Case Report
Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Orthop. Jan 18, 2019; 10(1): 33-44
Published online Jan 18, 2019. doi: 10.5312/wjo.v10.i1.33
Contralateral trapezius transfer to treat scapular winging: A case report and review of literature
Juan José Gil-Álvarez, Pablo García-Parra, Manuel Anaya-Rojas, María del Pilar Martínez-Fuentes
Juan José Gil-Álvarez, Pablo García-Parra, Manuel Anaya-Rojas, Department of Orthopedics and Traumatology, Hospital Universitario Virgen del Rocío, Sevilla 41013, Spain
María del Pilar Martínez-Fuentes, Department of Rehabilitation, Hospital Universitario Virgen del Rocío, Sevilla 41013, Spain
Author contributions: All authors contributed equally to this paper in regards to conception and structure of this case report, data collection, literature review, and drafting and critical revisions of the manuscript; all authors gave approval of the final version.
Supported by Fundación Pública Andaluza para la Gestión de la investigación en Salud de Sevilla; “FISEVI”.
Informed consent statement: Written informed consent was given by the participant before the beginning of the study.
Institutional review board statement: The Institutional Review Board (IRB) of Hospital Universitario Virgen del Rocío gave approval for the study, No. JGA-TCEA-2017.
Conflict-of-interest statement: The authors of the study have no potential conflicts of interest to declare.
CARE Checklist (2016) statement: The guidelines of the “CARE Checklist - 2016: Information for writing a case report” have been adopted.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Corresponding author: Juan José Gil-Álvarez, MD, PhD, Associate Professor, Department of Orthopedics and Traumatology, Hospital Universitario Virgen del Rocío, Avenida Manuel Siurot s/n, Sevilla 41013, Spain.
Telephone: +34-95-5012000
Received: September 12, 2018
Peer-review started: September 12, 2018
First decision: October 19, 2018
Revised: November 17, 2018
Accepted: December 17, 2018
Article in press: December 17, 2018
Published online: January 18, 2019
Case characteristics

A 37-year-old male presented at 2 years after a right shoulder indirect injury, with right scapular winging, shoulder function impairment, and pain.

Clinical diagnosis

Physical examination of the patient suggested a lateral scapular winging. Definitive diagnosis was obtained after neurophysiological studies revealed an isolated dorsal scapular nerve injury.

Differential diagnosis

Lateral scapular winging is due to lack of function of the trapezius and/or rhomboid muscles, so these two entities should be considered. Given that in obese patients it is difficult to differentiate medial from lateral scapular winging, medial scapular winging due to lack of function of serratus anterior muscle should also be taken into account.

Laboratory diagnosis

Electrophysiological studies showed an isolated dorsal scapular nerve lesion and proper function of other nerves, such as the long thoracic and spinal nerves.

Imaging diagnosis

Imaging studies (plain X-rays and magnetic resonance imaging) did not reveal any structural injury.

Pathological diagnosis

Not applicable in this case.


Scapular stabilization was performed by attaching, to the spine of the scapula, a compound osteomuscular flap obtained from the contralateral trapezius and T11 and T12 hemispinal processes.

Term explanation

Scapular winging: Scapular malposition with its inferior angle prominent, which leads to impairment of shoulder function and pain.

Experiences and lessons

Contralateral trapezius compound osteomuscular flap is a technique that we consider not especially complex if performed by surgeons with experience in shoulder and periscapular surgery. Given the good result obtained with this dynamic technique for scapular stabilization when the scapular winging was due to dorsal scapular nerve injury, we have abandoned the static techniques that were carried out previously and that yielded worse results with higher associated morbidity.