Unilateral winged scapula: Clinical and electrodiagnostic experience with 128 cases, with special attention to long thoracic nerve palsy

Séror, P.; Lenglet, Timothée; Nguyen, Christelle; Ouaknine, M.; Lefèvre-Colau, Marie-Martine

doi:10.1002/mus.26059

Cited by 25 publications

(32 citation statements)

References 42 publications

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“…Data for 156 patients with unilateral dynamic WS, related or not to a defined neuromuscular disorder, were prospectively collected from 2001 to 2020 1,2,4‐7 and retrospectively reanalyzed. All patients were referred for electrodiagnostic (EDX) evaluation because of marked unilateral WS, with variable shoulder pain and weakness.…”

Section: Methodsmentioning

confidence: 99%

“…The diagnosis of unilateral winged scapula (WS) or unilateral scapular dyskinesia is challenging and, therefore, is often delayed or complicated by errors. Causes of WS or scapular dyskinesia are diverse and can be related to nerve, muscle, bone, or joint disorders 1‐7 . Neuromuscular disorders produce dynamic dyskinesia, called WS, whereas bone and joint disorders produce mainly static WS or scapular dyskinesia, which is a non‐specific response to a painful condition in the shoulder 8‐12 .…”

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confidence: 99%

“…Neuromuscular disorders produce dynamic dyskinesia, called WS, whereas bone and joint disorders produce mainly static WS or scapular dyskinesia, which is a non‐specific response to a painful condition in the shoulder 8‐12 . Long thoracic nerve (LTN) and spinal accessory nerve (SAN) palsies as well as facio‐scapulo‐humeral dystrophy (FSHD) are the most frequent causes of unilateral dynamic neuromuscular WS 1,6,7 …”

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confidence: 99%

“…Voluntary winging of the scapula (VWS) is an infrequent cause of S that is infrequently recognized and is not part of Medical Subject Headings used by PubMed for indexing articles. Moreover, the query “voluntary winged or winging of the scapula,” resulted in only five articles in PubMed, and the term VWS does not appear in the title of any of these five papers and is a keyword in only one 6 . In contrast, 276 articles were found with “winging scapula,” “winged scapula,” or “scapular winging” and 497 with “scapular dyskinesis” or “dyskinesia.”…”

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Voluntary winging of the scapula: Proposed diagnostic criteria

et al. 2020

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We report a series of 10 patients with unilateral, dynamic, winged scapula (WS), without cause, that was diagnosed as voluntary winging of the scapula (VWS). We compared clinical, electrodiagnostic, and other examination data for 10 patients with VWS and 146 with dynamic WS-related neuromuscular disorders, to establish a detailed pattern of the VWS subtype. In VWS, electrodiagnostic and other examinations did not reveal any neuromuscular or orthopedic cause. Winging was dynamic, obvious, neither medial nor lateral, and mainly involved the inferior angle of the scapula, in young patients. VWS never appeared during floor push-ups. Patients could produce WS at will with the index and healthy shoulder, between 25 and 65 of anterior elevation, or with shoulder internal rotation. VWS is a benign disorder that can be distinguished from neuromuscular WS by normal electrodiagnostic results for muscles and nerves of both shoulders and two specific clinical tests.

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confidence: 99%

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Voluntary winging of the scapula: Proposed diagnostic criteria

et al. 2020

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“…2 NA is defined as (sub) acute (within hours or days) monophasic painful (numerical rating scale score ≥7/ 10) neurologic injury, with multifocal distribution involving mainly the brachial plexus, excluding a direct trauma, malignancy and local radiation, and with normal cervical spine MRI findings. [2][3][4][5] It is triggered at least in 25% by viral infection 6 : Parvovirus B19 (PVB19), human cytomegalovirus (HCMV), herpes simplex virus (HSV), etc. In 2009, the first case of hepatitis E virus (HEV) associated NA was reported by Fong & Illahi 7 and recently, some cases were reported.…”

Section: Introductionmentioning

confidence: 99%

Neuralgic amyotrophy and hepatitis E infection: 6 prospective case reports

et al. 2020

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IntroductionHepatitis E virus (HEV) represents the main cause of enterically transmitted hepatitis worldwide. It is known that neuralgic amyotrophy (NA) is one of the most frequent neurological manifestations of HEV. However, clinical, electrodiagnostic (EDX) and MRI characteristics, as well as long-term follow-up of HEV-related NA have not been fully described yet.Case reportsWe describe longitudinally clinical, EDX, biological and MRI results of six cases of HEV-associated NA, diagnosed from 2012 to 2017. Patients were between the ages of 33 and 57 years old and had a positive HEV serology. Clinical patterns showed the whole spectrum of NA, varying from extensive multiple mononeuropathy damage to single mononeuropathy. EDX results showed that the patients totalised 26 inflammatory mononeuropathies (1 to 8 per patient). These involved classical nerves such as suprascapular (6/6 cases), long thoracic (5/6 cases) and accessory spinal nerves (2/6 cases) and, some less frequent more distal nerves like anterior interosseous nerve (3/6 cases), as well as some unusual ones such as the lateral antebrachial cutaneous nerve (1/6 case), sensory fibres of median nerve (1/6 case) and phrenic nerves (1/6 case). After 2 to 8 years, all nerves had clinically recovered (muscle examination above 3/5 on MRC scale for all muscles except in one patient).DiscussionHEV should be systematically screened when NA is suspected, whatever the severity, if the onset is less than 4 months (before IgM HEV-antibodies disappear) and appears to be frequently associated with severe clinical and EDX pattern, without increasing the usual recovery time.

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Neuralgic amyotrophy: An update in evaluation, diagnosis, and treatment approaches

Gabet,

Anderson,

Groothuis

et al. 2024

Muscle and Nerve

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Neuralgic amyotrophy (NA) is an underrecognized peripheral nerve disorder distinguished by severe pain followed by weakness in the distribution of one or more nerves, most commonly in the upper extremity. While classically felt to carry a favorable prognosis, updates in research have demonstrated that patients frequently endure delay in diagnosis and continue to experience long term pain, paresis, and fatigue even years after the diagnosis is made. A transition in therapeutic approach is recommended and described by this review, which emphasizes the necessity to target compensatory abnormal motor control and fatigue by focusing on motor coordination, energy conservation strategies, and behavioral change, rather than strength training which may worsen the symptoms. The development of structural hourglass‐like constrictions (HGCs) on imaging can help confirm the suspected clinical diagnosis, and in association with persistent weakness and limited recovery on electrodiagnostic testing may be considered for surgical consultation. Given the complex nature of management, a multidisciplinary approach is described, which can provide an optimal level of care and support for patients with persistent symptoms from NA and allow more unified guidance of rehabilitation and surgical referrals.

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Unilateral winged scapula: Clinical and electrodiagnostic experience with 128 cases, with special attention to long thoracic nerve palsy

Cited by 25 publications

References 42 publications

Voluntary winging of the scapula: Proposed diagnostic criteria

Voluntary winging of the scapula: Proposed diagnostic criteria

Neuralgic amyotrophy and hepatitis E infection: 6 prospective case reports

Neuralgic amyotrophy: An update in evaluation, diagnosis, and treatment approaches

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