EpistemisWinged scapula
Specialty: Musculoskeletal.
Why it occurs
- Injury or neuropathy due to traction of the long thoracic nerve (paralysis of the serratus anterior muscle)
- Spinal accessory nerve injury (paralysis of the trapezius muscle)
- Dorsal scapular nerve injury (paralysis of the rhomboid muscles)
- Fascioscapulohumeral muscular dystrophy (hereditary genetic origin)
- Penetrating or iatrogenic trauma during neck, thorax or axilla surgery
- Parsonage-Turner syndrome (brachial plexus neuritis)
Initial workup
Electromyography (EMG) of the serratus anterior, trapezius and rhomboid muscles, with motor conduction speeds | Magnetic resonance imaging of the shoulder girdle and brachial plexus | Chest x-ray to rule out pulmonary apical masses (Pancoast tumor) that compress nerve roots.
red flags
Sudden establishment of the scapular wing accompanied by burning shoulder pain of intolerable intensity that lasts for days or weeks, followed by selective muscle weakness and loss of active mobility to raise the arm above the head (suggests acute neuralgic amyotrophy).
Standard management
- Pregabalin — 75 mg every 12 hours orally, indicated in the phase of neuritic shoulder pain
- Prednisone — 30 mg once a day orally for 5 days with a rapid descending regimen, in the hyperacute phase of neuralgic amyotrophy
- Vitamin B complex (B1, B6, B12 orally as a neurotrophic adjuvant).
Educational guidance for study. It is NOT a prescription recommendation. The actual choice depends on the cause, the patient, and current guidelines.
- Area
- Musculoskeletal
- Listed causes
- 6
- Treatment options
- 3