Published online Jan 18, 2019. doi: 10.5312/wjo.v10.i1.33
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
A 37-year-old male presented at 2 years after a right shoulder indirect injury, with right scapular winging, shoulder function impairment, and pain.
Physical examination of the patient suggested a lateral scapular winging. Definitive diagnosis was obtained after neurophysiological studies revealed an isolated dorsal scapular nerve injury.
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.
Electrophysiological studies showed an isolated dorsal scapular nerve lesion and proper function of other nerves, such as the long thoracic and spinal nerves.
Imaging studies (plain X-rays and magnetic resonance imaging) did not reveal any structural injury.
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.
Scapular winging: Scapular malposition with its inferior angle prominent, which leads to impairment of shoulder function and pain.
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.