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Scapular Winging / Surgery
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Scapular Winging / Surgery

I sustained a work related injury a year ago.  There was scapular winging present as well as labrum tear in the shoulder.  I had surgery to repair the labrum which was successful.  However, 2 EMG's have shown no long thoracic nerve activity and no serratus anterior muscle activity.  The shoulder is extremely weak and painful when used.  There have been three surgical opinions.  One, being to wait 18 months to see if the nerve re-intervenes, another being to surgically transfer pectoral minor tendons to the scapula for stabilization, and the third to just leave it alone and strengthen the surrounding muscles through physical therapy.

Has anyone seen or experienced a similar result to an injury?  If so, what was the treatment and success?

Thank You
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10 Comments Post a Comment
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Avatar_f_tn
Hi,
   How are you? Winging of scapula might occur due to damage to the long thoracic nerve and due to weak serratus anterior muscle and trapezius muscle. Damage to the nerve can be caused by a contusion or blunt trauma of the shoulder, traction of the neck.

It can present with difficulty in lifting weights, pain and limited shoulder elevation and winging of scapula. Muscle strengthening exercises for serratus anterior can be tried, if this does not help then surgery would be necessary.

The latest mode of surgical treatment is Scapulothoracic stabilisation for winging of the scapula using strips of autogenous fascia lata. The procedure stabilises the scapulothoracic articulation by using strips of autogenous fascia lata wrapped around the 4th, 6th and 7th ribs at least two, and preferably three, times. Satisfactory stability is achieved with no complications.

Discuss with your doctor and decide upon the treatment options.
All the best.


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Avatar_n_tn
Hi,

I had a lifting accident 6months ago and was diagnosed with Scapular Winging with Thoracic Nerve Damage. A surgeon suggested the Pectoral Transfer, however he coulddn't tell me if it would help, he just kept saying that it would keep the shoulder blade in place. I am doing research trying to find Doctors who are more familiar with the injury and it is extremely hard! I have found a few, one at NYU and the other in Houston TX. Keep looking don't just settle for a surgery and hope it will work. Good Luck
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Avatar_dr_m_tn
Only go for a surgery after you are explained all pros and cons.

There are expert orthopaedic surgeons all around the world and it is a matter of time when you find one who would have expirience in your case.

Take care!
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Avatar_f_tn
Hi there,

I am 38 yrs old female. I have also gone thru a similar experience. What is most frustrating is that the doctors appear not to take scapular winging seriously enough. For me, this disability has turned my world upside down. Reading the forums, I have realised that early detection and treatment has the best chances of a recovery. Heres hoping that I am not already too late..........

Let me recount my history-

In May 09, I was diagnosed with Pappillary Ca with multiple nodes (likely Ca) on left side of neck. Histopathology confirmed Pappillary Ca in thyroid and ONLY ONE neck node with Ca growth. I underwent complete thyroidectomy and left neck lymph nodes removal on 25 May 09 (a neck dissection was done). Post surgery, I have difficulty in moving my left arm upwards above shoulder level and am unable to do even simple tasks with this hand. Occasionally, there is shooting pain across the entire arm (which I understand could be due to pressure on thoracic nerves caused by a compensating shoulder). From 2 July onwards, I have been undergoing physiotherapy with IFT, stretching exercises and ultrasound. The physiotherapist says I have Scapular Dyskinesis (which is apparent to me too !) and I also have winged scapula of left shoulder. I read online that radical neck dissection has the added risk of damage to Long Thoracic Nerve and Spinal Accessory Nerve which in turn may cause winged scapula and shoulder dysfunction. However, when I consulted my operating surgeon, he confirmed that none of the above nerves have been damaged during surgery. However, after doing a considerable amount of research online, my conclusions are that it is most likely a Spinal Accessory Nerve Damage.

Even after 6 weeks of physiotherapy, there has been no improvement to my shoulder and left arm.

Should I go for EMG to confirm the nerve damage ?

Does the nerve heal itself ?

Is nerve graft a viable option and how much delay is acceptable ? I cant get it done before Nov 09 which would be 6 months from (likely) trauma.

In the meantime, should I start exercises for strengthening of muscles related to shoulder movement, as advised for scapular winging  ?  

Glad if someone can help here.

  
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Avatar_dr_m_tn
You should continue Physiotherapy.

You should also take a second opinion and have your EMG done to ascertain the damage of any nerves during the surgery. Your treatment is dependent on this diagnosis.

If you have to go for any surgical intervention you can plan it in advance and this would not be any emergency now but the diagnosis is important so that your future course of action becomes clear.

Take care!
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Avatar_f_tn
Yes, I would agree with you on getting an EMG done soonest. However, I am also skeptical of the depending on EMG test alone. This is also borne out by many opinions online which say that a clinical exam is best in such cases and EMG may be inconclusive. However, I am still hoping for the best.

I shall post the results after my EMG test.

Thanks again.  
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Avatar_dr_m_tn
EMG along with clinical correlation would be enough for proper diagnosis.
Based on that you can take the best route of action.

Take care!
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Avatar_n_tn
I have had winging scapula since 1995.. many MDs of all specialties mostly orthopeadics and nuerologist were clueless.. some said it's NOTHING, some said ah!! 15 years later "you are suffering from fading athelte syndrome!!- the more honest ones said "don't know what that scapular flailing was about!"

Disgusted I packed up and took a trip to Houston TX - from NYC... Dr. Nath
He was able to give a name to what I have suffered from as soon as took my short off!!
"you have winging scapula" he beamed !
I said "that was impossible... it's a very easy diagnosis to make and I have seen professors in highly reputable institutes in NYC for that past 15 years or so, and none were able to say winging scapula?... I'm highly doubtful" I said..

"let's confirm it with a EMG" Dr. Nath said, sent me the same day to a neurologist whom confirmed the diagnosis ! "CHRONIC LONG THORACIC PALSY!!"

I'm so happy now I know what have broken my neck and upper back literally for so many long years.. And will undergo a very simple less drastic "decompression procedure with Dr. Nath sometime Next month... However having had the winging for well over 15 years reduces my chances for simple nerve decompression and grafting success but still I have shot at it....
No tendin transfer no God awful scapulothoracic fusion etc of commonly accepted surgeries for this type of injury...

Dr. Nath Houston TX check him out..

Good Luck
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Avatar_m_tn
Did you have the surgery and was it a success?  My son is contemplating the same surgery.  His injury is 3 years old.
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Avatar_m_tn
Did you have the surgery and was it a success?  My son is contemplating the same surgery.  His injury is 3 years old.
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