Anatomy, Etiology, and Management of Scapular Winging

Didesch, Jacob; Tang, Peter

doi:10.1016/j.jhsa.2018.08.008

Cited by 46 publications

(48 citation statements)

References 23 publications

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“…In the absence of normal trapezial force vectors, the unopposed activity of the serratus anterior, deltoid, and rotator cuff musculature results in characteristic lateral scapular winging and abnormal glenohumeral biomechanics. 5 , 6 Therefore, the transfer of the levator scapulae along the spine of the scapula is intended to recreate the force vector of the upper portion of the trapezius, resulting in proper elevation and upward rotation of the scapula. Similarly, the transfer of the rhomboid major and minor along the infraspinatus fossa, lateral to the medial border of the scapula, attempts to recreate the force vector of the middle and lower trapezius, resulting in retraction and rotation of the scapula to provide the stabilizing forces.…”

Section: Discussionmentioning

confidence: 99%

“…The primary goal of the procedure is to mimic the balanced force normally exerted by a functional trapezius muscle via transfer of the levator scapulae, rhomboid major, and rhomboid minor lateral to their usual anatomic insertion on the scapula. 5 , 6 First described by Eden and later corroborated by Lange, the Eden-Lange transfer produces good to excellent outcomes in 57% to 75% of patients. 18 , 23 , 24 The Eden-Lange procedure has undergone multiple modifications since first being described in 1924, differing in the final placement of the rhomboid major, rhomboid minor, or levator scapulae muscles, with excellent results reported in 59% to 95% of patients.…”

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confidence: 97%

“… 1 , 2 , 3 The loss of trapezius innervation disrupts the intricate muscular balance around the shoulder that serves as the basis for scapulohumeral rhythm and the symmetrical suspension of the shoulder girdle. 3 , 4 , 5 , 6 The manifestations of such imbalance can be functionally debilitating for patients, who may exhibit a shoulder droop on physical examination and lateral winging of the scapula, while exhibiting profound limitations in forward flexion and abduction; they may also experience neuropraxia in the ipsilateral upper extremity as a result of brachial plexus traction and impingement. 3 , 4 , 5 …”

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confidence: 99%

“…The Eden-Lange muscle transfer can alleviate pain, improve range of motion, and restore the functional capacity and balance of the shoulder girdle. 5 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 …”

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confidence: 99%

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The Modified Eden-Lange Tendon Transfer for Lateral Scapular Winging Secondary to Spinal Accessory Nerve Injury

Gustin

Olszewski

Parisien

et al. 2020

Arthroscopy Techniques

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Trapezius paralysis following injury to the spinal accessory nerve can be a debilitating complication resulting from lymph node biopsy, radical neck dissection, or penetrating trauma in the region of the posterior cervical triangle. Disruption of the delicate muscular balance in the shoulder girdle may result in lateral scapular winging, ipsilateral upper extremity radiculopathy, and limited shoulder function and range of motion. Spontaneous recovery with nonoperative management is possible in some patients, and restoration of function after reparative neural procedures has been observed in patients undergoing timely repair. However, extended delays from the time of injury to surgery are common and may necessitate various muscle transfers to reestablish the complex biomechanics and balance of the shoulder girdle. We describe a modification to the classic Eden-Lange procedure with lateral transfer of the levator scapulae and rhomboid minor to the scapula spine and rhomboid major transfer with a small wafer of bone to the scapula body for chronic lateral winging of the scapula following injury to the spinal accessory nerve as the result of a cervical lymph node biopsy.

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 97%

mentioning

confidence: 99%

mentioning

confidence: 99%

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The Modified Eden-Lange Tendon Transfer for Lateral Scapular Winging Secondary to Spinal Accessory Nerve Injury

Gustin

Olszewski

Parisien

et al. 2020

Arthroscopy Techniques

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“…In McGarvey et al's studies, HNC survivors with neck dissection showed greater muscle activity of SA in the affected side than the unaffected side when performing scapular exercise [6,12]. The function of SA muscle is to stabilize the medial border of the scapula on the chest wall when elevating the arm overhead and protracting scapula [57] (i.e. shoulder horizontal adduction and flexion).…”

Section: Scapular Muscle Activationsmentioning

confidence: 99%

Motor control integrated into muscle strengthening exercises has more effects on scapular muscle activities and joint range of motion before initiation of radiotherapy in oral cancer survivors with neck dissection: A randomized controlled trial

et al. 2020

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Background Accessory nerve shoulder dysfunction is common after neck dissection in oral cancer survivors. This study aimed to investigate the short-term effects of scapular muscle strengthening exercises with motor-control techniques on neck dissection-related shoulder dysfunction in oral cancer survivors before the initiation of radiotherapy. Methods Thirty-eight participants were randomly allocated into the motor-control and regular-exercise groups. Each group received conventional physical therapy and specific scapular muscle strengthening exercises for 1 month immediately after neck dissection. Motor control techniques were integrated with scapular strengthening exercises for the motor-control group. Shoulder pain, active range of motion (AROM) of shoulder abduction, and scapular muscle activities including upper trapezius (UT), middle trapezius (MT), lower trapezius (LT), and serratus anterior (SA) when performing maximal voluntary isometric contraction (MVIC) and scapular muscle exercises were evaluated at baseline and after 1 month of training. Results Both groups reduced shoulder pain and increased muscle activity of maximum voluntary isometric contraction (MVIC) of each muscle after the intervention. Increased AROM of shoulder abduction was only observed in the motor-control group (95% CI 3.80 to 20.51, p = 0.004). Relative to baseline evaluation, muscle activities of UT decreased in the motor-control group when performing shoulder shrug with 1-kg weight (95% CI-33.06 to-1.29, p = 0.034). Moreover, the SA activity decreased in the motor-control group (95% CI-29.73 to

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Topographic and morphometric anatomy of the proximal part of the dorsal scapular nerve

Çelikgün,

Gayretli,

Gürses

et al. 2023

Clinical Anatomy

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The dorsal scapular nerve (DSN) entrapment neuropathy has recently been recognized as a common cause of circumscapular pain and cases of winged scapula. Course of the nerve is important because the middle scalene muscle is frequently accessed for surgical treatments. Studies in the literature have not focused on the morphometric relationship of the DSN with the scalene muscles and its relationship with the long thoracic nerve (LTN). The neck regions of 13 adult cadavers were dissected bilaterally. The relationship of DSN with scalene muscles and LTN was evaluated. Cervical spinal nerves involved in the formation of the DSN were identified. Three types of DSN were observed based on the cervical spinal nerves from which it originates, five types of DSN from its relationship with the scalene muscles, and two types of DSN from its relationship with the LTN. The distance from where the nerve pierces the scalene muscle to the mastoid process was found to be greater in DSNs originating from C4 and C5 (93.85 ± 4.11 mm, p = 0.033). In DSNs not connected with LTN, the distance from where the nerve pierces the scalene muscle to the superior trunk/C5 (12.74 ± 7.73 mm, p = 0.008) and the length of the nerve within the scalene muscle (14.94 ± 5.5 mm, p = 0.029) were found to be statistically significantly greater. The topographic and morphometric anatomy of the proximal part of the DSN is important, especially for scalene muscles‐focused surgical treatments and interscalene nerve blocks. We believe our results may guide clinical approaches and surgery.

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Anatomy, Etiology, and Management of Scapular Winging

Cited by 46 publications

References 23 publications

The Modified Eden-Lange Tendon Transfer for Lateral Scapular Winging Secondary to Spinal Accessory Nerve Injury

The Modified Eden-Lange Tendon Transfer for Lateral Scapular Winging Secondary to Spinal Accessory Nerve Injury

Motor control integrated into muscle strengthening exercises has more effects on scapular muscle activities and joint range of motion before initiation of radiotherapy in oral cancer survivors with neck dissection: A randomized controlled trial

Topographic and morphometric anatomy of the proximal part of the dorsal scapular nerve

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