5 patients with LTN palsy, an associated and unexpected SAN palsy was found …”

“…The initial physical examination revealed unilateral WS in 128 patients, but the 6 patients with voluntary WS could voluntarily produce a similar winging of the contralateral healthy scapula. The mechanism of the WS varied according to the diverse origins (nerve, muscle, bone, joint pathology), and these determined its clinical pattern. A good clinical examination allowed for establishing a correct diagnosis in many cases (about 70%), but this did not reduce the value of EDX in confirming the diagnosis, determining the severity of the lesions, or assessing for the presence of associated lesions.…”

“…The assessment also evaluated muscle wasting and strength of the infraspinatus, serratus anterior, trapezius, deltoid, biceps, and triceps muscles, and tendon reflex testing of the upper limbs. When the WS was not obvious, some tests to enhance the winging were performed: the patient was asked to push on a wall with the hand at the level of the shoulder or slightly above, perform push‐ups, or externally rotate the shoulder against resistance . The digitations of the serratus anterior muscle on the 5th–8th ribs were systematically inspected.…”

“…Winslow first reported a case of bilateral WS in 1723 (in Fery and Sommelet, but the first unilateral case with isolated serratus anterior palsy related to acromioclavicular dislocation was described by Velpeau, in 1837 (see Fery and Sommelet and Gooding et al …”

“…Winslow first reported a case of bilateral WS in 1723 (in Fery and Sommelet 4 , but the first unilateral case with isolated serratus anterior palsy related to acromioclavicular dislocation was described by Velpeau, in 1837 (see Fery and Sommelet 4 and Gooding et al 5 ). In 1935, Patel and colleagues first reported 5 cases related to serratus anterior muscle palsy, 6 then 2 series of 28 and 20 cases, respectively, were reported.…”