Winged Scapula: A Comprehensive Review of Surgical Treatment

Abstract

Winged scapula is caused by paralysis of the serratus anterior or trapezius muscles due to damage to the long thoracic or accessory nerves, resulting in loss of strength and range of motion of the shoulder. Because this nerve damage can happen in a variety of ways, initial diagnosis may be overlooked. This paper discusses the anatomical structures involved in several variations of winged scapula, the pathogenesis of winged scapula, and several historical and contemporary surgical procedures used to treat this condition. Additionally, this review builds upon the conclusions of several studies in order to suggest areas for continued research regarding the treatment of winged scapula.

Iatrogenic injury to long thoracic nerve following thoracotomy for right thoracic scoliosis in Marfan syndrome: a case report

“…Several reasons for long thoracic nerve damage have been reported in literature, such as closed trauma, stretching, compression, traction, penetrating injury, direct extrinsic force, inappropriate surgical technique, electrocution, chiropractic manipulation, and various sports-related injuries. Also, scapular winging can result from repetitive or sudden external biomechanical forces [ 4 , 5 , 7 , 8 ]. In the anterior approach, when a patient is under general anesthesia, there is less control of the shoulder girdle muscles.…”

Winged scapula following axillary thoracotomy with long thoracic nerve preservation

“…Second, use of an electric scalpel might damage the LTN. As a cause of iatrogenic nerve palsy, use of an electric knife may play a role not only for direct damage, but also for thermal damage by hardening or during coagulation 113. The thoracotomy procedure was performed urgently to stop bleeding; therefore, the electrical scalpel may have damaged the LTN by strong electrical stimulation or heat.…”

“…Winged scapula is likely to develop after thoracic surgeries, like posterolateral thoracotomy,4 5 transaxillary thoracotomy6 and first rib resection 7. However, to the best of our knowledge, postoperative winged scapula after thoracic surgery has not been reported over the past 16 years, except for after posterolateral thoracotomy in paediatric patients 18. Considering that the size of incisions made during thoracic surgery has decreased over the past 20 years, due to the increased use of video-assisted thoracic surgery (VATS), fewer injuries of the LTN have occurred.…”

“…Winged scapula is a rare condition induced by injuries to the long thoracic nerve (LTN) and accessory nerves. Palsies of the serratus anterior (SA) or the trapezius muscles result in loss of stabilisation of the scapula and reduced strength and range of motion of the shoulder 1. Damage to the LTN has numerous causes, including non-surgical or postoperative complications.…”

Modified Eden-Lange procedure for iatrogenic lateral scapular winging

“…Surgical neck dissections are what happened to our patient, and it has been associated with spinal accessory nerve palsy. Football tackles, blunt trauma, stabbing, gunshot, and bite injury, also described as the cause of spinal accessory nerve injury and subsequent trapezius palsy [ 11 , 12 ].…”