Surgical management of winged scapula/shoulder disability in adults who failed conservative treatments
- Department of Research, Texas Nerve and Paralysis Institute, Houston, Texas, United States.
Rahul K. Nath, Department of Research, Texas Nerve and Paralysis Institute, Houston, Texas, United States.
DOI:10.25259/SNI_639_2021Copyright: © 2021 Surgical Neurology International This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-Share Alike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.
How to cite this article: Rahul K. Nath, Chandra Somasundaram. Surgical management of winged scapula/shoulder disability in adults who failed conservative treatments. 16-Aug-2021;12:407
How to cite this URL: Rahul K. Nath, Chandra Somasundaram. Surgical management of winged scapula/shoulder disability in adults who failed conservative treatments. 16-Aug-2021;12:407. Available from: https://surgicalneurologyint.com/?post_type=surgicalint_articles&p=11049
Background: Scapular winging, muscle weakness, chronic discomfort, and overall impairment of shoulder function are commonly caused by injuries to and/or compression of the upper brachial plexus, long thoracic, and accessory nerves. These injuries can have significant social and financial impacts on patients.
Methods: Twenty-one adults who sustained shoulder injuries (a bilateral injury in two patients and a total of 23 shoulder surgeries) presented with winged scapulas, limited shoulder range of motion, and severe shoulder pain.
Results: Patients underwent unilateral decompression, neurolysis of the upper brachial plexus/long thoracic nerve (LTN), and partial resection of the scalene muscle. The mean shoulder abduction/flexion improved significantly, and 15 of 21 (71%) patients regained full range of motion (180°) postoperatively. In addition, the winged scapula appearance improved significantly in 20 of 21 patients (96%) postoperatively.
Conclusion: All except one of 21 patients with scapular winging, muscle weakness, chronic discomfort, and overall impairment of shoulder function improved following unilateral decompression, neurolysis of the upper brachial plexus/LTN, and partial resection of the scalene muscle.
Keywords: Anatomical posture, Long thoracic nerve injury, Shoulder range of motion, Sports and recreational related physical activities, Winging scapula
Scapular winging, muscle weakness, chronic discomfort, and overall impairment of shoulder function are commonly caused by injuries to and/or compression of the upper brachial plexus, long thoracic, and accessory nerves.[
Here, we report the anatomical and functional improvements in 21 sports and recreational related upper extremity-musculoskeletal disorders in adult patients after decompression and neurolysis of the upper brachial plexus and LTNs.
Twenty-one patients (a bilateral injury in two patients and 23 shoulder surgeries) underwent surgeries and postoperative evaluations. The mean time interval between the onset of injury and surgery was 2.3 years. Preoperatively, the extent of scapula winging was severe in 10 of 21 patients (48%) and moderate in other 11 of 21 patients (52%) [
An incision was created over the area where the LTN exited through the middle scalene muscle, about 3 cm superior to the upper clavicular border. The supraclavicular nerves were identified and retracted laterally. The upper trunk of the brachial plexus was identified deep in the anterior scalene fat pad; the fat pad was retracted, and the underlying upper trunk of the brachial plexus was identified. There was epineural scarring that was released sharply. The substance of the upper trunk was entered, and the perineurium was dissected using microsurgical instrumentation and high magnification. Major fascicle groups were separated through internal neurolysis to decompress the upper trunk internally. The upper trunk was decompressed surgically with partial release/excision of the anterior scalene muscle and dissected around the lateral and posterior aspects of the upper trunk - (i.e. where the LTN exited the middle scalene muscle). The LTN also was noted to have an hourglass-shaped impingement at this exit point, and the nerve was circumferentially neurolysed. The perineurium of the LTN was then dissected; several fascicles were separated using internal microneurolysis. In addition, the middle scalene muscle was resected partially to decompress the LTN.
Statistical tests included; the paired Student’s t-test with Analyze-it 2.12 software in Excel 2003 (Analyze-it, Leeds, UK; Microsoft, Redmond, WA). A value of P < 0.05 was considered statistically significant.
Postoperative clinical assessment
The anatomical appearance of the winged scapula improved significantly in 20 of 21 patients (96%) after the surgery [
The LTN injury and paralysis of the SA muscle are well documented in professional athletic and non-professional sports and recreational-related activities. Muscle-strengthening exercise such as weightlifting is more likely to cause shoulder damage in adults, while sports-related activities can cause shoulder injury in youth [
Göransson et al.[
Twenty of the 21 patients in this report achieved functional shoulder movements and a healthy appearance of the scapula after decompression, and neurolysis of the upper brachial plexus and LTNs, with partial resection of the scalene muscles.
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