Scapular Winging: A Great Masquerader of Shoulder Disorders

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Scapular Winging: A Great Masquerader of Shoulder Disorders by Umasuthan Srikumaran, Jessica H. Wells, Michael T. Freehill, Eric W. Tan, Laurence D. Higgins, and Jon J.P. Warner J Bone Joint Surg Am Volume 96(14):e122 July 16, 2014 ©2014 by The Journal of Bone and Joint Surgery, Inc.

Figs. 1-A and 1-B Clinical example of a patient with serratus anterior palsy and medial winging. Figs. 1-A and 1-B Clinical example of a patient with serratus anterior palsy and medial winging. Fig. 1-A With forward elevation, superior translation of the scapula with medial winging of the inferior angle is noted in the right shoulder. Fig. 1-B This medial winging becomes more prominent with resisted forward elevation. Umasuthan Srikumaran et al. J Bone Joint Surg Am 2014;96:e122 ©2014 by The Journal of Bone and Joint Surgery, Inc.

The shoulder “droops” down (inferior translation of the scapula) and is positioned more laterally compared with the normal left side. The shoulder “droops” down (inferior translation of the scapula) and is positioned more laterally compared with the normal left side. Umasuthan Srikumaran et al. J Bone Joint Surg Am 2014;96:e122 ©2014 by The Journal of Bone and Joint Surgery, Inc.

The lateral winging is more prominent with attempted forward elevation of the shoulder. Umasuthan Srikumaran et al. J Bone Joint Surg Am 2014;96:e122 ©2014 by The Journal of Bone and Joint Surgery, Inc.

Umasuthan Srikumaran et al. J Bone Joint Surg Am 2014;96:e122 ©2014 by The Journal of Bone and Joint Surgery, Inc.

Umasuthan Srikumaran et al. J Bone Joint Surg Am 2014;96:e122 ©2014 by The Journal of Bone and Joint Surgery, Inc.

Umasuthan Srikumaran et al. J Bone Joint Surg Am 2014;96:e122 ©2014 by The Journal of Bone and Joint Surgery, Inc.

Umasuthan Srikumaran et al. J Bone Joint Surg Am 2014;96:e122 ©2014 by The Journal of Bone and Joint Surgery, Inc.

Umasuthan Srikumaran et al. J Bone Joint Surg Am 2014;96:e122 ©2014 by The Journal of Bone and Joint Surgery, Inc.

Umasuthan Srikumaran et al. J Bone Joint Surg Am 2014;96:e122 ©2014 by The Journal of Bone and Joint Surgery, Inc.

Umasuthan Srikumaran et al. J Bone Joint Surg Am 2014;96:e122 ©2014 by The Journal of Bone and Joint Surgery, Inc.

Umasuthan Srikumaran et al. J Bone Joint Surg Am 2014;96:e122 ©2014 by The Journal of Bone and Joint Surgery, Inc.

Umasuthan Srikumaran et al. J Bone Joint Surg Am 2014;96:e122 ©2014 by The Journal of Bone and Joint Surgery, Inc.

Umasuthan Srikumaran et al. J Bone Joint Surg Am 2014;96:e122 ©2014 by The Journal of Bone and Joint Surgery, Inc.

Umasuthan Srikumaran et al. J Bone Joint Surg Am 2014;96:e122 ©2014 by The Journal of Bone and Joint Surgery, Inc.

Scapular motion (arrows) with serratus anterior palsy leads to downward tilting of the acromion and inability of the greater tuberosity to clear the acromion during elevation. Scapular motion (arrows) with serratus anterior palsy leads to downward tilting of the acromion and inability of the greater tuberosity to clear the acromion during elevation. Reproduced, with permission from: Kuhn JE, Plancher KD, Hawkins RJ. Scapular winging. J Am Acad Orthop Surg. 1995 Nov;3(6):319-25. Umasuthan Srikumaran et al. J Bone Joint Surg Am 2014;96:e122 ©2014 by The Journal of Bone and Joint Surgery, Inc.

An algorithm for approaching the treatment of trapezius palsy. An algorithm for approaching the treatment of trapezius palsy. Reproduced from: Teboul F, Bizot P, Kakkar R, Sedel L. Surgical management of trapezius palsy. J Bone Joint Surg Am. 2004;86(9):1884-90. Umasuthan Srikumaran et al. J Bone Joint Surg Am 2014;96:e122 ©2014 by The Journal of Bone and Joint Surgery, Inc.