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Albert W. Pearsall, MD, Chad
L. Loup, MD, Sudhakar Madanagopal, MD, University of South
Alabama
Recognition of scapular winging
is potentially difficult with incorrect diagnosis and treatment
errors possibly causing morbidity for the patient. Various
conditions may result in scapular winging; however, dysfunction
of the serratus anterior muscle from long thoracic nerve injury
is the most common cause. Paralysis of the serratus anterior
can be functionally disabling and present with pain, weakness,
decreased shoulder elevation, medial translation of the scapula,
rotation of the inferior angle towards the midline, and prominence
of the vertebral border of the scapula.
We present a patient who had
a 7-year history of pain, weakness, and decreased range of
motion in the left shoulder secondary to lifting a heavy object.
Examination revealed left scapular pain, elevation and rotation
of the inferior angle medially, and slight decreased range
of motion of the left shoulder. EMG nerve conduction studies
confirmed long thoracic nerve injury as the cause of the patient's
serratus anterior dysfunction. Failing conservative therapy,
the patient underwent operative management consisting of transfer
of the sternal head of pectoralis major to the inferior border
of the scapula with fascia lata augmentation. The patient
experienced pain relief, elimination of winging, and return
to normal function.
Long thoracic nerve injury causing
serratus anterior dysfunction can be functionally disabling.
Our case along with many other series illustrates that transfer
of the sternal head of pectoralis major with fascia lata augmentation
yields consistent functional improvement, elimination of winging,
and reduction of pain.
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