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Crimi S, Battaglia S, Maugeri C, Mirabella S, Fiorillo L, Cervino G, Bianchi A. Does Age Affect the Rate of Spinal Nerve Injury after Selective Neck Dissection? Age as a Prognostic Factor of Spinal Nerve Injury after Selective Neck Dissection. J Pers Med 2023; 13:1082. [PMID: 37511696 PMCID: PMC10381417 DOI: 10.3390/jpm13071082] [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: 04/18/2023] [Revised: 06/12/2023] [Accepted: 06/28/2023] [Indexed: 07/30/2023] Open
Abstract
OBJECTIVE The objective of this study is to investigate whether age is a significant risk factor for spinal nerve injury following selective neck dissection (SND) in patients with head and neck cancer. METHODS A retrospective cohort study was conducted on patients who had undergone SND for head and neck cancer at a tertiary hospital between 2020 and 2022. The primary outcome was the incidence of spinal nerve injury after SND. The secondary outcomes included the types and severity of spinal nerve injury and the impact of age on these outcomes. RESULTS A total of 78 patients were included in the study and subdivided into two groups. Two shoulder-specific questionnaires (the Shoulder Pain and Disability Index (SPADI) and the Shoulder Disability Questionnaire (SDQ)) were administered to assess shoulder morbidity postoperatively. Twelve patients showed shoulder impairment following surgery. We divided the sample into two age-based groups; the older group showed a higher rate of SAN injury and the younger group showed a lower rate of improvement over time. CONCLUSION This study suggests that age is a significant risk factor for spinal nerve injury following SND in patients with head and neck cancer. Older patients are more likely to experience spinal nerve injury after SND than younger patients. The findings of this study may help in the development of strategies to prevent spinal nerve injury in older patients undergoing SND for head and neck cancer.
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Affiliation(s)
- Salvatore Crimi
- Department of Biomedical and Surgical and Biomedical Sciences, Catania University, 95123 Catania, Italy
| | - Salvatore Battaglia
- Department of Biomedical and Surgical and Biomedical Sciences, Catania University, 95123 Catania, Italy
| | - Claudia Maugeri
- Division of Maxillofacial Surgery, Surgical Science Department, Città della Salute e Delle Scienze Hospital, University of Turin, 10024 Turin, Italy
| | - Sergio Mirabella
- Department of Biomedical and Surgical and Biomedical Sciences, Catania University, 95123 Catania, Italy
| | - Luca Fiorillo
- Department of Biomedical and Dental Sciences, Morphological and Functional Images, University of Messina, 98100 Messina, Italy
- Multidisciplinary Department of Medical-Surgical and Odontostomatological Specialties, University of Campania "Luigi Vanvitelli", 80121 Naples, Italy
- Department of Public Health Dentistry, Dr. D.Y. Patil Dental College and Hospital, Dr. D.Y. Patil Vidyapeeth, Pimpri 411018, India
| | - Gabriele Cervino
- Department of Biomedical and Dental Sciences, Morphological and Functional Images, University of Messina, 98100 Messina, Italy
| | - Alberto Bianchi
- Department of Biomedical and Surgical and Biomedical Sciences, Catania University, 95123 Catania, Italy
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Geurkink TH, Gacaferi H, Marang-van de Mheen PJ, Schoones JW, de Groot JH, Nagels J, Nelissen RGHH. Treatment of neurogenic scapular winging: a systematic review on outcomes after nonsurgical management and tendon transfer surgery. J Shoulder Elbow Surg 2023; 32:e35-e47. [PMID: 36252782 DOI: 10.1016/j.jse.2022.09.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Revised: 09/06/2022] [Accepted: 09/20/2022] [Indexed: 11/20/2022]
Abstract
BACKGROUND Scapular winging is a rare condition of the shoulder girdle that presents challenging treatment decisions for clinicians. To inform clinical practice, clinicians need guidance on what the best treatment decision is for their patients, and such recommendations should be based on the total evidence available. Therefore, the purpose of this review was to systematically review the evidence regarding nonsurgical management and tendon transfer surgery of patients with neurologic scapular winging due to serratus anterior (SA) or trapezius (TP) palsy. METHODS PubMed, Embase, Web of Science, Cochrane Library, Emcare, and Academic Search Premier were searched up to April 5, 2022, for studies reporting on clinical outcomes after nonsurgical management and tendon transfer surgery of scapular winging due to weakness of the SA or TP muscle. The Integrated quality Criteria for Review Of Multiple Study (ICROMS) tool was used to classify the quality of the studies. Primary outcomes were the fraction of patients with spontaneous recovery after nonsurgical management and improvement in shoulder function, pain scores, and shoulder scores after tendon transfer surgery. Data were pooled if data on the same outcome were available for at least 3 studies, using random-effects meta-analysis. RESULTS Twenty-three (10 moderate-quality [MQ] and 13 low-quality) studies were included. Six studies (3 MQ; 234 shoulders) reported on outcomes after nonsurgical management of SA palsy, whereas 12 (6 MQ; 221 shoulders) and 6 studies (1 MQ; 80 shoulders) evaluated the outcomes of tendon transfer for SA or TP palsy (1 study addressed both). Spontaneous recovery of scapular winging with nonsurgical management varied between 21% and 78% across studies after a median follow-up of 72 months. For surgical management of SA palsy, pooling data in a meta-analysis showed that patients on average improved by 47° (95% confidence interval [CI]: 34-61, P ≤ .001) in active forward flexion, had lower visual analog scale scores for pain (mean difference [MD]: -3.0, 95% CI: -4.9 to -1.0, P = .003), and had substantial improvements in American Shoulder and Elbow Surgeons (MD: 24, 95% CI: 9-39, P = .002) and Constant scores (MD: 45, 95% CI: 39-51, P ≤ .001). Patients with TP palsy on average improved by 36° (95% CI: 21-51, P ≤ .001) in active forward flexion after tendon transfer. Statistical pooling was not possible for other outcome measures as insufficient data were available. CONCLUSION A substantial part of nonsurgically managed patients with scapular winging seem to have persistent complaints, which should be part of the information provided to patients. Data pooling demonstrated significant improvements in shoulder function, pain scores, and shoulder scores after tendon transfer surgery, but higher quality evidence is needed to allow for more robust recommendations and guide clinical decision-making on when to perform such functional surgery.
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Affiliation(s)
- Timon H Geurkink
- Department of Orthopaedics, Leiden University Medical Center, Leiden, the Netherlands; Laboratory for Kinematics and Neuromechanics, Department of Orthopaedics and Rehabilitation, Leiden University Medical Center, Leiden, the Netherlands.
| | - Hamez Gacaferi
- Botnar Research Centre, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS), University of Oxford, Oxford, UK
| | - Perla J Marang-van de Mheen
- Department of Biomedical Data Sciences, Medical Decision Making, Leiden University Medical Center, Leiden, the Netherlands
| | - Jan W Schoones
- Directorate of Research Policy (formerly Walaeus Library), Leiden University Medical Center, Leiden, the Netherlands
| | - Jurriaan H de Groot
- Laboratory for Kinematics and Neuromechanics, Department of Orthopaedics and Rehabilitation, Leiden University Medical Center, Leiden, the Netherlands
| | - Jochem Nagels
- Department of Orthopaedics, Leiden University Medical Center, Leiden, the Netherlands
| | - Rob G H H Nelissen
- Department of Orthopaedics, Leiden University Medical Center, Leiden, the Netherlands
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Hoang V, Meter J, Anthony T, Amesur A, Elhassan BT. Triple Tendon Transfer of the Levator Scapulae, Rhomboid Major, and Rhomboid Minor to Reconstruct the Paralyzed Trapezius. Arthrosc Tech 2022; 11:e2213-e2218. [PMID: 36632399 PMCID: PMC9827030 DOI: 10.1016/j.eats.2022.08.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Accepted: 08/15/2022] [Indexed: 11/18/2022] Open
Abstract
Trapezius paralysis is a relatively uncommon condition that orthopaedic surgeons may encounter. Despite the paucity, it presents as a debilitating condition with sequelae of poor function and deconditioning. Conservative management often fails, and patients are left with limited surgical options. In the current Eden-Lange procedure, tendon transfer of the levator scapulae, rhomboid major, and rhomboid minor is performed to reconstruct the paralyzed trapezius. Although good outcomes have been found with this technique, the pull of the levator scapulae and the pull of the rhomboids are in opposition to each other, which presents a biomechanical problem for patients because this fails to re-create the natural function of the trapezius. In this article, we present a technique that is a modification of the Eden-Lange triple tendon transfer using suture bone bridges in which the levator scapulae is transferred as with the original procedure; however, the rhomboids with bony bridges are transferred to a different point along the medial scapula. Our technique therefore may better re-create the natural pull of the fibers of the upper, middle, and lower trapezius.
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Affiliation(s)
- Victor Hoang
- Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA,Address correspondence to Victor Hoang, D.O., Brigham and Women’s Hospital, Harvard Medical School, 75 Francis St, Boston, MA 02115, USA
| | - Joseph Meter
- Valley Hospital Medical Center, Las Vegas, Nevada, USA
| | - Taylor Anthony
- Valley Hospital Medical Center, Las Vegas, Nevada, USA,Touro University Nevada College of Osteopathic Medicine, Henderson, Nevada, USA
| | - Ajit Amesur
- Valley Hospital Medical Center, Las Vegas, Nevada, USA
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Li X, Galvin JW, Zalneraitis BH, Gasbarro G, Parada SA, Eichinger JK, Boileau P, Warner JJP, Elhassan BT. Muscle Tendon Transfers Around the Shoulder: Diagnosis, Treatment, Surgical Techniques, and Outcomes. J Bone Joint Surg Am 2022; 104:833-850. [PMID: 35213452 DOI: 10.2106/jbjs.21.00398] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
➤ Muscle tendon transfers (MTTs) are effective surgical procedures for reducing pain and for improving active shoulder range of motion and patient-reported outcomes for a wide range of pathologies, including serratus anterior and trapezius muscle palsy, irreparable subscapularis tears, irreparable posterosuperior rotator cuff tears, irreparable posterior rotator cuff tears in the setting of reverse shoulder arthroplasty, and symptomatic complete deltoid deficiency. ➤ The principles of MTT include ensuring that the transferred muscle is expendable, the muscle tendon unit has similar excursion, the line of pull of the transferred tendon and of the recipient muscle are similar in terms of biomechanical force, and the transferred muscle should replace at least 1 grade of strength of the deficient recipient muscle. ➤ When MTT procedures are considered, patients must have exhausted all nonoperative management, have preserved passive range of motion, and have an understanding of the postoperative expectations and potential complications. ➤ For patients with scapulothoracic abnormal motion (STAM) due to long thoracic nerve palsy, the indirect or direct pectoralis major tendon transfer is an effective procedure for reducing pain and improving active forward elevation. For patients with STAM due to spinal accessory nerve palsy, the Eden-Lange or the triple tendon transfer procedures reduce pain and improve active forward elevation and abduction as well as patient-reported clinical outcomes. ➤ Both pectoralis major and latissimus dorsi transfer procedures for isolated irreparable subscapularis deficiency without anterosuperior humeral head escape result in improvement with respect to pain, patient-reported outcomes, and forward elevation, with the pectoralis major tendon transfer demonstrating durable long-term outcomes. ➤ The latissimus dorsi or lower trapezius tendon transfer procedures for irreparable posterosuperior rotator cuff tears reliably improve patient-reported outcomes, forward elevation, abduction, and external rotation range of motion. Additionally, latissimus dorsi transfer with or without teres major transfer can be used to restore active external rotation, both in the native shoulder and in the setting of reverse shoulder arthroplasty. ➤ The complications of MTTs include infection, hematoma, and failure of tendon transfer healing; therefore, it is recommended that these complex procedures be performed by shoulder surgeons with appropriate training.
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Affiliation(s)
- Xinning Li
- Boston University School of Medicine, Boston, Massachusetts
| | | | | | - Gregory Gasbarro
- Orthopaedic Specialty Hospital, Mercy Medical Center, Baltimore, Maryland
| | | | | | - Pascal Boileau
- Institute for Sports and Reconstructive Bone and Joint Surgery, Nice, France
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Gatskiy AA, Tretyak IB, Tsymbaliuk YV. Transfer of the anterior C3 levator scapulae motor nerve branch for spinal accessory nerve injury: illustrative case. JOURNAL OF NEUROSURGERY: CASE LESSONS 2022; 3:CASE21609. [PMID: 36130564 PMCID: PMC9379750 DOI: 10.3171/case21609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/23/2021] [Accepted: 12/06/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Injury to the spinal accessory nerve (Acc) results in loss of motor function of the trapezius muscle and leads to severe shoulder problems. A vast number of surgical strategies have been proposed to reinnervate (suture, grafting, and nerve transfers) or compensate (tendon and muscle transfers) the lost function of the trapezius muscle. OBSERVATIONS The authors report a successful case of Acc reconstruction 5 months after the injury with the anterior C3 levator scapulae motor nerve branch transfer in omotrapezoid triangle of the neck. LESSONS The advantages of the proposed technique over preexisting nerve transfers were discussed. We believe that this technique can be considered as an alternative to already existing techniques for proximal injuries to Acc.
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Affiliation(s)
| | | | - Yaroslav V. Tsymbaliuk
- Group of Chronic Pain Treatment, Romodanov Neurosurgery Institute of NAMS of Ukraine, Kyiv, Ukraine
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Silkjær Bak S, Johnsen B, Fuglsang-Frederiksen A, Døssing K, Qerama E. Comparison of ultrasound with electrodiagnosis of scapular winging: A prospective case control study. Clin Neurophysiol 2021; 133:48-57. [PMID: 34801963 DOI: 10.1016/j.clinph.2021.09.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 09/27/2021] [Accepted: 09/28/2021] [Indexed: 12/21/2022]
Abstract
OBJECTIVE Compare high-resolution ultrasound (HRUS) and electrodiagnostic examination (EDX) in the diagnostic workup of patients with scapulae alatae. METHODS 27 patients with scapulae alatae and 41 healthy subjects (HS) and underwent a standardized clinical examination (CEX), EDX and HRUS. We measured the thickness of the serratus anterior (SER), rhomboid major and trapezius muscles and the diameter of the long thoracic (LTN), dorsal scapular and spinal accessory nerves (SAN). RESULTS Twenty patients showed medial winging and six patients showed lateral winging on CEX. One patient had both lateral and medial winging. In patients with medial winging, the SER muscle was thinner and the LTN diameter was larger on the symptomatic side compared with the asymptomatic side and with the dominant side in HS. In this group, both EDX and HRUS detected abnormalities of SER muscle/ LTN with sensitivity of 65%, and with specificity of 100% and 57%, respectively. EDX and HRUS detected abnormalities of the trapezius muscle/ SAN with sensitivity of 60% and 40%, and specificity of 91%, and 86 % a, respectively. There was no significant difference between the two methods. CONCLUSION HRUS can contribute to the diagnostic workup of scapulae alatae by demonstrating atrophy of muscles and enlargement in nerve diameter. SIGNIFICANCE HRUS supplements EDX in the diagnostic workup of scapulae alatae.
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Affiliation(s)
- Sara Silkjær Bak
- Department of Clinical Neurophysiology, Aarhus University Hospital, Palle juul-Jensens Boulevard 16, Plan 2, J209, DK-8200 Aarhus N, Denmark
| | - Birger Johnsen
- Department of Clinical Neurophysiology, Aarhus University Hospital, Palle juul-Jensens Boulevard 16, Plan 2, J209, DK-8200 Aarhus N, Denmark; Department of Clinical Medicine, Aarhus University Hospital, Palle Juul-Jensens Boulevard 82, Incuba/Skejby, Building 2, DK-8200 Aarhus N, Denmark
| | - Anders Fuglsang-Frederiksen
- Department of Clinical Neurophysiology, Aarhus University Hospital, Palle juul-Jensens Boulevard 16, Plan 2, J209, DK-8200 Aarhus N, Denmark; Department of Clinical Medicine, Aarhus University Hospital, Palle Juul-Jensens Boulevard 82, Incuba/Skejby, Building 2, DK-8200 Aarhus N, Denmark
| | - Kaj Døssing
- Department of Orthopaedics, Viborg Regional Hospital, Heibergs Alle 4F Indgang F, Etage 3, 8800 Viborg, Denmark
| | - Erisela Qerama
- Department of Clinical Neurophysiology, Aarhus University Hospital, Palle juul-Jensens Boulevard 16, Plan 2, J209, DK-8200 Aarhus N, Denmark; Department of Clinical Medicine, Aarhus University Hospital, Palle Juul-Jensens Boulevard 82, Incuba/Skejby, Building 2, DK-8200 Aarhus N, Denmark.
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Werthel JD, Masmejean E, Elhassan B. Tendon transfer for trapezius palsy. HAND SURGERY & REHABILITATION 2021; 41S:S34-S38. [PMID: 34082158 DOI: 10.1016/j.hansur.2018.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/04/2018] [Revised: 05/19/2018] [Accepted: 06/08/2018] [Indexed: 10/21/2022]
Abstract
The trapezius muscle produces upward scapular rotation that in turn allows complete lateral elevation (abduction) by maintaining the acromiohumeral distance and the deltoideus resting length. Loss of trapezius function leads to shoulder drooping, loss of scapular external rotation with secondary loss of abduction. When conservative treatment has failed and in cases where nerve surgery is not indicated, the most common procedure for treating this condition is the Eden-Lange (EL) procedure. This procedure entails transferring the levator scapulae (LS) to the lateral part of the scapular spine, and the rhomboid major (RM) and minor (Rm) to the infraspinatus fossa to restore the lost trapezius function. Recently, Elhassan et al. proposed a modification of the original EL procedure to recreate the line of pull of the different parts of the trapezius muscle. The modified transfer may yield successful outcomes in patients with trapezius paralysis who failed to improve after well-conducted conservative treatment. Longer follow-up is needed to confirm the stability of the good outcomes of this reconstruction.
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Affiliation(s)
- J-D Werthel
- Hôpital Ambroise Paré, 9, Avenue Charles de Gaulle, 92100 Boulogne-Billancourt, France.
| | - E Masmejean
- Orthopaedics & Trauma Surgery, Hand, Upper Limb & Peripheral Nerve Surgery Department, Georges-Pompidou European Hospital (HEGP) - APHP, 20, Rue Leblanc, 75015 Paris, France.
| | - B Elhassan
- Department of Orthopedic Surgery, Mayo Clinic, 200 First Street S.W., Rochester, MN, 55905, USA.
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The Modified Eden-Lange Tendon Transfer for Lateral Scapular Winging Secondary to Spinal Accessory Nerve Injury. Arthrosc Tech 2020; 9:e1581-e1589. [PMID: 33134064 PMCID: PMC7587927 DOI: 10.1016/j.eats.2020.06.026] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Accepted: 06/17/2020] [Indexed: 02/03/2023] Open
Abstract
Trapezius paralysis following injury to the spinal accessory nerve can be a debilitating complication resulting from lymph node biopsy, radical neck dissection, or penetrating trauma in the region of the posterior cervical triangle. Disruption of the delicate muscular balance in the shoulder girdle may result in lateral scapular winging, ipsilateral upper extremity radiculopathy, and limited shoulder function and range of motion. Spontaneous recovery with nonoperative management is possible in some patients, and restoration of function after reparative neural procedures has been observed in patients undergoing timely repair. However, extended delays from the time of injury to surgery are common and may necessitate various muscle transfers to reestablish the complex biomechanics and balance of the shoulder girdle. We describe a modification to the classic Eden-Lange procedure with lateral transfer of the levator scapulae and rhomboid minor to the scapula spine and rhomboid major transfer with a small wafer of bone to the scapula body for chronic lateral winging of the scapula following injury to the spinal accessory nerve as the result of a cervical lymph node biopsy.
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Didesch JT, Tang P. Anatomy, Etiology, and Management of Scapular Winging. J Hand Surg Am 2019; 44:321-330. [PMID: 30292717 DOI: 10.1016/j.jhsa.2018.08.008] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Revised: 07/08/2018] [Accepted: 08/01/2018] [Indexed: 02/02/2023]
Abstract
Scapular winging is a painful and debilitating condition. The composite scapular motion of rotation, abduction, and tilting is necessary for proper shoulder function. Weakness or loss of scapular mechanics can lead to difficulties with elevation of the arm and lifting objects. The most common causes reported in the literature for scapular winging are dysfunction of the serratus anterior from long thoracic nerve injury causing medial winging or dysfunction of the trapezius from spinal accessory nerve injury causing lateral winging. Most reviews and teaching focus on these etiologies. However, acute traumatic tears of the serratus anterior, trapezius, and rhomboids off of the scapula are important and under-recognized causes of scapular winging and dysfunction. This article will review the relevant anatomy, etiology, clinical evaluation, diagnostic testing, and treatment of scapular winging. It will also discuss the differences in diagnosis and management between scapular winging arising from neurogenic causes and traumatic muscular detachment.
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Affiliation(s)
- Jacob T Didesch
- Division of Hand and Upper Extremity Surgery, Department of Orthopaedic Surgery, Allegheny General Hospital, Pittsburgh, PA.
| | - Peter Tang
- Division of Hand and Upper Extremity Surgery, Department of Orthopaedic Surgery, Allegheny General Hospital, Pittsburgh, PA
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Abstract
INTRODUCTION The purpose of this study was to evaluate the biomechanical effectiveness regarding scapulothoracic (ST) upward rotation of two different tendon transfer procedures involving the levator scapulae, rhomboid major, and rhomboid minor to restore the function of the paralyzed trapezius. METHODS Six fresh frozen hemithoraces were mounted on a custom-built apparatus. A three-dimensional electromagnetic tracking system was used to record ST upward/downward rotation of the (1) normal trapezius, levator scapulae, rhomboid minor, and rhomboid major; (2) Eden-Lange (EL) transferl and (3) a modified EL transfer (triple transfer). RESULTS The normal trapezius was found to be an upward rotator of the scapula and led to a mean ST rotation angle of 26.98°. Similarly, the modified triple transfer led to an upward rotation of the scapula, with a mean ST rotation angle of 22.23°, whereas the EL led to an initial downward rotation of the scapula to -6.69°, with a mean scapulothoracic displacement angle of 1.13°. DISCUSSION The upward rotation of the scapula from the modified transfer mimicked the function of the normal trapezius better than did the traditional EL transfer. LEVEL OF EVIDENCE Level V, biomechanical study.
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Beger O, Dinç U, Beger B, Uzmansel D, Kurtoğlu Z. Morphometric properties of the levator scapulae, rhomboid major, and rhomboid minor in human fetuses. Surg Radiol Anat 2018. [DOI: 10.1007/s00276-018-2002-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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Amroodi MN, Salariyeh M. Single-incision Eden-Lange procedure in trapezius muscle paralysis: A report of 11 cases. ACTA ORTHOPAEDICA ET TRAUMATOLOGICA TURCICA 2018; 52:115-119. [PMID: 29426800 PMCID: PMC6136329 DOI: 10.1016/j.aott.2017.12.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/04/2016] [Revised: 10/29/2017] [Accepted: 12/03/2017] [Indexed: 12/22/2022]
Abstract
OBJECTIVE The aim of this study was to evaluate the outcome of single-incision Eden-Lange procedure in trapezius muscle paralysis. METHODS The medical records of 11 patients (3 females and 8 males); mean age: 41 (25-59) years with trapezius muscle paralysis who underwent Eden-Lange procedure in our Center, between February 2009 and April 2013, were retrospectively analyzed. The clinical outcomes were evaluated with the American Shoulder and Elbow Surgeons Shoulder (ASES) score and visual analogue scale (VAS). RESULTS The mean duration of symptoms before surgery was 10.18 months. The average duration of follow-up was 33.5 (24-48) months. The mean VAS score improved from 7.8 to 1.6 points (p < 0.05). The total ASES improved from 32.8 to 82.1 points (p < 0.05). The mean range of motion in forward elevation and abduction increased significantly from 121.80 to 154.40 (p < 0.05) and 80.00 to 148.18° (p < 0.05), respectively. CONCLUSION Single incision Eden-Lange procedure appears to be a safe and effective treatment option for the patients with trapezius muscle paralysis. LEVEL OF EVIDENCE Level IV, therapeutic study.
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Li T, Yang ZZ, Deng Y, Xiao M, Jiang C, Wang JW. Indirect transfer of the sternal head of the pectoralis major with autogenous semitendinosus augmentation to treat scapular winging secondary to long thoracic nerve palsy. J Shoulder Elbow Surg 2017; 26:1970-1977. [PMID: 28688935 DOI: 10.1016/j.jse.2017.04.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2016] [Revised: 04/24/2017] [Accepted: 04/26/2017] [Indexed: 02/01/2023]
Abstract
BACKGROUND Scapular winging resulting from long thoracic nerve palsy is uncommon but debilitating, and the choice of surgical treatment is inconsistent. The autogenous semitendinosus tendon plays a key role as an interposed tendon graft, although its use in the indirect transfer of the sternal head of the pectoralis major during the treatment of scapular winging has rarely been reported. MATERIALS AND METHODS A retrospective review was performed during a 9-year period from the clinical data of 26 cases (28 shoulders) with indirect transfer of the sternal head of the pectoralis major with the interposition of an autogenous semitendinosus tendon graft for dynamic stabilization of the scapula. The range of active movement (forward elevation, abduction, and external rotation), American Shoulder and Elbow Surgeons score, visual analog scale score, and complications were evaluated with a mean of 47 months of clinical follow-up. RESULTS Patients' active shoulder movements (forward elevation, abduction, and external rotation), American Shoulder and Elbow Surgeons score, and visual analog scale score showed significant improvements (P < .01). One seroma developed and resolved with extraction. Four shoulders had adhesive capsulitis and recovered after physiotherapy. There was no recurrence of scapular winging in any patient. CONCLUSION Timely treatment, often surgical, is vital to the recovery of scapular winging secondary to long thoracic nerve palsy. Our results suggest that indirect transfer of the sternal head of the pectoralis major with interposition of the autogenous semitendinosus tendon can effectively treat scapular winging due to long thoracic nerve palsy with limited sequelae. Widespread use of this technique is recommended.
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Affiliation(s)
- Tao Li
- Shanghai Key Laboratory of Orthopaedic Implant, Department of Orthopaedic Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
| | - Ze Z Yang
- Shanghai Key Laboratory of Orthopaedic Implant, Department of Orthopaedic Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yuan Deng
- School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - Ming Xiao
- Shanghai Key Laboratory of Orthopaedic Implant, Department of Orthopaedic Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Chuan Jiang
- Department of Orthopaedics, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Jin W Wang
- Shanghai Key Laboratory of Orthopaedic Implant, Department of Orthopaedic Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Srikumaran U, Wells JH, Freehill MT, Tan EW, Higgins LD, Warner JJP. Scapular Winging: A Great Masquerader of Shoulder Disorders: AAOS Exhibit Selection. J Bone Joint Surg Am 2017; 96:e122. [PMID: 25031384 DOI: 10.2106/jbjs.m.01031] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND The incidence of scapular winging is unclear, but it may be more common than previously thought. It can be difficult to diagnose because the presenting complaint and physical examination may direct the practitioner toward more common shoulder and neck conditions. Ongoing scapular dysfunction may result in inappropriate or failed surgery. Our goals were to (1) describe the common misdiagnoses (instability, labral abnormality, impingement, and cervical spine disease), the clinical scenarios and examination findings leading to diagnostic difficulty, the definitive treatment options available, and the clinical outcomes and complications; and (2) review the important aspects of the patient history, physical examination of the scapula, and associated studies necessary to make the correct diagnosis of scapular winging. METHODS We reviewed the literature relative to, and our own experience with, the treatment of scapular winging and identified a series of patients with this condition who were initially misdiagnosed with other shoulder or spine abnormalities. In our literature search, only nine clinical studies reported on a series of patients with scapular winging that was initially misdiagnosed or had a delay in diagnosis (n = 53 patients). We examined these cases for presenting or preexisting diagnoses and for surgical procedures that had been performed before the diagnosis of scapular winging. RESULTS For patients ultimately diagnosed with scapular winging, initial presentations and diagnoses included rotator cuff disorders (20%), glenohumeral instability (8%), peripheral nerve disorders (6%), cervical spine disease (6%), acromioclavicular disorders (6%), thoracic outlet syndrome (4%), and unknown or unspecified (41%). The most common surgical procedures performed before definitive scapular winging treatment were rotator cuff (22%), instability (22%), nerve (14%), acromioclavicular (12%), cervical spine (5%), and thoracic outlet (4%) procedures. CONCLUSIONS Clinically, scapular winging often mimics more common shoulder abnormalities and can result in unnecessary or unsuccessful surgical procedures. Diagnosis can be readily achieved with simple physical examination and specific provocative maneuvers in conjunction with electromyography and nerve conduction studies. Prompt diagnosis and recognition can avoid substantial shoulder dysfunction.
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Affiliation(s)
- Umasuthan Srikumaran
- c/o Elaine P. Henze, BJ, ELS, Medical Editor and Director, Editorial Services, Department of Orthopaedic Surgery, The Johns Hopkins University/Johns Hopkins Bayview Medical Center, 4940 Eastern Avenue #A665, Baltimore, MD 21224-2780. E-mail address for E.P. Henze:
| | - Jessica H Wells
- c/o Elaine P. Henze, BJ, ELS, Medical Editor and Director, Editorial Services, Department of Orthopaedic Surgery, The Johns Hopkins University/Johns Hopkins Bayview Medical Center, 4940 Eastern Avenue #A665, Baltimore, MD 21224-2780. E-mail address for E.P. Henze:
| | - Michael T Freehill
- c/o Elaine P. Henze, BJ, ELS, Medical Editor and Director, Editorial Services, Department of Orthopaedic Surgery, The Johns Hopkins University/Johns Hopkins Bayview Medical Center, 4940 Eastern Avenue #A665, Baltimore, MD 21224-2780. E-mail address for E.P. Henze:
| | - Eric W Tan
- c/o Elaine P. Henze, BJ, ELS, Medical Editor and Director, Editorial Services, Department of Orthopaedic Surgery, The Johns Hopkins University/Johns Hopkins Bayview Medical Center, 4940 Eastern Avenue #A665, Baltimore, MD 21224-2780. E-mail address for E.P. Henze:
| | - Laurence D Higgins
- c/o Elaine P. Henze, BJ, ELS, Medical Editor and Director, Editorial Services, Department of Orthopaedic Surgery, The Johns Hopkins University/Johns Hopkins Bayview Medical Center, 4940 Eastern Avenue #A665, Baltimore, MD 21224-2780. E-mail address for E.P. Henze:
| | - Jon J P Warner
- c/o Elaine P. Henze, BJ, ELS, Medical Editor and Director, Editorial Services, Department of Orthopaedic Surgery, The Johns Hopkins University/Johns Hopkins Bayview Medical Center, 4940 Eastern Avenue #A665, Baltimore, MD 21224-2780. E-mail address for E.P. Henze:
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Meta-Analysis of Long Thoracic Nerve Decompression and Neurolysis Versus Muscle and Tendon Transfer Operative Treatments of Winging Scapula. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2017; 5:e1481. [PMID: 28894676 PMCID: PMC5585449 DOI: 10.1097/gox.0000000000001481] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2017] [Accepted: 07/12/2017] [Indexed: 01/20/2023]
Abstract
Background: Injury to long thoracic and the spinal accessory nerves can cause winging scapula as a result of weakness and paralysis of the trapezius and serratus anterior muscles. Although these nerve and muscle operations have been reported to correct winging scapula due to various causes, there is no report on comparing the outcomes of these procedures in peer-reviewed Pubmed-indexed literature. In this article, we compared the improvements in the restoration of shoulder functions in winging scapula patients after long thoracic nerve decompression (LTND) in our present study with outcomes of muscle and tendon transfer operations published in the literature (Aetna cited articles). Methods: Twenty-five winging scapula patients met the inclusion criteria, who had LTND and neurolysis at our clinic since 2008. Electromyographic evaluation of the brachial plexus and long thoracic nerve distribution was performed preoperatively for all our patients in this study. Operating surgeon (R.K.N.) examined all patients and measured pre- and postoperative range of motion of the affected shoulder. The mean follow-up was 23 months (range, 13–46 months). Age of our patients in this study at the time of surgery was between 13 and 63 years. These patients had winging scapula between 5 days (tennis injury) and several years before surgery and some were unknown. Results: Shoulder flexion and abduction improved to an average of 163˚ (P < 0.000006) and 157˚ (P < 0.0000005) from 104˚ and 97˚ at least 1-year post-LTND in 25 winging scapula patients in our present study. This is statistically significant in comparison to the reported improvements resulting from muscle and tendon transfer procedures in the Pubmed-indexed (Aetna cited) literature. Conclusion: This meta-analysis suggests that nerve surgeries such as LTND and neurolysis are effective techniques in correcting winging scapula in comparison with muscle transfer operations.
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Lehmann L, Schmalzl J, Moursy M, Rzepka D. Skapulothorakaler Rhythmus, Skapulasporn und Incisura-scapulae-Syndrom. ARTHROSKOPIE 2017. [DOI: 10.1007/s00142-017-0132-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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17
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Minkis K, Whittington A, Alam M. Dermatologic surgery emergencies: Complications caused by systemic reactions, high-energy systems, and trauma. J Am Acad Dermatol 2017; 75:265-84. [PMID: 27444069 DOI: 10.1016/j.jaad.2015.11.054] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2015] [Revised: 11/16/2015] [Accepted: 11/19/2015] [Indexed: 12/28/2022]
Abstract
While the overall incidence of emergencies in dermatologic surgery is low, emergent situations can occasionally pose a risk to patients undergoing such procedures. The clinical importance of several types of emergences related to systemic reactions, high energy systems, and trauma are reviewed, and relevant epidemiology, clinical manifestations, diagnosis, work-up, management, and prevention are discussed. Early detection of surgical emergencies can mitigate any associated adverse outcomes, thereby allowing the outstanding record of safety of dermatologic surgery to continue.
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Affiliation(s)
- Kira Minkis
- Department of Dermatology, Weill Cornell Medical College, New York, New York
| | - Adam Whittington
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Murad Alam
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois; Department of Otolaryngology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois; Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois.
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18
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Berthold JB, Burg TM, Nussbaum RP. Long Thoracic Nerve Injury Caused by Overhead Weight Lifting Leading to Scapular Dyskinesis and Medial Scapular Winging. J Osteopath Med 2017; 117:133-137. [DOI: 10.7556/jaoa.2017.025] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Abstract
Scapular winging represents a rare phenomenon that most commonly results from nerve damage to either the long thoracic nerve, spinal accessory nerve, or, less commonly, the dorsal scapular nerve. This injury results in an abnormal scapulohumeral interaction during kinetic motion known as scapular dyskinesis. In this case report, the patient presented with scapular dyskinesis and medial scapular winging caused by overhead weight-lifting exercises, and a long thoracic nerve injury was diagnosed. Physicians are encouraged to consider long thoracic nerve damage in a patient with a history of repetitive overhead movements who presents with scapular dyskinesis and the corresponding restriction of overhead arm motions. Potential mechanisms of injury and treatment options are also discussed.
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Partial transfer from C7 root to external branch of accessory nerve for trapezius palsy. HAND SURGERY & REHABILITATION 2016; 35:418-419. [DOI: 10.1016/j.hansur.2016.08.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/10/2016] [Accepted: 08/21/2016] [Indexed: 11/19/2022]
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20
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Minami R, Ito E, Nishijima N. Trapezius Palsy Resulting from Accessory Nerve Injury after Cervical Lymph Node Biopsy Dramatically Improved with Conservative Treatment. Prog Rehabil Med 2016; 1:20160006. [PMID: 32789203 DOI: 10.2490/prm.20160006] [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: 08/02/2016] [Accepted: 09/25/2016] [Indexed: 11/09/2022] Open
Abstract
Background Iatrogenic injuries to the spinal accessory nerve (SAN) are not uncommon during cervical lymph node biopsy. Many operative treatments for SAN injury in the posterior cervical triangle have been reported, but there are no guidelines regarding the choice between operative and nonoperative treatments. Because it is believed that the nerve seldom spontaneously regenerates, some articles suggest surgical intervention within 3 months from the nerve injury to achieve good postoperative results. However, we experienced a case of spontaneous accessory nerve recovery more than 3 months after accessory nerve injury. It is necessary to carefully exclude similar patients from unnecessary surgery. Case A 41-year-old woman underwent cervical lymph node biopsy at an otolaryngology clinic. She experienced pain across her neck and weakness of the shoulder in abduction just after the biopsy. Three months after the biopsy, her symptoms persisted and she was referred to our hospital for surgical treatment. On careful examination, we detected signs of accessory nerve regeneration. Consequently, we prescribed physical therapy and a rehabilitation program, including active and passive range-of-motion exercises of the shoulder and muscle strengthening exercises. Six months after the injury, there was a dramatic improvement of the trapezius muscle function and the patient became pain free. Discussion When the biopsy incision is more than one finger's breadth away from the normal course of the SAN, and when Tinel-like signs advance along the trapezius muscle over time, spontaneous SAN recovery can be anticipated.
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Affiliation(s)
- Runa Minami
- Department of Orthopaedics, Tango Central Hospital, Kyotango, Kyoto, Japan
| | - Emi Ito
- Department of Physical and Occupational Therapy, Nagoya University, Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Naoki Nishijima
- Department of Orthopaedics, Tango Central Hospital, Kyotango, Kyoto, Japan
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Göransson H, Leppänen OV, Vastamäki M. Patient outcome after surgical management of the spinal accessory nerve injury: A long-term follow-up study. SAGE Open Med 2016; 4:2050312116645731. [PMID: 27152195 PMCID: PMC4843049 DOI: 10.1177/2050312116645731] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2015] [Accepted: 03/28/2016] [Indexed: 01/17/2023] Open
Abstract
Objectives: A lesion in the spinal accessory nerve is typically iatrogenic: related to lymph node biopsy or excision. This injury may cause paralysis of the trapezius muscle and thus result in a characteristic group of symptoms and signs, including depression and winging of the scapula, drooped shoulder, reduced shoulder abduction, and pain. The elements evaluated in this long-term follow-up study include range of shoulder motion, pain, patients’ satisfaction, delay of surgery, surgical procedure, occupational status, functional outcome, and other clinical findings. Methods: We reviewed the medical records of a consecutive 37 patients (11 men and 26 women) having surgery to correct spinal accessory nerve injury. Neurolysis was the procedure in 24 cases, direct nerve repair for 9 patients, and nerve grafting for 4. Time elapsed between the injury and the surgical operation ranged from 2 to 120 months. The patients were interviewed and clinically examined after an average of 10.2 years postoperatively. Results: The mean active range of movement of the shoulder improved at abduction 44° (43%) in neurolysis, 59° (71%) in direct nerve repair, and 30° (22%) in nerve-grafting patients. No or only slight atrophy of the trapezius muscle was observable in 75%, 44%, and 50%, and no or controllable pain was observable in 63%, 56%, and 50%. Restriction of shoulder abduction preceded deterioration of shoulder flexion. Patients’ overall dissatisfaction with the state of their upper extremity was associated with pain, lower strength in shoulder movements, and occupational problems. Conclusion: We recommend avoiding unnecessary delay in the exploration of the spinal accessory nerve, if a neural lesion is suspected.
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Affiliation(s)
- Harry Göransson
- Department of Hand and Microsurgery, Tampere University Hospital, Tampere, Finland
| | - Olli V Leppänen
- Department of Hand and Microsurgery, Tampere University Hospital, Tampere, Finland; School of Medicine, University of Tampere, Tampere, Finland
| | - Martti Vastamäki
- ORTON Orthopaedic Hospital and ORTON Research Institute, Helsinki, Finland
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22
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Nguyen C, Guérini H, Roren A, Zauderer J, Vuillemin V, Seror P, Ouaknine M, Palazzo C, Bourdet C, Pluot É, Roby-Brami A, Drapé JL, Rannou F, Poiraudeau S, Lefèvre-Colau MM. Scapula alata dynamique d’origine neuromusculaire : diagnostic clinique, électromyographique et à l’imagerie par résonance magnétique. Presse Med 2015; 44:1256-65. [DOI: 10.1016/j.lpm.2015.08.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2015] [Revised: 07/06/2015] [Accepted: 08/25/2015] [Indexed: 11/17/2022] Open
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23
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Lee S, Savin DD, Shah NR, Bronsnick D, Goldberg B. Scapular Winging: Evaluation and Treatment: AAOS Exhibit Selection. J Bone Joint Surg Am 2015; 97:1708-16. [PMID: 26491136 DOI: 10.2106/jbjs.o.00727] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Scapular winging is a rare, underreported, and debilitating disorder that produces abnormal scapulothoracic kinematics, which can lead to shoulder weakness, decreased range of motion, and substantial pain. Although there are numerous underlying etiologies, injuries to the long thoracic nerve or spinal accessory nerve are the most common, with resultant neuromuscular imbalance in the scapulothoracic stabilizing muscles. Early diagnosis followed by initiation of a treatment algorithm is important for successful outcomes. Most cases resolve with nonsurgical management. However, in patients with persistent symptoms despite nonsurgical management, appropriate dynamic muscle transfers can effectively treat the scapular winging, with good clinical outcomes.
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Affiliation(s)
- Simon Lee
- Department of Orthopaedic Surgery, University of Michigan Health System, 2912 Taubman Center, 1500 East Medical Center Drive, Ann Arbor, MI 48109-5328
| | - David D Savin
- Department of Orthopedic Surgery, University of Illinois at Chicago, 835 South Wolcott Avenue, Room E270, M/c 844, Chicago, IL 60612. E-mail address for D. Savin:
| | - Neal R Shah
- Department of Orthopedic Surgery, University of Illinois at Chicago, 835 South Wolcott Avenue, Room E270, M/c 844, Chicago, IL 60612. E-mail address for D. Savin:
| | - Daniel Bronsnick
- ARIA 3B Orthopaedic Institute, 380 North Oxford Valley Road, Langhorne, PA 19047
| | - Benjamin Goldberg
- Department of Orthopedic Surgery, University of Illinois at Chicago, 835 South Wolcott Avenue, Room E270, M/c 844, Chicago, IL 60612. E-mail address for D. Savin:
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24
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Cabrera AL, Plancher KD, Petterson SC, Kuhn JE. Treatment for Medial and Lateral Scapular Winging: Tendon Transfers. OPER TECHN SPORT MED 2014. [DOI: 10.1053/j.otsm.2014.02.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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25
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Gooding BWT, Geoghegan JM, Wallace WA, Manning PA. Scapular Winging. Shoulder Elbow 2014; 6:4-11. [PMID: 27582902 PMCID: PMC4986647 DOI: 10.1111/sae.12033] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2012] [Accepted: 06/14/2013] [Indexed: 11/28/2022]
Abstract
This review explores the causes of scapula winging, with overview of the relevant anatomy, proposed aetiology and treatment. Particular focus is given to lesions of the long thoracic nerve, which is reported to be the most common aetiological factor.
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Affiliation(s)
- Benjamin W. T. Gooding
- Nottingham Shoulder and Elbow Unit, Nottingham University Hospitals, Nottingham, UK,
Correspondence: Benjamin W. T. Gooding, Nottingham Shoulder and Elbow Unit, Nottingham University Hospitals, City Hospital Campus, Hucknall Road, Nottingham NG5 1PB, UK. Tel.: +44 07947835045. Fax: 4-44 0115 9628062. E-mail:
| | - John M. Geoghegan
- Nottingham Shoulder and Elbow Unit, Nottingham University Hospitals, Nottingham, UK
| | - W. Angus Wallace
- Nottingham Shoulder and Elbow Unit, Nottingham University Hospitals, Nottingham, UK
| | - Paul A. Manning
- Nottingham Shoulder and Elbow Unit, Nottingham University Hospitals, Nottingham, UK
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26
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Skedros JG, Knight AN. Treatment of scapular winging with modified Eden-Lange procedure in patient with pre-existing glenohumeral instability. J Shoulder Elbow Surg 2012; 21:e10-3. [PMID: 22484388 DOI: 10.1016/j.jse.2011.11.037] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2011] [Revised: 11/11/2011] [Accepted: 11/28/2011] [Indexed: 02/01/2023]
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27
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Skedros JG, Kiser CJ. Modified Eden-Lange procedure for trapezius paralysis with ipsilateral rotator cuff-tear arthropathy: a case report. J Bone Joint Surg Am 2011; 93:e131(1-5). [PMID: 22262391 DOI: 10.2106/jbjs.j.01954] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
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Abstract
Scapular winging is a rare disorder often caused by neuromuscular imbalance in the scapulothoracic stabilizer muscles. Lesions of the long thoracic nerve and spinal accessory nerves are the most common cause. Numerous underlying etiologies have been described. Patients report diffuse neck, shoulder girdle, and upper back pain, which may be debilitating, associated with abduction and overhead activities. Accurate diagnosis and detection depend on appreciation of the scapulothoracic anatomy and a comprehensive physical examination. Although most cases resolve nonsurgically, surgical treatment of scapular winging has been met with success.
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29
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Sergides NN, Nikolopoulos DD, Polyzois IG. Idiopathic spinal accessory nerve palsy. A case report. Orthop Traumatol Surg Res 2010; 96:589-92. [PMID: 20580628 DOI: 10.1016/j.otsr.2010.03.017] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2009] [Revised: 12/25/2009] [Accepted: 03/16/2010] [Indexed: 02/02/2023]
Abstract
Spinal accessory nerve palsy may lead to dysfunction or paralysis of the trapezius muscle. Common causes are iatrogenic or secondary due to trauma, infection or tumour. Idiopathic palsy is considered extremely rare. We present the case of a 42-year-old Caucasian male suffering from a unilateral, isolated paralysis of his ipsilateral trapezius muscle. There was no related trauma, nor any past history of surgical procedures. An electromyographic study confirmed the idiopathic paralysis of the distal segment of the spinal accessory nerve.
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Affiliation(s)
- N N Sergides
- Orthopaedic Department, Central Clinic of Athens, Diagnostic and Treatment Center, Asklepiou 31 STR, ZC 10680, Athens, Greece
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Abstract
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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Charopoulos IN, Hadjinicolaou N, Aktselis I, Lyritis GP, Papaioannou N, Kokoroghiannis C. Unusual insidious spinal accessory nerve palsy: a case report. J Med Case Rep 2010; 4:158. [PMID: 20507553 PMCID: PMC2890620 DOI: 10.1186/1752-1947-4-158] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2009] [Accepted: 05/27/2010] [Indexed: 12/24/2022] Open
Abstract
INTRODUCTION Isolated spinal accessory nerve dysfunction has a major detrimental impact on the functional performance of the shoulder girdle, and is a well-documented complication of surgical procedures in the posterior triangle of the neck. To the best of our knowledge, the natural course and the most effective way of handling spontaneous spinal accessory nerve palsy has been described in only a few instances in the literature. CASE PRESENTATION We report the case of a 36-year-old Caucasian, Greek man with spontaneous unilateral trapezius palsy with an insidious course. To the best of our knowledge, few such cases have been documented in the literature. The unusual clinical presentation and functional performance mismatch with the imaging findings were also observed. Our patient showed a deterioration that was different from the usual course of this pathology, with an early onset of irreversible trapezius muscle dysfunction two months after the first clinical signs started to manifest. A surgical reconstruction was proposed as the most efficient treatment, but our patient declined this. Although he failed to recover fully after conservative treatment for eight months, he regained moderate function and is currently virtually pain-free. CONCLUSION Clinicians have to be aware that due to anatomical variation and the potential for compensation by the levator scapulae, the clinical consequences of any injury to the spinal accessory nerve may vary.
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Results after delayed axillary nerve reconstruction with interposition of sural nerve grafts. J Shoulder Elbow Surg 2010; 19:461-6. [PMID: 19800261 DOI: 10.1016/j.jse.2009.07.011] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2009] [Revised: 05/27/2009] [Accepted: 07/12/2009] [Indexed: 02/01/2023]
Abstract
HYPOTHESIS Satisfactory results after repair of isolated axillary nerve lesions using sural nerve autografts have been reported, but a delay between injury and surgical repair exceeding 6 months was one of the most important negative predictors of functional outcome. From our experience, we hypothesize that good results can be obtained even after a delay exceeding 6 months and we opted in this study to assess the value of delayed axillary nerve reconstruction. MATERIALS AND METHODS We evaluated clinical outcome and donor-site morbidity in 12 patients (mean age, 37; range, 19-66 years) who underwent axillary nerve repair with sural nerve graft with an average 11.25-month a delay between trauma and surgery (range, 8-20 months). Follow-up examination at least 24 months after treatment included assessment of shoulder range of motion, deltoid muscle strength in near full extension, deltoid extension lag, and sensibility. Constant Score, subjective shoulder value, and the Disabilities of Arm, Shoulder and Hand score were also assessed. RESULTS All patients showed an improved deltoid function of at least M3. Postoperative extension lag, as the most specific sign of isolated deltoid function, improved from 57.5 degrees to 14.2 degrees. All stated that they would have identical elective surgery again. Relevant donor-site morbidity was not observed. CONCLUSION Our data indicate that even delayed axillary nerve grafting may lead to satisfactory functional results with a low morbidity and should therefore be done in selected patients.
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Millett PJ, Romero A, Braun S. Spinal accessory nerve injury after rhytidectomy (face lift): a case report. J Shoulder Elbow Surg 2009; 18:e15-7. [PMID: 19328018 DOI: 10.1016/j.jse.2009.01.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2008] [Revised: 12/02/2008] [Accepted: 01/01/2009] [Indexed: 02/01/2023]
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Grossman JAI, Ruchelsman DE, Schwarzkopf R. Iatrogenic spinal accessory nerve injury in children. J Pediatr Surg 2008; 43:1732-5. [PMID: 18779017 DOI: 10.1016/j.jpedsurg.2008.04.029] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2008] [Revised: 04/17/2008] [Accepted: 04/18/2008] [Indexed: 11/28/2022]
Abstract
Injury to the spinal accessory nerve in the posterior triangle of the neck results in trapezius paralysis and shoulder dysfunction. The most common etiology is iatrogenic and has been reported extensively in adults. We report 3 cases of spinal accessory nerve injury recognized postoperatively in children and discuss the microsurgical treatment, results, and simple strategies to avoid this complication.
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Affiliation(s)
- John A I Grossman
- Brachial Plexus and Peripheral Nerve Program, Miami Children's Hospital, Miami, FL 33176, USA
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Galano GJ, Bigliani LU, Ahmad CS, Levine WN. Surgical treatment of winged scapula. Clin Orthop Relat Res 2008; 466:652-60. [PMID: 18196359 PMCID: PMC2505206 DOI: 10.1007/s11999-007-0086-2] [Citation(s) in RCA: 76] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2007] [Accepted: 11/27/2007] [Indexed: 02/07/2023]
Abstract
Injuries to the long thoracic and spinal accessory nerves present challenges in diagnosis and treatment. Palsies of the serratus anterior and trapezius muscles lead to destabilization of the scapula with medial and lateral scapular winging, respectively. Although nonoperative treatment is successful in some patients, failures have led to the evolution of surgical techniques involving various combinations of fascial graft and/or transfer of adjacent muscles. Our preferred method of reconstruction for serratus anterior palsy is a two-incision, split pectoralis major transfer without fascial graft. For trapezius palsy, we prefer a modified version of the Eden-Lange procedure. At a minimum followup of 16 months (mean, 47 months), six patients who underwent the Eden-Lange procedure showed improvement in mean American Shoulder and Elbow Surgeons Shoulder scores (33.3-64.6), forward elevation (141.7-151.0), and visual analog scale (7.0-2.3). At a minimum followup of 16 months (mean, 44 months), 10 patients (11 shoulders) who underwent split pectoralis transfer also improved American Shoulder and Elbow Surgeons Shoulder scores (53.3-63.8), forward elevation (158.2-164.5), and visual analog scale (5.0-2.9). We encountered two complications, both superficial wound infections. These tendon transfers were effective for treating scapular winging in patients who did not respond to nonoperative treatment.
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Affiliation(s)
- Gregory J. Galano
- Center for Shoulder, Elbow and Sports Medicine, Columbia University Medical Center, 622 West 168th Street, PH-1117, New York, NY 10032 USA
| | - Louis U. Bigliani
- Center for Shoulder, Elbow and Sports Medicine, Columbia University Medical Center, 622 West 168th Street, PH-1117, New York, NY 10032 USA
| | - Christopher S. Ahmad
- Center for Shoulder, Elbow and Sports Medicine, Columbia University Medical Center, 622 West 168th Street, PH-1117, New York, NY 10032 USA
| | - William N. Levine
- Center for Shoulder, Elbow and Sports Medicine, Columbia University Medical Center, 622 West 168th Street, PH-1117, New York, NY 10032 USA
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Abstract
BACKGROUND Injury to the spinal accessory nerve causes paralysis of the trapezius muscle, which is a painful and disabling condition. Many injuries are iatrogenic. Diagnosis is often made after a long delay, suggesting that current clinical signs are inadequate. METHODS Accessory nerve palsy is known to be a cause of winging of the scapula. Observation of six patients with accessory nerve palsy has shown that winging of the scapula is most prominent when the patient actively externally rotates the shoulder against resistance. RESULTS This is in contrast to the other causes of winging of the scapula including long thoracic nerve palsy and muscular dystrophy, where the scapula is most prominent on flexion or abduction of the shoulder. CONCLUSION We propose that the resisted active external rotation test should be regarded as the key clinical sign for accessory nerve palsy.
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Affiliation(s)
- Peter K H Chan
- Department of Orthopaedic Surgery, Chesterfield Royal Hospital, Chesterfield, England.
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Bertelli JA, Ghizoni MF. Improved Technique for Harvesting the Accessory Nerve for Transfer in Brachial Plexus Injuries. Oper Neurosurg (Hagerstown) 2006; 58:ONS-366-70; discussion ONS-370. [PMID: 16582662 DOI: 10.1227/01.neu.0000205286.70890.27] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
AbstractObjective:The accessory nerve is frequently used as a donor for nerve transfer in brachial plexus injuries. In currently available techniques, nerve identification and dissection is difficult because fat tissue, lymphatic vessels, and blood vessels surround the nerve. We propose a technique for location and dissection of the accessory nerve between the deep cervical fascia and the trapezius muscle.Methods:Twenty-eight patients with brachial plexus palsy had the accessory nerve surgically transplanted to the suprascapular nerve. To harvest the accessory nerve, the anterior border of the trapezius muscle was located 2 to 3 cm above the clavicle. The fascia over the trapezius muscle was incised and detached from the anterior surface of the muscle, initially, close to the clavicle, then proximally. The trapezius muscle was detached from the clavicle for 3 to 4 cm. The accessory nerve and its branches entering the trapezius muscle were identified. The accessory nerve was sectioned as distally as possible. To allow for accessory nerve mobilization, one or two proximal branches to the trapezius muscle were cut. The most proximal branch was always identified and preserved. A tunnel was created in the detached fascia, and the accessory nerve was passed through this tunnel to the brachial plexus.Results:In all of the cases, the accessory nerve was easily identified under direct vision, without the use of electric stimulation. Direct coaptation of the accessory nerve with the suprascapular nerve was possible in all patients.Conclusion:The technique proposed here for harvesting the accessory nerve for transfer made its identification and dissection easier.
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Affiliation(s)
- Jayme Augusto Bertelli
- University of the South of Santa Catarina-Unsul, Center of Biological Science and Health, CCBS, Tubarão, Brazil.
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