Scapular Winging Surgical Treatment
The scapula has attached to it many important muscles that stabilize the shoulder joint and provide arm movement. Scapular winging is a dysfunction of the stabilizing muscles (the serratus anterior muscle or the trapezius muscle) caused by damage to the long thoracic nerve and related spinal nerves that results in the loss of shoulder strength and range of motion. The nerve damage that causes the paralysis can happen in a variety of ways which often makes diagnosis a challenge. The most common cause is dysfunction of the long thoracic nerve from spinal nerve injury.
In many cases, nonsurgical management with pain control and physical therapy may be attempted to relieve pain and dysfunction. Early treatment is important to prevent progression of the condition and complications. Most people with scapular winging who receive early treatment can fully recover. When this fails to improve function and reduce pain, surgery will be recommended.
A variety of corrective surgical procedures have evolved over the years to treat winged scapula. Each procedure has advantages and disadvantages. Some are indicated when patients fail to improve using nonsurgical management within six months. Others are indicated when nonsurgical treatment fails within one to two years.
The most common procedures are nerve and muscle transfers. Simply stated nerve and muscle transfer surgeries take some or all of a healthy muscle or nerve and move it to another part of the body to substitute for the damaged muscle or nerve.
Muscle transfer involves replacing the function of the paralyzed muscle by transferring a tendon from the pectoralis muscle to the lower part of the scapula which provides dynamic control and normalizes movement.
Static stabilization (called Scapulopexy) is another type of surgery where a wire it used to attach the scapula to a rib or a vertebra.
Another type of surgery involves fusion of the scapula directly to the ribs. It is called scapulothoracic arthrodesis. The disadvantage of this procedure is that the patient may lose the ability to lift the arm, and it can cause permanent bone fractures and lung problems.
Decompression and Microneurolysis of the thoracic nerve or a spinal accessory nerve. Decompression releases pressure on the nerve by removing part of the damaged muscle and scar tissue around the nerve. This allows the nerve to function correctly. This is a very successful surgery so long as the nerve has not suffered with winged scapula for a long period. Dr. Johnston will assess nerve health and function before, during and after surgery.
This is a partial list of surgical procedures. Dr. Peter Johnston is an expert in complex surgeries of the shoulder; and exactly who you want to diagnose and treat scapular winging. He manages complex shoulder problems with both open and arthroscopic surgery using evidence - based, cutting edge techniques. Contact Dr. Johnston at Maryland Shoulder and Elbow in Leonardtown, Maryland and White Plains, Maryland.
