Transfer of the Levator Scapulae, Rhomboid Major, and Rhomboid Minor for Paralysis of the Trapezius*

Surgical Treatment of Winged Scapula

“…Langenskiold and Ryoppy in 1973 reported favorable results of the Eden-Lange procedure in a series of three patients [23]. Bigliani et al [2,3]. in two separate studies demonstrated excellent or satisfactory results in the majority of patients treated with the modified Eden-Lange procedure in the short and intermediate term.…”

“…Nonoperative treatment has also been advocated in older people who are sedentary, have minimal symptoms, or can modify their daily activities. Rehabilitation as treatment (such as strengthening accessory muscles, antiinflammatories, acupuncture, electrical stimulation, nerve blocks, or steroid injections) for chronic trapezius palsy has had poor outcomes [2,3]. One study reported seven of eight patients treated with nonoperative rehabilitation had an unsatisfactory result [3].…”

“…This procedure was also fraught with failure, however, as a result of the inability of the small levator scapulae to substitute for the large trapezius muscle and stretching of the sling [2,3]. Eden first described a procedure of laterally transferring the insertions of the rhomboids major and minor and the levator scapulae for treatment of trapezius palsy in 1924 [11].…”

“…This patient with spinal accessory and long thoracic palsy benefited from a combined split pectoralis major transfer and Eden-Lange procedure. This combination palsy is not unheard of; in fact, it has been hypothesized long thoracic nerve palsy may develop as a traction injury secondary to an unsupported scapula in patients with concurrent spinal accessory nerve palsy [2]. Romero and Gerber noted inferior results in patients with multiple nerve palsies [34].…”

“…The trapezius and serratus anterior muscles are integral to proper shoulder function, because they are the only muscles able to produce upward rotation and elevation of the scapula [17]. Scapular winging also presents a diagnostic challenge as evidenced by the fact that many of these patients are initially misdiagnosed [2,3]. The two main causes of scapular winging are injuries to the spinal accessory and long thoracic nerves.…”