Scapular Winging in the Pediatric Patient

Abstract

* Scapular winging is a rare condition that can lead to considerable functional impairment and cosmetic deformity but is frequently missed or misdiagnosed.* Scapular winging is of particular concern in the pediatric patient given its association with birth injuries, perinatal thoracic operations, inherited disorders, and potential malignancies.* Primary scapular winging may develop from nerve palsy, an osseous abnormality, or a soft-tissue defect.* Secondary scapular winging is typically due to glenohumeral dysfunction but can also be voluntary or habitual.

A Rare Cause of Winged Scapula in Two Male Adolescents: Dorsal Scapular Nerve Neuropathy

“…4 In addition to a few cases of isolated DSN neuropathy due to hypertrophy of the middle scalene muscle or acute trauma to the neck and shoulder, isolated DSN neuropathy has been reported in a few cases such as volleyball and baseball players, judo competitors, and boxers. 1,6,9 Neither of our cases had a history of acute trauma; however, the first case had a history of repetitive minor traumas, including heavy backpack usage in addition to bodybuilding and basketball, while the second case was involved in bodybuilding sports.…”

“…Rarely, the wing scapula may also be seen due to neuropathies. 1 A comprehensive medical history, physical examination, and imaging are essential for accurately diagnosing winged scapula. Scapular winging resulting from osseous pathology is present at rest and is neither provoked nor relieved by positional changes.…”

“…Scapular winging resulting from osseous pathology is present at rest and is neither provoked nor relieved by positional changes. 1 In both cases, shoulder pathologies were ruled out through detailed physical examinations and various diagnostic tests. Biochemical values, including muscle enzymes, hemogram, erythrocyte sedimentation rate, thyroid function tests, cervical radiography, cervical MRI, and shoulder MRI, were all within normal ranges.…”

“…Winged scapula is an often overlooked cause of shoulder pain resulting from dysfunction in the shoulder stabilizer muscles. 1,2 The prevalence of scapular winging has been reported to range between 0.21 and 0.003%. 3 More recent studies suggest a potentially higher prevalence due to misdiagnosis or underreporting.…”

“…3 More recent studies suggest a potentially higher prevalence due to misdiagnosis or underreporting. 1 Scapular winging can arise from various causes, including osseous pathologies, genetic disorders, myopathies, and neuropathies. While nerve-induced scapular winging is most commonly attributed to long thoracic nerve injury, it can also occur due to damage to the accessory nerve and, more rarely, the dorsal scapular nerve (DSN).…”