ABSTRACT
INTRODUCTION: In this study we report a large series of patients with unilateral winged scapula (WS), with special attention to long thoracic nerve (LTN) palsy. METHODS: Clinical and electrodiagnostic data were collected from 128 patients over a 25-year period. RESULTS: Causes of unilateral WS were LTN palsy (n = 70), spinal accessory nerve (SAN) palsy (n = 39), both LTN and SAN palsy (n = 5), facioscapulohumeral dystrophy (FSH) (n = 5), orthopedic causes (n = 11), voluntary WS (n = 6), and no definite cause (n = 2). LTN palsy was related to neuralgic amyotrophy (NA) in 61 patients and involved the right side in 62 patients. DISCUSSION: Clinical data allow for identifying 2 main clinical patterns for LTN and SAN palsy. Electrodiagnostic examination should consider bilateral nerve conduction studies of the LTN and SAN, and needle electromyography of their target muscles. LTN palsy is the most frequent cause of unilateral WS and is usually related to NA. Voluntary WS and FSH must be considered in young patients. Muscle Nerve 57: 913-920, 2018.
Subject(s)
Neural Conduction/physiology , Paralysis/diagnosis , Scapula/diagnostic imaging , Thoracic Nerves/physiopathology , Adolescent , Adult , Electrodiagnosis , Female , Humans , Magnetic Resonance Imaging , Male , Middle Aged , Paralysis/diagnostic imaging , Paralysis/physiopathology , Thoracic Nerves/diagnostic imaging , Young AdultABSTRACT
Dyskinesia of the scapula is a clinical diagnosis and includes all disorders affecting scapula positioning and movement whatever its etiology. Scapular winging is a subtype of scapular dyskinesia due to a dynamic prominence of the medial border of the scapula (DSW) secondary to neuromuscular imbalance in the scapulothoracic stabilizer muscles. The two most common causes of DSW are microtraumatic or idiopathic lesions of the long thoracic nerve (that innerves the serratus anterior) or the accessory nerve (that innerves the trapezius). Diagnosis of DSW is clinical and electromyographic. Use of magnetic resonance imaging (MRI) could be of interest to distinguish lesion secondary to a long thoracic nerve from accessory nerve and to rule out scapular dyskinesia related to other shoulder disorders. Causal neuromuscular lesion diagnosis in DSW is challenging. Clinical examinations, combined with scapular MRI, could help to their specific diagnosis, determining their stage, ruling out differential diagnosis and thus give raise to more targeted treatment.
Subject(s)
Dyskinesias/diagnosis , Dyskinesias/physiopathology , Electromyography , Magnetic Resonance Imaging , Scapula/innervation , Superficial Back Muscles/innervation , Diagnosis, Differential , Humans , Thoracic Nerves/physiopathologyABSTRACT
An irreparable tear of the subscapularis is a surgical challenge. Open approaches have been widely described to restore the anatomy and the function of the shoulder. Pectoralis major transfer is the most common technique used in this difficult clinical situation. Although this procedure has only been performed through an open approach, we describe a new arthroscopic technique for pectoralis major transfer. The critical part in this technique, in general, is the musculocutaneous nerve dissection, which is also possible through the arthroscopic approach. Together with an alternative method of harvesting using chips of bone and a minimal skin incision, this promising, less invasive technique presents all the advantages of the arthroscopic approach and provides a strong fixation to the lesser tuberosity.
