winging scapula, causes, approach & treatment · 2018. 5. 4. · summary • scapular winging...
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Winging Scapula, causes, approach & treatment
M. N. Naderi , MD
H. Kyhanshokoh, MD
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Scapula
Dysfunction of the muscles
Winging
• Largest bone in shoulder
• Greatest number of muscle attached
• Synchronized action of muscles
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scapular winging
• Scapulohumeral rhythm disruption :
– limited flexion and abduction
– considerable pain
– Mostly due to nerve lesions
• long thoracic nerve
• spinal accessory nerve
– Muscle dystrophies
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• Winging secondary to RC injury or instability
• Winging secondary to pain
Winging is mild
EMG & NCV is normal
scapular winging
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Complex and revision problems in shoulder surgery. Philadelphia: Lippincott-Raven Publishers, 1997:357-375.)
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Secondary Scapular Winging
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Long thoracic nerve
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Injury to long thoracic nerve
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Treatment for Serratus anterior palsy
• Conservative treatment
– Physiotherapy , scapular brace
• Surgery
– Scapulothoracic fusion
– Static stabilization
– Dynamic muscle transfer
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Pectoralis major transfer
Treatment for Serratus anterior palsy Dynamic muscle transfer
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Pre-operation Post-op
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Injury to accessory nerve
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Treatment for Trapezius palsy
• Conservative treatment
– Physiotherapy , scapular brace
• Surgery
– Early spinal accessory nerve exploration
– Dynamic muscle transfer
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Eden-Lange Procedure
Treatment for Trapezius palsy
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Pre-operation
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Post-operation
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Scapulothoracic fusion
• Indicated in debilitating scapulothoracic dysfunction – Dystrophic conditions : FSC muscle dystrophy
– Nondystrohic condition : Failed previous operations
• Indications :
– pain relief
– improvement of function
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Scapulothoracic fusion
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Pre-operation photos
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Post-operation care
• Swap Sling for 6 weeks
• Pendulum & passive movement after 6 wks
• Active movement after 10 - 12 wks
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Summary
• Scapular winging is not uncommon, can be debilitating
• Electromyographical testing is essential
• Conservative treatment try first up to 6 - 24 month
• Dynamic muscle transfer in resistant cases
• Scapulothoracic fusion indicated in selected cases
Thank you for attention