The outcome of scapulothoracic fusion for painful winging of the scapula in dystrophic and non-dystrophic conditions

Abstract

Scapulothoracic fusion (STF) for painful winging of the scapula in neuromuscular disorders can provide effective pain relief and functional improvement, but there is little information comparing outcomes between patients with dystrophic and non-dystrophic conditions. We performed a retrospective review of 42 STFs in 34 patients with dystrophic and non-dystrophic conditions using a multifilament trans-scapular, subcostal cable technique supported by a dorsal one-third semi-tubular plate. There were 16 males and 18 females with a mean age of 30 years (15 to 75) and a mean follow-up of 5.0 years (2.0 to 10.6). The mean Oxford shoulder score improved from 20 (4 to 39) to 31 (4 to 48). Patients with non-dystrophic conditions had lower overall functional scores but achieved greater improvements following STF. The mean active forward elevation increased from 59° (20° to 90°) to 97° (30° to 150°), and abduction from 51° (10° to 90°) to 83° (30° to 130°) with a greater range of movement achieved in the dystrophic group. Revision fusion for nonunion was undertaken in five patients at a mean time of 17 months (7 to 31) and two required revision for fracture. There were three pneumothoraces, two rib fractures, three pleural effusions and six nonunions. The main risk factors for nonunion were smoking, age and previous shoulder girdle surgery. STF is a salvage procedure that can provide good patient satisfaction in 82% of patients with both dystrophic and non-dystrophic pathologies, but there was a relatively high failure rate (26%) when poor outcomes were analysed. Overall function was better in patients with dystrophic conditions which correlated with better range of movement; however, patients with non-dystrophic conditions achieved greater functional improvement.

Scapular Winging

“…More recently, however, good results have been reported for scapulothoracic fusion as a primary surgical treatment for those who have failed conservative management, with high satisfaction levels in 82% of patients at mean follow-up of 5 years. This series of 42 patients included patients with dystrophic and nondystrophic scapula winging, including nine with isolated serratus anterior palsy [62]. Nerve transfer with microneurosurgical techniques is a developing area with reports of successful resolution of winging from transfers, including the thoracodorsal nerve to the long thoracic nerve [63].…”

Split Pectoralis Major Transfer for Chronic Medial Scapular Winging

“…In the setting of long thoracic nerve palsy, initial management is conservative and often successful. 9 , 13 In those patients who have persistent symptoms after 12 to 24 months of nonoperative care, surgical treatment may be indicated.…”

“…STF was initially described for the treatment of scapular winging due to facioscapulohumeral muscular dystrophy, 14 , 15 but results of STF in the treatment of nondystrophic conditions, such as isolated serratus anterior or trapezius weakness, have also been reported. 6 , 8 , 9 , 16 Bizot et al. 6 were the first authors to publish outcomes of STF in the treatment of serratus anterior paralysis.…”

“… 6 , 7 Unfortunately, this procedure is characterized by a high complication rate (up to 50%) and modest range-of-motion improvements. 6 , 7 , 8 , 9 , 10 Additional options include neurolysis or nerve transfer but are less effective in the chronic setting with irreversible muscle motor endplate degeneration. 4 , 11 …”

Changes in the loadings on the shoulder girdle in the case of scapulothoracic fusion

“…Sewell et al . reported their results as maximum 150° flexion and 130° abduction postoperatively. During the analysis in the current study, a maximum of 150° ROM for flexion and abduction was used.…”