Scapula winging in a sports injury clinic.

Abstract

Scapula winging is an uncommon condition but one which may be underdiagnosed. Four patients with scapula winging referred to a sports injury clinic are presented. None of the patients was aware of any trauma and a traction injury to the long thoracic nerve is proposed as the aetiology of this condition. These case reports emphasize the importance of excluding winging of the scapula in patients who present to sports injury clinics with shoulder pain. Keywords: Scapula winging, sports injury clinic Four patients from a variety of sports attended the clinic with scapula winging over an 18-month period and are presented below. Case reports Case 1A 23-year-old right-handed boxer was referred with pain in the right shoulder of 8-10 weeks' duration. He had been training normally but there was no history of particular trauma. On examination he had winging of the right scapula. The winging recovered spontaneously over an 18-month period.Case 2 A 50-year-old weightlifter presented with 1 year's history of an abnormal appearance of the right shoulder. There was no history of trauma. On examination he had winging of the right scapula.Electromyographic (EMG) studies demonstrated a neurogenic lesion of the serratus anterior in isolation. No recovery occurred over 1 year and he was discharged from follow-up. Case 3A 27-year-old right-handed squash player presented 6 months after a sudden onset of aching in the right shoulder and a loss of power in the right arm while playing squash. On examination (Figure 1) he had winging of the right scapula. This recovered spontaneously over a 6-month period.Case 4 A 38-year-old right-handed rugby player experienced a sudden onset of pain in the right shoulder after a game of rugby, although he was unaware of injury during the game. Examination demonstrated scapula winging which recovered spontaneously over the next 6 months. DiscussionFour cases of scapula winging were detected in a sports injury clinic over an 18-month period. Scapula winging is said to be a rare condition, the subject of some 250 case reports since first described in 18251. The incidence among sportsmen may be higher, Gregg et al.l detecting ten cases in a sports injury clinic over a 3-year period. Trauma has been the precipitating factor in many of the previous case reports2.Scapula winging has been classified into static or dynamic types, and of bone, joint, muscle or nerve aetiology3. The cadaveric studies of Gregg et al.' suggested that the most likely aetiology in the

The Natural Course of Serratus Palsy at 2 to 31 Years

“…Winging of the scapula disappeared in 60% to 75% of the patients in small series of four to 10 patients [2,8,11,14,17] or in similar series in only 36% to 47% of patients [6,7,13] (Table 6). In our series, winging was absent from 78% of the patients.…”

An unusual cause of scapular winging following trauma in an army personnel

“…[4][5][6] Other unusual patterns of direct and indirect scapular injury have been described without winging as a cosequence. 1,3,9 Hayes and Zehr 8 reported a post traumatic winging of scapula leading to weakness and easy tiring of the shoulder because of detachment of serratus anterior muscle from the border of the scapula. We describe a case of persistent, painful winging of the scapula caused by traumatic fracture of the inferior angle of the scapula without co-existent nerve injury.…”

Scapular Winging

“…It is easy to rationalize the damage caused to the nerve from an acute traumatic event such as direct blow in a road traffic collision with acute onset of scapular winging, or iatrogenic damage from needle thoracocentesis [11,41]. The mechanism of nerve injury from repetitive minor trauma where no specific event can be identified is more difficult to appreciate, yet this supposed aetiology is more common across the literature [4,21,30,[42][43][44][45][46]41]. In this scenario with no clear acute traumatic event, the classic presentation is of an initial onset of severe pain, which subsides over a period of approximately 2 weeks before the weakness and scapular winging becomes apparent.…”

“…The initial symptoms of serratus anterior palsy are often vague, with pain along the base of the neck and over the scapula and deltoid, which is then replaced by weakness and scapular winging after 10 days to 2 weeks [1,9,17,[19][20][21]. In rare cases with definite acute trauma, the winging can be immediate [22].…”

“…To plan effective treatment, an understanding of the natural history of scapular winging from isolated long thoracic nerve palsy is required because this involves spontaneous recovery in the majority of patients within 2 years [6,16,21,22,24,32,33,46,47].…”