Scapular Winging: A Great Masquerader of Shoulder Disorders

Abstract

Clinically, scapular winging often mimics more common shoulder abnormalities and can result in unnecessary or unsuccessful surgical procedures. Diagnosis can be readily achieved with simple physical examination and specific provocative maneuvers in conjunction with electromyography and nerve conduction studies. Prompt diagnosis and recognition can avoid substantial shoulder dysfunction.

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

“…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 …”

“…Diagnosing the cause of unilateral winged scapula (WS) is a challenge, and WS is a frequent cause of delayed diagnosis and misdiagnosis . Long thoracic nerve (LTN) palsy is an infrequent cause, but it is well‐recognized by specialists such as neurologists, rheumatologists, rehabilitation physicians, sport physicians, and orthopedists.…”

Effect of scapular dyskinesis on supraspinatus repair healing in a rat model

“…Thirdly, acute transection of both the spinal accessory and long thoracic nerve to induce scapular dyskinesis does not exactly mimic the most common clinical scenario of scapular dyskinesis. Specifically, the etiology of scapular dyskinesis could be attributed to nerve injury in only approximately 6% of cases 41 and several other factors may contribute to scapular dysfunction clinically. However, nerve injuries, due to a traumatic blow, a severe stretch or traction, or laceration, are common in sports 26 and can be found secondary to various surgical interventions.…”

Neuromuscular ultrasound for evaluation of scapular winging

“…The scapulothoracic stabilizers include the serratus anterior, trapezius, rhomboid major and minor, and levator scapulae. Additional muscles with attachments to the scapula include the deltoid, supraspinatus, infraspinatus, subscapularis, teres minor, teres major, latissimus dorsi, long head of the triceps, coracobrachialis, pectoralis minor, and omohyoid . The scapula can perform movements in a variety of different axes …”

“…The inferior angle is rotated medially as in serratus anterior weakness, but unlike serratus anterior weakness, the rest of the scapula is farther from the midline. The superior angle is more laterally displaced, and the scapula is frequently displaced inferiorly …”