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Examination of Pediatric Shoulder
Published in Nirmal Raj Gopinathan, Clinical Orthopedic Examination of a Child, 2021
Winging of the scapula is a condition in which the scapula’s medial border moves away from the posterior chest wall. Dynamic winging is seen in injury to the long thoracic nerve with serratus anterior weakness and spinal accessory nerve palsy causing trapezius weakness. Less commonly, involvement of the rhomboids, multidirectional instability, voluntary action, or a protective reflex in shoulder pain results in reversal of scapulohumeral rhythm. Spinal accessory nerve palsy and trapezius muscle deficiency cause the scapula to move laterally, with the inferior angle rotated laterally (occurs before 90° abduction, and there is little winging on forward flexion). Long thoracic nerve palsy causes the scapula to elevate and move medially, with the inferior angle rotating medially on abduction and forward flexion. Dynamic winging is also seen with painful shoulder pathologies leading to reverse origin-insertion of the rotator cuff muscles so that instead of the humerus, the scapula starts to move. Static winging is usually caused by a structural deformity of the scapula, clavicle, spine, or ribs.
Principles of thoracic surgery
Published in Mark Davenport, James D. Geiger, Nigel J. Hall, Steven S. Rothenberg, Operative Pediatric Surgery, 2020
Shaun M. Kunisaki, James D. Geiger
Early complications include intercostal vessel bleeding and wound infection. Damage to the long thoracic nerve results in winging of the scapula. If the incision is too close to the inferior angle of the scapula, adhesions to the scapula may develop, leading to limited shoulder abduction and elevation. Overzealous reapproximation on the ribs can lead to chest wall deformities and scoliosis. In infants, all follow-up evaluations should include an examination of the spine to screen for scoliosis.
Scapula and parascapular flaps
Published in John Dudley Langdon, Mohan Francis Patel, Robert Andrew Ord, Peter Brennan, Operative Oral and Maxillofacial Surgery, 2017
Long thoracic nerve injury. Injury to this nerve is uncommon and usually occurs with overzealous dissection deep to teres major and latissimus dorsi where it passes to innervate serratus anterior resulting in scapula winging.
Scapula winging secondary to prone plank exercise: a case report
Published in International Journal of Neuroscience, 2023
Şükran Güzel, Selin Ozen, Seyhan Sözay
The aetiology of long thoracic nerve injury may include trauma to the nerve, surgical intervention, physical activity, brachial neuritis, electrical injuries, neural foramen anomalies, vaccinations, infections, toxic causes, radiation, and nerve compression [9]. The long thoracic nerve courses a long superficial route passing below the clavicle, under the first or second rib, and then follows the thoracic cage to its insertion into the serratus anterior muscle. The superficial nature of the long thoracic nerve may leave it exposed to traumatic injury [10]. Although it is difficult to establish a consensus on where the nerve lesion typically occurs, one mechanism may be a traction injury that occurs when the long thoracic nerve exits the surrounding fascial sheath along the thoracic wall [11].
Neuralgic amyotrophy detected by magnetic resonance neurography: subclinical, bilateral, and multifocal brachial plexus involvement
Published in Neurological Research, 2023
Claudia Cejas, José M. Pastor Rueda, Jairo Hernández Pinzón, Nadia Stefanoff, Fabio Barroso
Of the 14 cases analyzed, most patients were men (78.6%), with a mean age at presentation of 43.1 years (range 18–76 years) and the most common onset symptom was pain. Although paresis was the debut symptom in two cases, both patients later developed pain during follow-up. Predisposing factors such as infection, exercise or trauma were identified in six cases. Classic NA phenotype was frequent, but only four patients presented the complete form, and an additional four patients presented non-classic, sequential, and bilateral forms (Table 1– supplementary material). When clinical and electrophysiological features were assessed, superior and middle brachial plexus trunks were frequently affected. The long thoracic nerve was affected in about one-third of patients (Table 2– supplementary material).
Notalgia paresthetica: treatment review and algorithmic approach
Published in Journal of Dermatological Treatment, 2020
Ahmed Ansari, David Weinstein, Naveed Sami
Physical treatments aim to reduce irritation and disruption of the cutaneous sensory nerves by targeting muscular dysfunction and instability. One case series analyzed the efficacy of transcutaneous EMS – which elicits muscle contraction via electrical impulses – in treating four patients with underlying long thoracic nerve injury causing scapular instability and NP. EMS was applied directly to the serratus anterior for a total of 15 min daily (alternating 30 s on and then off). All patients reported symptomatic improvement, but discontinuation resulted in a return to baseline. The treatment was well tolerated. The authors hypothesize that EMS causes contraction of the overstretched muscle fibers that are supporting the denervated scapula. Thus, tension on the surrounding nerve fibers is relieved, resulting in symptomatic relief (28).