Disclosures: Nicholas A. Wilcox, MD: Nothing to disclose

Case Description: 1) A 64-year-old male underwent aortic arch dissection repair 3 months ago and now presented with right shoulder pain and weakness (low-hanging and protracted right shoulder). Active abduction range was 80° with neck ROM lacking 10° to left. Shoulder abduction/flexion strength was 4/5. 2) A 51-year-old male underwent resection of dermatofibrosarcoma and trapezius pedicle flap followed by reconstruction, and now presented with left shoulder pain and arm weakness (fatiguability of shoulder abductors and a low-hanging, protracted left shoulder). 3) A 60-year-old female who had two cervical fusions (C4-7) in 1998 and now presented with chronic neck and interscapular pain (> 10 years), and left prominent medial scapula on eccentric abduction.

Setting: An outpatient pain clinic

Patient: Three patients with neck or shoulder pain.

Assessment/Results: 1) EMG 6 weeks prior to presentation revealed right accessory nerve neurapraxic injury, explaining upper trap and SCM weakness. This was likely an intraoperative traction injury to the nerve. 2) EMG 1 month after presentation showed an incomplete neuropathy of the left accessory nerve. This neurapraxia could be secondary to his radiation, traction injury or post-op changes. 3) Winging with eccentric abduction is a classic sign of serratus anterior weakness, which is likely related to her left C7-8 radiculopathy as evidenced by EMG/NCS. Multiple compensatory abnormalities may also contribute to her symptoms.

Discussion: Defined by abnormal prominence of the scapular borders, scapular winging has significant functional implications for neck or shoulder pain. Patients can present with weakness, pain or both. The most common cause of primary scapular winging is damage to the long thoracic nerve leading to serratus anterior weakness. However, the above cases suggest that this pathologic process can be multifactorial. Addressing the etiology of scapular winging will help relieve symptoms.

Conclusion: Evaluation of the scapulae function should be routinely performed to assess neck or shoulder pain.

Level of Evidence: Level IV

« Back to AAPM&R Annual Assembly 2019

PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/scapular-winging-an-often-overlooked-functional-implication-in-neck-or-shoulder-pain-case-series/