The weakness of forward arm flexion and abduction is seen. Most important muscles for the function of the scapula are given below. Fardin P, Negrin P, Dainese R. The isolate paralysis of the serratus anterior muscle: clinical and electromyographical follow-up of 10 cases. 17 muscles attach to the scapula which functions to provide stability to the scapula, provide power to upper limb and synchronize glenohumeral motion by scapulohumeral rhythm. Winging of the scapula is a rare but potentially debilitating condition that can affect the ability to lift, pull, and push heavy objects, as well as to perform daily activities of living. Rhomboid major muscle originates from T2-T5 spinous processes and inserts onto the medial scapular border, just below the insertion of the rhomboid minor. This is considered when there is a failure to improve with conservative treatment, for 1-2 years and there is no nerve lesion. doi: 10.1055/s-2001-12694. Clin Orthop Relat Res. This protrusion is worsened by forward arm flexion. It can be considered in elderly and sedentary patients and those without an identifiable injury. The abduction is often limited to 90° or less. Any painful condition of the shoulder will lead to abnormal movements of the entire shoulder complex. Recurrent dislocations of the shoulder lead to dysfunction of the muscles that move and support the shoulder complex and scapula. Muscle transfers may have complications like the failure of attachment at scapula, breast asymmetry in women and adhesive capsulitis. It is also helpful in the nerve site involved. It is often the last resort when treatments have failed. Its primary motion is upward rotation and elevation of the scapula and is innervated by the spinal accessory nerve which is a cranial nerve [XI]. Loss of trapezius function caused weak superior and medializing force on the scapula and excessive lateralizing scapular protraction caused by serratus anterior, pectoralis major and minor occurs. It is the more common type and is due to dysfunction of the serratus anterior. pectoralis transfer to the medial border of the scapula. It is supplied by the spinal accessory nerve which is a cranial nerve. Levator scapulae muscle originates from C1-C4 transverse processes and inserts onto the medial border of scapula at the level of the scapular spine. Applying ice or cold therapy may help reduce the shoulder blade pain although the back isn’t the easiest place to apply a cold pack. Muscle Nerve. A 42-year-old male sustains a flail chest injury and subsequently undergoes operative stabilization of his chest wall. His EMG shows denervation of the trapezius muscle. Friedenberg SM, Zimprich T, Harper CM. Which of the following is most likely affected? Correction of scapular winging by supraclavicular neurolysis of the long thoracic nerve. The most important muscle to strengthen if you have a Winged scapular is the serratus anterior muscle. 2006;26:237–77. The repetitive stretch injury is most common. At first follow-up, the inferior angle of his ipsilateral scapula translates medially with any attempt at overhead activity. This muscle also has three parts with different functions. Nakano KK. The decompression is supraclavicular and is associated with better results than muscle transfers. It is the more common type and is due to dysfunction of the serratus anterior. doi: 10.1002/mus.880010403. It mainly occurs due to injury to the spinal accessory nerve. defined by the direction of the superomedial corner of the scapula; medial scapular winging . The denervation or paralysis of any of these muscles results in the winging of the medial border of the scapula as it lifts off the thoracic wall. Collagen is the most abundant protein and is found all over the body in bones, tendons, and ligaments. It is more commonly seen in young athletes. (SBQ07SM.9) J Bone Joint Surg. lateral transfer of the levator scapulae and rhomboid minor and major. Reduced movement at the glenohumeral joint will lead to more compensatory movement at the scapula. There would be a weakness when lifting away from the body and overhead activity. Medial scapular winging. J Bone Joint Surg. It is supplied by C3-C4 cervical plexus with contributions from the dorsal scapular nerve. Surgical treatment for this condition involves It is worsened by arm abduction and resisted external rotation. The observation is for a minimum of 6 months and ideally up to  2 years for the nerve to recover. Winging may be caused by injury or dysfunction of the muscles themselves or the nerves that supply the muscles. The thickness of human articular cartilage varies from area to area within a single joint and from joint to joint. (OBQ12.258) In large […], Knee allows locomotion with minimum energy requirements from the muscles and stability for accommodating for different terrains. It is supplied by long thoracic artery and branches of the thoracodorsal artery. This is one of the commonest causes of scapula dysrhythmia (and winging). The knee is a major weight-bearing joint and the knee injuries require proper management with appropriate treatment. The presentation is similar both in medial and lateral scapular winging. The risk increases with activities involving head tilting during overhead arm activity, repetitive throwing, prolonged abduction. protraction caused by serratus anterior, pectoralis major and minor occurs. In most joints, adult human articular cartilage is of the hyaline type. This is indicated in avulsion of the serratus anterior muscle. The patient may also complain of discomfort sitting against a chair. Types of scapular winging . The term adjacent segment degeneration (ASDeg) is used […], knee injuries occur following trauma or fall. Which of the following muscles labeled in Figure B is most likely deficient and leading to his symptoms? This is indicated when there is a failure to improve with conservative treatment taken at least 6 months and electromyography with signs of nerve compression. Chronic nerve compression may be caused by compression at following sites, Direct injury to the nerve may occur in the following cases. A clinical picture is shown in Figure A. Muscle transfer [ Eden-Lange transfer] is done when a nerve injury is diagnosed late (> 20 months after injury). Acute injury occurs in cases of high-energy trauma as in motorcycle accident. Copyright © 2020 Lineage Medical, Inc. All rights reserved. Its main function is to produce smooth articulations among the joint surfaces. Tested Concept. Examination reveals winging of the left scapula. It can also lead to cosmetic issues and though not often, it may result in pain. Foo CL, Swann M. Isolated paralysis of the serratus anterior: a report of 20 cases. Shoulder impingement may be seen in lateral scapular winging due to the inferior translation of the coracoacromial arch as scapula depresses secondary to loss of trapezius. It is innervated by the long thoracic nerve which carries ventral rami of C5, C6, C7 from the brachial plexus. Bone morphogenic proteins are different entities and not structural bone protein. It is important to mention about bone morphogenic proteins in passing. Scapulothoracic articulation is not a true joint but the bone is attached to thorax via ligaments at the acromioclavicular joint and stabilized by the muscles. Compressive nerve injury could be acute or chronic. 1978;18:379–86. Tested Concept, Type in at least one full word to see suggestions list, 2018 Winter SKS Meeting: Shoulder, Knee, & Sports Medicine, Long Thoracic Neuropathy / Scapular Winging - Robert Z. Tashjian, MD (2.20, 2018 Winter SKS), Eden Lange Transfer for Trapezius Palsy - Dr. Richard Hawkins, Surgical Treatment of Long Thoracic Nerve Palsy. The patient should avoid painful or heavy lifting activities. doi: 10.1002/mus.10068. The problem is extremely common with 23% of the general population having a discrepancy of 1 cm or more Leg length discrepancy causes compensatory gait abnormalities, degenerative arthritis of the lower extremity […], Adjacent Segment Disease is defined as new degenerative changes at a spinal level adjacent to a surgically treated level or levels in the spine, leading to symptoms of radiculopathy, myelopathy, or instability. It has total 7-10 slips. This website is an effort to educate and support people and medical personnel on orthopedic issues and musculoskeletal health. Scapular winging is almost always caused by damage to one of three nerves that control muscles in your arms, back, and neck: the long thoracic nerve, which controls the … Majority of patients will spontaneously resolve with full return of shoulder function and resolution of winging by 2 years. In this procedure fusion of the anterior scapula is done the posterior rib cage, with wire cables and/or plates and screws. Medial scapular winging is caused by a deficit in serratus anterior function due to injury to the muscle itself or to the long thoracic nerve. Iceton J, Harris WR. It is also considered in scapular winging from diffuse neuromuscular disorders. A collegiate swimmer develops medial winging of the scapula. After a fall 2 months ago, he sustained several blows and kicks to his upper. 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