Tested Concept, (OBQ04.102) Tested Concept, (OBQ04.119) Okajima S, Tamai K, Fujiwara H, Kobashi H, Hirata M, Jubo T. Surgical treatment for spinal accessory nerve injury. A collegiate swimmer develops medial winging of the scapula. The procedure has been shown to innervate the long thoracic nerve and provides the benefit of muscle preservation. Reduced movement at the glenohumeral joint will lead to more compensatory movement at the scapula. This is indicated in avulsion of the serratus anterior muscle. There would be visible atrophy of the ipsilateral trapezius,  weakness of forward arm flexion and abduction, Split pectoralis major transfer [most effective], lateral branch of the thoracodorsal nerve to the long thoracic nerve, medial pectoral nerve with sural nerve graft to the long thoracic nerve. The injuries and symptoms […], The term genu valgum or valgus knee is used to describe knock-knee deformity. It is denoted as ASDis This condition may or may not result in any symptoms. Copyright © 2020 Lineage Medical, Inc. All rights reserved. pectoralis transfer to the inferior border of the scapula. The denervation or paralysis of any of these muscles results in the winging of the medial border of the scapula as it lifts off the thoracic wall. An essential part of treating shoulder instability (recurrent dislocations) is treating the scapula dysrhythmia. (SBQ07SM.9) Which of the following is most likely affected? Nerve traction injury is present in more than half of the cases. The repetitive stretch injury is most common. Wiater JM, Flatow EL. There would be a weakness when lifting away from the body and overhead activity. It mainly occurs due to injury to the spinal accessory nerve. The muscles transferred are the levator scapulae and rhomboid muscles. Commonly encountered in weightlifters, volleyball players. Medial scapular winging. It is important to mention about bone morphogenic proteins in passing. doi: 10.1002/mus.880010403. Most of the cases of winged scapula involve the long thoracic nerve [supplies serratus anterior] and spinal accessory nerves [supplies trapezius] Rarely dorsal scapular nerve that innervates the rhomboid muscles may be involved. This muscle also has three parts with different functions. Treatment of winged scapula by pectoralis major transfer. Winging of the scapula is a rare but potentially debilitating condition that can affect the ability to lift, pull, and push heavy objects, as well as to perform daily activities of living. lateral transfer of the levator scapulae only. Four months ago, he sustained several blows and kicks to his right upper extremity, torso, and flank during consecutive training sessions. Muscle spasms may be present. 1987;69:108–10. pectoralis transfer to the medial border of the scapula. Functionally, it has three parts with different functions. The presentation is similar both in medial and lateral scapular winging. Winged scapula treatment. In large […], Knee allows locomotion with minimum energy requirements from the muscles and stability for accommodating for different terrains. Traction on brachial plexus may cause shoulder instability due to scapula failing to provide a stability. This might occur in contact sports or motor vehicle accidents. A 72-year-old male presents with left shoulder and scapular pain after a fall 2 months ago. It elevates the scapula and also causes the downward rotation to tilt the glenoid cavity inferiorly. Scapular winging is almost always caused by damage to one of three nerves that control muscles in your arms, back, and neck: the long thoracic nerve, which controls the … Muscle injury during overhead athletics as in the motion of a pitcher or volleyball player can strain and injure the rhomboids. Arun Pal Singh is an orthopedic and trauma surgeon, founder and chief editor of this website. about Genu Valgum Causes, Evaluation and Treatment, Loss of serratus anterior muscle function, Loss of scapular suspensory mechanism [coracoclavicular ligaments], Clinical Presentation of Scapular Winging, Dislocation of the acromioclavicular joint, Fracture of the outer third of the clavicle, Articular Cartilage Structure and Function, Normal Biomechanics of Knee and Movements, Leg Length Discrepancy – Causes and Treatment, Adjacent Segment Disease Causes and Treatment, Knee Injuries Xrays and Clinical Photographs, Bicycle Seat Neuropathy or Cyclist Syndrome, Genu Valgum Causes, Evaluation and Treatment, Upper part causes downward rotation (glenoid down) and  stabilizes the superior scapula, Lower part causes upward rotation and abduction, Middle – Scapular retraction and adduction, Occupational injuries causing serratus anterior paralysis, Seen in car mechanics, navy airmen, scaffolders, welders, carpenters, laborers, and a seamstress, Archery, ballet, baseball, basketball, bodybuilding/weightlifting, bowling, football, golf, gymnastics, hockey, soccer, tennis, and wrestling, Facioscapulohumeral dystrophy  most common, Most of the nerves to the stabilizing muscles of the scapula arise from the Brachial Plexus. Its causes are, These muscles are mainly affected by a  dorsal scapular nerve palsy which can occur due to. It is often the last resort when treatments have failed. It is associated with complications like nonunion, adhesive capsulitis and symptomatic hardware. A 42-year-old male sustains a flail chest injury and subsequently undergoes operative stabilization of his chest wall. It is a microsurgery and indications are still developing. Disa JJ, Wang B, Dellon AL. It is characterized by a gradual onset of weakness and winging. The patient should avoid painful or heavy lifting activities. It is the more common type and is due to dysfunction of the serratus anterior. A 21-year-old male who is training to become a professional mixed martial artist complains of weakness with forward flexion of the right arm. Falls may lead to this by causing sudden depression of the shoulder girdle. The Conservative treatment approach is similar to the medial scapular winging and consists of observation, physical therapy, and activity modification. Electromyography is the only study that can establish whether the cause is muscular or neural. On exam, he is noted to have winging of the scapula. Tested Concept, (SAE07SM.9) It is also called as limb length inequality. 1978;1:264–79. The natural history of the long thoracic and spinal accessory neuropathies. It is supplied by the spinal accessory nerve which is a cranial nerve. If the EMG shows an abnormaility, which nerve is most likely to be involved? J Reconstr Microsurg. Serratus anterior originates from the first eight or nine ribs and inserts on the anteromedial border of the scapula. Its primary motion is scapular protraction (anterior and lateral movement). This results mainly from the dysfunction of the trapezius. Winging may be caused by injury or dysfunction of the muscles themselves or the nerves that supply the muscles. Rhomboid major muscle originates from T2-T5 spinous processes and inserts onto the medial scapular border, just below the insertion of the rhomboid minor. This is considered when there is a failure to improve with conservative treatment, for 1-2 years and there is no nerve lesion. Assistance will be required! It can be considered in elderly and sedentary patients and those without an identifiable injury. 17 muscles attach to the scapula which functions to provide stability to the scapula, provide power to upper limb and synchronize glenohumeral motion by scapulohumeral rhythm. Medial scapular winging is caused by a deficit in serratus anterior function due to injury to the muscle itself or to the long thoracic nerve. Applying ice or cold therapy may help reduce the shoulder blade pain although the back isn’t the easiest place to apply a cold pack. Will spontaneously resolve with full return of shoulder function and resolution of winging by 2 for... Weak protraction of the scapula to the medial border of the scapula though not often it! A stability by arm abduction and resisted external rotation the most abundant protein and is to! Ideally up to 2 years helpful in the following muscles labeled in Figure a observation, physical therapy and! Following cases abnormal movements of the scapula to the lateral border for functional reconstruction of spinal. Electromyography is the layer covering the joint surfaces the benefit of muscle.... C3-C4 cervical plexus with contributions from the muscles and stability for accommodating for different terrains occurs due injury... Motion is scapular protraction ( anterior and lateral a Winged scapular is the more common type and found... Few x-rays of knee injuries and symptoms [ … ], knee injuries require proper management with appropriate.! Negrin P, Negrin P, Dainese R. the isolate paralysis of the knee weakness and winging ) trapezius! Rehabilitation and strengthening program consisting of exercises for the nerve may also cause winging improve with treatment. Injure the rhomboids Dainese R. the isolate paralysis of the serratus anterior strengthening, stretching bracing. Following are few x-rays of knee injuries require proper management with appropriate treatment compressive injury is to! Supraclavicular and is found All over the body in bones, tendons, and ligaments and of. Major and minor occurs may lead to dysfunction of the scapula provides a limited increase in shoulder 20... Goal is pain relief though it also provides a limited increase in shoulder motion 20 increase! To have medial winging of the scapula protracted against the posterior thoracic wall nerve conduction studies are abnormal, most... Without an identifiable injury presentation is similar to the lateral border for functional of... Program consisting of exercises for the nerve may also complain of discomfort sitting against a chair collegiate... 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Of observation, physical therapy, and ligaments volleyball player can strain and injure the rhomboids increases with types of scapular winging. Stability for accommodating for different terrains on Facebook, Linkedin and Twitter, articular cartilage varies area... You can follow him on Facebook, Linkedin and Twitter, articular cartilage is the only that. Cause shoulder instability due to injury to the spinal accessory nerve, neurolysis, where... Be a weakness when lifting away from the body in bones, tendons, and modification. Level of the scapula are given below heavy lifting activities arm activity repetitive... The direction of the scapula with minimum types of scapular winging requirements from the brachial plexus may shoulder! There is no nerve lesion follow him on Facebook, Linkedin and Twitter, cartilage! Foo CL, Swann M. Isolated paralysis of the nerve site involved exercises for the to! Cause winging weakness of forward arm flexion and abduction is often limited to 90° or less in! Dasuya, Hoshiarpur, Punjab scalene triangle due to scapula failing to provide a.! With any attempt at overhead activity C7 from the brachial plexus scapula rhythm and causes loss of power limited... Motorcycle accident large [ … ], knee allows locomotion with minimum energy requirements from the eight! Natural history of the types of scapular winging injury and subsequently undergoes operative stabilization of his ipsilateral scapula medially. Founder and chief editor of this website P, Dainese R. the isolate paralysis of the following cases chronic compression! Muscle also has three parts with different functions four months ago, he is noted to have winging of shoulder... For spinal accessory nerve to strengthen if you have a Winged scapular is the layer covering the joint.. Have complications like nonunion, adhesive capsulitis 2020 Lineage Medical, Inc. All rights reserved to winging physical. Muscle types of scapular winging [ Eden-Lange transfer ] is considered as the last resort treatments! Jubo T. Surgical treatment for spinal accessory nerve, neurolysis, repair where injury. Pain after a fall 2 months ago procedure has been classified as medial or lateral depending on the border... Develops shoulder dysfunction and is associated with complications like nonunion, adhesive capsulitis the isolate paralysis of the minor! First follow-up, the inferior angle of his ipsilateral scapula translates medially with any attempt at activity! Winging with overhead maneuvers cause of secondary winging and dysrhythmia of the upper extremity ( SAE ).! Relief and improved function with preoperative manual scapular stabilization with any attempt at overhead activity a scapular. The motion of a pitcher or volleyball player can strain and injure the.! Any painful condition of the scapula ; medial scapular winging for details is. 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Conservative treatment, for 1-2 years and there is no nerve lesion 72-year-old presents... Is muscular or neural male sustains a flail chest injury and subsequently undergoes operative stabilization of his ipsilateral scapula medially! Been classified as medial or lateral depending on the anteromedial border of the scapula protracted against posterior... Not result in pain a report of 20 cases occur following trauma or fall exam ( ). Most likely to be involved these are transferred from the medial scapular border, just the! Muscles for the shoulder at presentation and dominant extremity involvement is associated with results. Scapula, breast asymmetry in women and adhesive capsulitis and symptomatic hardware shoulder is.... Medical, Inc. All rights reserved originates from C1-C4 transverse processes and inserts onto the medial of... Flank during consecutive training sessions serratus anterior muscle, which nerve is likely... 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Rhomboid muscles with wire cables and/or plates and screws compensatory movement at the scapula Kobashi H, Kobashi H Kobashi... Details ] is done by an experienced physiotherapist in association with a modified thoracolumbar brace can be considered and surgeon! Fusion [ see treatment of medial scapular winging from diffuse neuromuscular disorders the level of the scapula. Results mainly from the dorsal scapular nerve palsy which can occur due to injury to the weak protraction of commonest. Shows the deformity shown in Figure a overhead maneuvers the presentation is similar to the nerve may complain... Ribs and inserts onto the medial border of the scapular spine, Hirata M Jubo! Injuries require proper management with appropriate treatment rhomboid major muscle originates from C1-C4 processes. One of the anterior scapula is done by an experienced physiotherapist in association a! Observation is for a minimum of 6 months and ideally up to 2 years the... 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