Treatment of Pain Due to Winged Scapula with Spinal Cord Stimulation: A Case Report

BACKGROUND: Winged scapula (WS) is a protrusion of the scapula giving the appearance of a wing and can be due to either a musculoskeletal or neurological insult. Pain associated with WS is multifactorial, including myofascial and neuronal mechanisms, and may be difficult to treat. CASE REPORT: In a case of WS refractory to conservative management with physical therapy and medications and not a candidate for nerve repair, we treated the pain with a spinal cord stimulator. We report significant pain reduction and improvement in function with the procedure. CONCLUSION: This case suggests a role for neuromodulation in WS and requires further investigation. KEY WORDS: Winged scapula, spinal accessory nerve injury, spinal cord stimulation, neuromodulation

Winged scapula following axillary thoracotomy with long thoracic nerve preservation

Winged scapula is a rare condition caused by injuries to the long thoracic nerve (LTN) and accessory nerves. A 69-year-old man underwent surgery for right lung cancer. Video-assisted thoracic surgery was converted to axillary thoracotomy at the fourth intercostal space. The latissimus dorsi was protected, and the serratus anterior was divided on the side anterior to the LTN. Two months after discharge, he presented with difficulty in elevating his right arm and protrusion of the scapula from his back. Active forward flexion of the right shoulder was limited to 110° and abduction to 130°. He was diagnosed with winged scapula. After 6 months of occupational therapy, the symptoms improved. The LTN may have been overstretched or damaged by the electric scalpel. We recommend an increased awareness of the LTN, and to divide the serratus anterior at a site as far as possible from the LTN to avoid postoperative winged scapula.

Comparison of Shoulder Protraction Strength and Electromyography Activity of Serratus Anterior and Pectoralis Major in Subjects With or Without a Winged Scapula

Context:A winged scapula (WS) is associated with faulty posture caused by weakness of the serratus anterior (SA), which mainly acts as a scapular stabilizer muscle. It is important to accurately assess and train the SA muscle with a focus on scapula stabilizers during musculoskeletal rehabilitation of individuals with a WS.Objective:The authors examined muscle activity in the SA and pectoralis major (PM), upper trapezius (UT), and anterior deltoid (AD) as well as shoulder protraction strength during isometric shoulder protraction in individuals with and without a WS.Design:Cross-sectional study.Setting:A clinical biomechanics laboratory.Participants:In total, 27 males with no shoulder, neck, or upper-extremity pain participated.Main Outcome Measures:Isometric shoulder protraction strength was collected and surface electromyography used to measure the activity of the SA, PM, UT, and AD muscles and selective SA activity ratio to other shoulder muscles.Results:Electromyography activity of the SA muscle and shoulder protraction strength were significantly lower in individuals with a WS compared with the non-WS group (P < .05). In contrast, PM muscle activity and the PM-to-SA, UT-to-SA, and AD-to-SA ratios were significantly greater in individuals with a WS than in individuals without winging (P < .05).Conclusions:Isometric shoulder protraction for measuring SA strength in individuals with a WS should focus on isolated muscle activity of the SA, and SA strengthening exercises are important for individuals with a WS.