Teaching NeuroImages: Differential diagnosis of scapular winging: Figure 1

Contralateral trapezius transfer to treat scapular winging: A case report and review of literature

BACKGROUND

No dynamic technique, such as tendon transfer, has been described for scapular winging due to levator scapulae or rhomboid major and minor palsies resulting from an isolated dorsal scapular nerve injury. Thus, we evaluated how the contralateral trapezius compound osteomuscular flap transfer would work in stabilizing lateral scapular winging, and the case is reported here. A literature review was also conducted, and articles relevant to the case are presented.

CASE SUMMARY

A 37-year-old male patient who had sustained an isolated dorsal scapular nerve injury underwent reconstructive surgery using the contralateral trapezius compound osteomuscular flap transfer technique to treat scapular winging and the consequent pain, and to restore function from the shoulder impairment. As a result, the involved shoulder showed an improved Constant-Murley score, from 19.5% to 81.88%.

CONCLUSION

Contralateral trapezius osteomuscular flap transfer succeeded in stabilizing scapular winging in this case, improving shoulder function and affording pain relief.

Syndrome of fascial incarceration of the long thoracic nerve: winged scapula

OBJECTIVE

To analyze the results from early intervention surgery in patients with the syndrome of fascial incarceration of the long thoracic nerve and consequent winged scapula.

METHODS

Six patients with a syndrome of nerve trapping without specific nerve strain limitations were followed up.

RESULTS

The patients achieved improvement of their symptoms 6-20 months after the procedure. The motor symptoms completely disappeared, without any persistent pain. The medial deformity of the winged scapula improved in all cases, without any residual esthetic disorders.

CONCLUSION

The approach of early surgical release seems to be a better predictor for recovery from non-traumatic paralysis of the anterior serratus muscle.