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Anass A, Fatima Zahrae T, Fatima Zahra A, Nihad T, Hicham F, Fatima Ezzahra A. Weightlifting Induced Spinal Accessory Nerve Palsy and Winged Scapula: A Case Report. Sports Health 2024:19417381231219218. [PMID: 38204298 DOI: 10.1177/19417381231219218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2024] Open
Abstract
Winged scapula is a rare musculoskeletal condition with numerous etiologies including spinal accessory nerve (SAN) palsy. Sport activities are rarely implicated with few scattered case reports. We report a case of an 18-year-old bodybuilder who suffered SAN palsy secondary to weightlifting exercises. Physical examination revealed winged scapula with painful mobility of the shoulder. A scapular magnetic resonance imaging scan and electromyography of the trapezius muscle were performed and confirmed the diagnosis of SAN palsy. Through this case, we review the literature of common and rare causes of SAN palsy and outline accepted treatment options.
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Affiliation(s)
- Adnine Anass
- Rheumatology Department, University Hospital Center of Tangier-Tetouan-Al Hoceima, Faculty of Medicine and Pharmacy, Abdelmalek Essaadi University, Tangier, Morocco
| | - Taik Fatima Zahrae
- Rheumatology Department, University Hospital Center of Tangier-Tetouan-Al Hoceima, Faculty of Medicine and Pharmacy, Abdelmalek Essaadi University, Tangier, Morocco
| | - Aharrane Fatima Zahra
- Rheumatology Department, University Hospital Center of Tangier-Tetouan-Al Hoceima, Faculty of Medicine and Pharmacy, Abdelmalek Essaadi University, Tangier, Morocco
| | - Takhrifa Nihad
- Rheumatology Department, University Hospital Center of Tangier-Tetouan-Al Hoceima, Faculty of Medicine and Pharmacy, Abdelmalek Essaadi University, Tangier, Morocco
| | - Fadel Hicham
- Neurology Department, Al Kortobi Hospital, Tangier, Morocco
| | - Abourazzak Fatima Ezzahra
- Rheumatology Department, University Hospital Center of Tangier-Tetouan-Al Hoceima, Faculty of Medicine and Pharmacy, Abdelmalek Essaadi University, Tangier, Morocco
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Seror P, Roren MA, Garofoli R, Zauderer J, Rannou F, Lefevre-Colau MM. Voluntary winging of the scapula: Proposed diagnostic criteria. Muscle Nerve 2020; 62:611-616. [PMID: 33103253 DOI: 10.1002/mus.27047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Revised: 08/09/2020] [Accepted: 08/11/2020] [Indexed: 11/09/2022]
Abstract
We report a series of 10 patients with unilateral, dynamic, winged scapula (WS), without cause, that was diagnosed as voluntary winging of the scapula (VWS). We compared clinical, electrodiagnostic, and other examination data for 10 patients with VWS and 146 with dynamic WS-related neuromuscular disorders, to establish a detailed pattern of the VWS subtype. In VWS, electrodiagnostic and other examinations did not reveal any neuromuscular or orthopedic cause. Winging was dynamic, obvious, neither medial nor lateral, and mainly involved the inferior angle of the scapula, in young patients. VWS never appeared during floor push-ups. Patients could produce WS at will with the index and healthy shoulder, between 25° and 65° of anterior elevation, or with shoulder internal rotation. VWS is a benign disorder that can be distinguished from neuromuscular WS by normal electrodiagnostic results for muscles and nerves of both shoulders and two specific clinical tests.
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Affiliation(s)
- Paul Seror
- Laboratoire d'électroneuromyographie, Paris, France.,Laboratoire d'électroneuromyographie, Hôpital de l'Est parisien, Aulnay-sous-Bois, France
| | - Mk Alexandra Roren
- Service de Rééducation et de Réadaptation de l'Appareil Locomoteur et des Pathologies du Rachis, Hôpital Cochin, APHP, Université Paris Descartes, PRES Sorbonne Paris Cité, Paris, France.,ECaMO Team, INSERM UMR-S 1153 et Institut Fédératif de Recherche sur le Handicap, Paris, France
| | - Romain Garofoli
- Service de Rééducation et de Réadaptation de l'Appareil Locomoteur et des Pathologies du Rachis, Hôpital Cochin, APHP, Université Paris Descartes, PRES Sorbonne Paris Cité, Paris, France
| | - Jennifer Zauderer
- Service de Rééducation et de Réadaptation de l'Appareil Locomoteur et des Pathologies du Rachis, Hôpital Cochin, APHP, Université Paris Descartes, PRES Sorbonne Paris Cité, Paris, France
| | - Francois Rannou
- Service de Rééducation et de Réadaptation de l'Appareil Locomoteur et des Pathologies du Rachis, Hôpital Cochin, APHP, Université Paris Descartes, PRES Sorbonne Paris Cité, Paris, France.,Inserm UMR 1124, Laboratoire de Pharmacologie, Toxicologie et Signalisation Cellulaire, Faculté des Sciences Fondamentales et Biomédicales, UFR Biomédicale des Saints-Pères, Paris, France
| | - Marie Martine Lefevre-Colau
- Service de Rééducation et de Réadaptation de l'Appareil Locomoteur et des Pathologies du Rachis, Hôpital Cochin, APHP, Université Paris Descartes, PRES Sorbonne Paris Cité, Paris, France.,ECaMO Team, INSERM UMR-S 1153 et Institut Fédératif de Recherche sur le Handicap, Paris, France
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Seror P, Roren A, Lefevre-Colau MM. Infraspinatus muscle palsy involving suprascapular nerve, brachial plexus or cervical roots related to inflammatory or mechanical causes: Experience of 114 cases. Neurophysiol Clin 2020; 50:103-111. [PMID: 32147283 DOI: 10.1016/j.neucli.2020.02.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2019] [Revised: 02/11/2020] [Accepted: 02/11/2020] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVES To report a large series of neurogenic infraspinatus muscle (ISM) palsy, in order to improve knowledge of diagnosis, diverse etiologies and care management. METHODS Clinical and electrodiagnostic (EDX) data for 114 cases of ISM palsy were collected over a 21-year period. Cases were attributed to 4 clinical conditions: (1) isolated suprascapular nerve mononeuropathy (n=48), (2) multiple mononeuropathies (n=33), (3) plexus lesions (n=17), and (4) cervical radiculopathy (n=16). These were related to 2 mechanisms: inflammatory (dysimmune) and mechanical. RESULTS Group 1 cases were younger, had the most severe ISM palsies, were mostly related to inflammatory lesions (81%) such as neuralgic amyotrophy (NA), and frequently had delayed diagnosis because disability was mild. Group 2 cases were all related to inflammatory lesions and had slightly less severe ISM palsies that were frequently hidden by winged scapula. In groups 3 and 4, ISM palsies were milder and all cases were related to mechanical lesions such as brachial plexus trauma or C4-C5-C6 radiculopathy. In these cases, deltoid and ISM palsies were equal in frequency and severity whereas biceps brachii impairment was less frequent and much milder. Deltoid palsy frequently appeared predominant as compared with ISM palsy, because upper limb elevation palsy was more disabling than external rotation palsy. CONCLUSIONS ISM palsy is a rare condition, often under-diagnosed and misidentified. The 4 main conditions of ISM palsy may be recognized by careful clinical, EDX and other examinations when necessary. Analysis of the present series highlights some clinical and EDX points that should help non-specialist and even specialist clinicians who are faced with this rare condition, to distinguish mechanical and inflammatory causes, and thus adapt patient management accordingly.
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Affiliation(s)
- Paul Seror
- Laboratoire d'électroneuromyographie, 146, avenue Ledru Rollin, 75011 Paris, France; Ramsay générale de santé, hôpital privé de l'Est Parisien, Aulnay sous-Bois, France.
| | - Alexandra Roren
- INSERM UMR-S 1153, Service de Rééducation et de Réadaptation de l'Appareil Locomoteur et des Pathologies du Rachis, PRES Sorbonne Paris Cité, ECaMO team, Institut Fédératif de Recherche sur le Handicap, Hôpital Cochin, Université Paris Descartes, AP-HP, Paris, France
| | - Marie Martine Lefevre-Colau
- INSERM UMR-S 1153, Service de Rééducation et de Réadaptation de l'Appareil Locomoteur et des Pathologies du Rachis, PRES Sorbonne Paris Cité, ECaMO team, Institut Fédératif de Recherche sur le Handicap, Hôpital Cochin, Université Paris Descartes, AP-HP, Paris, France
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Shiraishi K, Navarro J, Mayer S. La scapula alata dynamique : un diagnostic à évoquer en cas de douleur scapulaire. ANNALES FRANCAISES DE MEDECINE D URGENCE 2018. [DOI: 10.3166/afmu-2018-0040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Seror P, Lenglet T, Nguyen C, Ouaknine M, Lefevre-Colau MM. Unilateral winged scapula: Clinical and electrodiagnostic experience with 128 cases, with special attention to long thoracic nerve palsy. Muscle Nerve 2018; 57:913-920. [DOI: 10.1002/mus.26059] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/29/2017] [Indexed: 11/05/2022]
Affiliation(s)
- Paul Seror
- Laboratoire d'électroneuromyographie; 146, Avenue Ledru Rollin Paris 75011 France
- Département de Neurophysiologie Clinique; Hôpital de la Pitié-Salpétrière; Paris France
| | - Timothee Lenglet
- Département de Neurophysiologie Clinique; Hôpital de la Pitié-Salpétrière; Paris France
| | - Christelle Nguyen
- Service de Rééducation et de Réadaptation de l'Appareil Locomoteur et des Pathologies du Rachis, H^pital Cochin, APHP, Université Paris Descartes, PRES Sorbonne Paris Cité, ECaMO team, INSERM UMR-S 1153 et Institut Fédératif de Recherche sur le Handicap; Paris France
| | - MichaëL Ouaknine
- Service de chirurgie orthopédique et traumatologique Hôpital Cochin, APHP; Université Paris Descartes; Paris France
| | - Marie Martine Lefevre-Colau
- Service de Rééducation et de Réadaptation de l'Appareil Locomoteur et des Pathologies du Rachis, H^pital Cochin, APHP, Université Paris Descartes, PRES Sorbonne Paris Cité, ECaMO team, INSERM UMR-S 1153 et Institut Fédératif de Recherche sur le Handicap; Paris France
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Krzesniak-Swinarska M, Caress JB, Cartwright MS. Neuromuscular ultrasound for evaluation of scapular winging. Muscle Nerve 2017; 56:7-14. [PMID: 28006862 DOI: 10.1002/mus.25533] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/19/2016] [Indexed: 12/30/2022]
Abstract
INTRODUCTION Clinicians who treat nerve and muscle disorders may be asked to evaluate patients who have unilateral or bilateral scapular winging. Traditionally, this evaluation has relied upon a thorough history, physical examination, and electrodiagnostic testing to localize the cause of winging and detect the underlying neuromuscular pathology. Neuromuscular ultrasound has emerged as a non-invasive technique that can be used for structural evaluation of nerve and muscle abnormalities. METHODS Previous studies of imaging in scapular winging and experiences from our diagnostic laboratory are reviewed. RESULTS Four standard and 4 ancillary ultrasound views are described for evaluation of scapular winging. CONCLUSION Ultrasound is a non-invasive, painless, and radiation-free technology that can be used to evaluate scapular winging. Muscle Nerve 56: 7-14, 2017.
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Affiliation(s)
- Monika Krzesniak-Swinarska
- Department of Neurology, Wake Forest School of Medicine, Main Floor Reynolds Tower, Winston-Salem, North Carolina, 27157, USA
| | - James B Caress
- Department of Neurology, Wake Forest School of Medicine, Main Floor Reynolds Tower, Winston-Salem, North Carolina, 27157, USA
| | - Michael S Cartwright
- Department of Neurology, Wake Forest School of Medicine, Main Floor Reynolds Tower, Winston-Salem, North Carolina, 27157, USA
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Seror P, Stojkovic T, Lefevre-Colau MM, Lenglet T. Diagnosis of unilateral trapezius muscle palsy: 54 Cases. Muscle Nerve 2017; 56:215-223. [DOI: 10.1002/mus.25481] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/15/2016] [Indexed: 11/08/2022]
Affiliation(s)
- Paul Seror
- 146 Laboratoire d'électroneuromyographie; Av. Ledru Rollin 75011 Paris France
- Département de Neurophysiologie Clinique; Hôpital de la Pitié-Salpétrière; Paris France
| | - Tanya Stojkovic
- Unité clinique de Pathologie Neuromusculaire; Institut de Myologie. Hôpital Pitié-Salpêtrière; Paris France
| | - Marie Martine Lefevre-Colau
- Service de Rééducation et de Réadaptation de l'Appareil Locomoteur et des Pathologies du Rachis, Hôpital Cochin, APHP, Université Paris Descartes, PRES Sorbonne Paris Cité, ECaMO team; INSERM UMR-S 1153 et Institut Fédératif de Recherche sur le Handicap; Paris France
| | - Timothée Lenglet
- Département de Neurophysiologie Clinique; Hôpital de la Pitié-Salpétrière; Paris France
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