A winged scapula (bb> scapula alata ) is a bone medical condition in which the shoulder blade, or shoulder bone, protrudes from one's back in an abnormal position. In rare conditions it has the potential to lead to limited functional activity in adjacent upper extremities. It can affect a person's ability to lift, pull, and push heavy objects. In some serious cases, the ability to perform daily activities such as changing one's clothes and washing one's hair may be hindered. The name of this condition comes from its appearance, a likeness as a wing, because the medial border of the scapula is sticking straight out from behind. Scapular winging has been observed to interfere with the scapulohumeral rhythm, contributing to decreased flexion and upper limb abduction, as well as considerable loss of power and source of pain. Winged scapula is considered normal posture in small children, but not in older children and adults.
Video Winged scapula
Signs and symptoms
The severity and appearance of the winged scapula vary by the individual as well as the affected muscles and/or nerves. Pain is not seen in every case. In a study of 13 individuals with facioscapulohumeral muscular dystrophy (FSH), no individual complained of pain. Fatigue, however, is a common characteristic and all have noted that there are limitations in their daily activities of life.
In most cases of winged scapula, damage to the anterior muscle serratus causes back deformation. The anterior serratus muscle attaches to the anterior aspect of the medial scapula (ie attached to the side closest to the spine and extends along the side of the scapula facing the ribs) and usually clamps the scapula against the ribs. When the anterior contract serratus, upward rotation, kidnapping, and the weaker elevation of the scapula occur, allowing the arm to be raised above the head. The long thoracic nerves invade the anterior serratus; Therefore, this nerve damage or collision can lead to weakening or muscle paralysis. If this happens, the scapula may be detached from the ribs, giving it a wing-like appearance on the upper back. This characteristic is especially noticeable when the affected person encourages resistance. The person may also have limited ability to lift their arms above their heads.
In facioscapulohumeral muscular dystrophy (FSH), the winged scapula is detected during glenohumeral joint contraction. In this movement, the glenohumeral joint is atypically and concurrently abducts and the shoulder blades are internally rotated.
Maps Winged scapula
Cause
The most common cause of scapular winging is anterior serratus paralysis. This is usually caused by damage (ie lesions) to long thoracic nerves. This nerve supplies the anterior serratus, located on the thorax side and acts to pull the scapula forward. Serratus anterior palsy is a dysfunction characteristic of trauma, non-traumatic, and idiopathic injury to the long thoracic nerves. The severe atrophy of the trapezius is seen by accidental damage to the spinal accessory nerve during lymph node biopsy in the neck. There are many ways in which a long thoracic nerve can sustain an injury-induced trauma. These include, but are not limited to, blunt trauma (eg blows to the neck or shoulders, sudden depression on the corsetal shoulders, unusual twisting and shoulders), repetitive motion (as observed in athletic activities such as weight lifting or sports involving throwing , excessive compression of the shoulder area with a strap (see rucksack palsy), and various household activities (eg gardening, digging, car washing, prolonged arm arbitrary sleep, head support for reading, etc.) Sometimes, other structures in the body such as subcytokoids or subscapular bursa that are inflamed and enlarged in the nerves.Clinical treatment may also cause injury to the long thoracic nerves (iatrogenesis of strong manipulation, mastectomy with axillary node dissection, spontaneous pneumothorax surgery, post-general anesthesia for various clinical reasons, and electric shock, among others).
Non-traumatic injuries induced in the long thoracic nerves include, but are not limited to, causes such as viral disease (eg influenza, tonsillitis-bronchitis, polio), allergic drug reactions, drug overdose, toxic exposure (eg herbicides, tetanus), C7 radiculopathy , and coarctation of the aorta.
Secondary to serratus anterior palsy, winged scapula also caused by trapezius and rhomboid palsy involving nerve accessory and dorsal scapular nerve, respectively.
Although the most common cause of winged scaps is that serratus anterior palsy, and trapezius and rhomboid palsy are less common, there are still other conditions that present the disease. These incidents include direct injury to the scapulothoracic muscle (ie trapezius and rhomboid muscle), and structural abnormalities (eg rotator cuff pathology, shoulder instability, etc.).
Diagnosis
In addition to history and examinations, it has been recommended to do radiographic projections of the neck, chest, shoulders, and chest lines to exclude structural abnormalities such as fractures or broken bones. Computed tomography (CT) or magnetic resonance imaging (MRI) is rarely indicated, but may be useful for excluding certain diagnoses if suspected, such as neurofibromatosis-related injuries, intervertebral disc interference, radiculopathy, and tumors.
Treatment
Because there are various classifications of winged scaps, there is also more than one type of treatment. Massage Therapy is an effective early approach to relaxing damaged muscles. In more severe cases, Physical Therapy can help by strengthening the affected muscles and surrounding areas. Physical therapy is a treatment option if there is a weakness of the glenohumeral joint muscles, but if the muscles do not contract clinically and the symptoms continue to weigh for more than 3-6 months, surgery may be the next option. Surgery with knife shoulder fixation to the ribs may be performed for those with an isolated winged wing. Some options are neurolysis (chordotomy), intercostal nerve transfer, scapulothoracic fusion, arthrodesis (scapulodesis), or scapulothoracic fixation without arthrodesis (scapulopexy).
Epidemiology
A winged scapula because the serratus anterior palsy is rare. In one report (Fardin et al.), There was an incidence of 15 cases of 7,000 patients seen in the electromyography laboratory. In other reports (Overpeck and Ghormley), there was only one case of the 38,500 patients observed at the Mayo Clinic. In another report (Remak), there are three diagnoses of anterior cerebral palsy along a series of 12,000 neurologic examinations.
Additional images
References
External links
- Illustrations in UCSD
Source of the article : Wikipedia
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