Serratus anterior paralysis as an occupational injury in scaffolders: Two case reports

Elders, L. A. M.; Meché, F.G.A. van der; Burdorf, Alex

doi:10.1002/ajim.10021

Cited by 15 publications

(6 citation statements)

References 6 publications

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“…Sports like weightlifting, volleyball, archery, and even ballet can cause nerve-stretching problems [ 3 , 4 ]. Scapular winging is a rare side effect of repetitive industrial shoulder use [ 5 ]. Scapular winging can be caused by nontraumatic factors such as vaccinations, viral and nonviral diseases, systemic lupus erythematosus, and brachial plexus neuritis (Parsonage-Turner syndrome).…”

Section: Discussionmentioning

confidence: 99%

An Incidental Finding of Unilateral Winged Scapula in a Patient Presenting With Acute Abdomen: A Case Report

Sharma,

Khanna,

Kumari

2024

Cureus

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The primary cause of scapular winging, also known as scapula alata, is typically a malfunction of the serratus anterior, trapezius, and rhomboids, the three major scapular stabilizers. Scapular winging is often caused by injuries to the long thoracic nerve, which weakens the serratus anterior muscle. The long thoracic nerve is particularly vulnerable to both acute and nontraumatic damage due to its longer and superficial course. There are very few documented cases of isolated scapula winging. Here, we present the case of a 15-year-old Asian female who initially presented with right hypochondrium pain, and during a general physical examination, an incidental finding of a left-winged scapula was noted.

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Section: Discussionmentioning

confidence: 99%

An Incidental Finding of Unilateral Winged Scapula in a Patient Presenting With Acute Abdomen: A Case Report

Sharma,

Khanna,

Kumari

2024

Cureus

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“…This injury has been described in army personnel during the second world war, who carried their bags on the shoulder, and in hod carriers, who used a V shaped wooden trough carried on the shoulder to transport stones and coals. 7,8 Injury to the nerve from direct trauma may occur as it follows a subcutaneous path on exiting the pectoralis muscle at the forth or the fifth rib. 9 Another traumatic mechanism resulting in nerve injury is nerve traction.…”

Section: Discussionmentioning

confidence: 99%

Bilateral Traumatic Long Thoracic Nerve Palsies

Alcelik

Marsh²,

Savvidis³

et al. 2008

Journal of Trauma: Injury, Infection &Amp; Critical Care

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alsy of the long thoracic nerve of Bell results in winging of the scapula secondary to paralysis of serratus anterior muscle. The first reported literature was in 1837 by Velpeau. 1 Paralysis of serratus anterior is functionally disabling, as the scapula does not remain apposed to the thorax when the upper extremity is elevated forward at the shoulder. This produces pain and loss of a stable base for movement of the upper extremity. 2 The common causes for this condition are iatrogenic after invasive procedures, idiopathic, trauma, neurogenic diseases, and viral illness. Goodman et al. 3 reported that long thoracic nerve palsies secondary to acute trauma often had partial or no recovery of serratus anterior function with time; whereas the palsies secondary to other causes, such as infections, toxins, or idiopathic causes had much more favorable prognoses, usually with full recovery. We report a patient with chronic shoulder instability and permanent functional disabilities after bilateral traumatic long thoracic nerve injuries. CASE REPORTA 30-year-old ex-soldier was referred to our outpatient department by a chartered physiotherapist giving a history of chronic pain, restriction of the shoulder movements and associated disability. The patient reports that he had been unable to raise either arm above shoulder height and on doing so experiences a painful click in each shoulder. As a direct result of this disability, he has been forced to change his job and has become a driver.The patient's history began 3 years earlier with a fall on his right shoulder while carrying heavy weight on his back during a weapon training exercise. He recalls his right arm becoming completely numb immediately after the fall. After this, the patient was recommended a course of physiotherapy to strengthen his shoulder. Later on that year, because of continued inability to flex and abduct his right shoulder beyond 90 degrees he was seen by an orthopedic surgeon and was diagnosed as having a neurologic illness. Several months later, the patient reported his 'numbness' had gradually settled but the functional impairment relating to his right shoulder continued.The following year when the patient was on another exercise and carrying a heavy Bergen backpack, he developed pain in his left shoulder in association with numbness in the left arm and the hand. Although there was no fall this time, the patient clearly attributed weakness of his left shoulder to carrying the heavy pack. Since then he reported that he had undergone numerous investigations and treatment modalities performed by a variety of personnel in specialties including orthopedics, neurosurgery, and physiotherapy and had imaging by computerized tomography of his cervical spine. However, there had been no firm diagnosis and there had been no functional improvement in his symptoms during the following years.On presentation to our outpatient department, the patient was found to be well motivated, fit, and muscular looking. Viewed from the front there was no asymmetry of the shoulders...

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“…Electromyographic testing typically shows resting denervation potentials, decreased motor unit recruitment and polyphasic motor unit potentials during volitional activity [4, 5, 13, 21, 22, 26, 28, 29, 34, 35, 37, 39, 40, 42, 43, 48, 53, 59, 65, 66]. Although diagnostically helpful in determining muscle involvement and detecting improvement and reinnervation, the initial degree of denervation cannot be used to predict the extent of recovery [28, 66].…”

Section: Clinical Picture and Diagnosismentioning

confidence: 99%

Scapular winging: anatomical review, diagnosis, and treatments

Martin¹,

Fish²

2007

Curr Rev Musculoskelet Med

200

181

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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.

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Serratus anterior paralysis as an occupational injury in scaffolders: Two case reports

Abstract: Shoulder pads in the overall and limiting the weight to carry may prevent future injuries.

Cited by 15 publications

References 6 publications

An Incidental Finding of Unilateral Winged Scapula in a Patient Presenting With Acute Abdomen: A Case Report

An Incidental Finding of Unilateral Winged Scapula in a Patient Presenting With Acute Abdomen: A Case Report

Bilateral Traumatic Long Thoracic Nerve Palsies

Scapular winging: anatomical review, diagnosis, and treatments

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