Surgical treatment of winged scapula. Academic Article uri icon

Overview

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.

publication date

  • January 8, 2008

Research

keywords

  • Accessory Nerve Injuries
  • Joint Deformities, Acquired
  • Joint Instability
  • Muscle, Skeletal
  • Paralysis
  • Scapula
  • Shoulder Joint
  • Tendon Transfer
  • Thoracic Nerves

Identity

PubMed Central ID

  • PMC2505206

Scopus Document Identifier

  • 42449162358

Digital Object Identifier (DOI)

  • 10.1002/micr.10046

PubMed ID

  • 18196359

Additional Document Info

volume

  • 466

issue

  • 3