Winged Scapula

Winging of the scapula due to long thoracic nerve injury is a common diagnosis and can become a significant functional problem. The compensatory muscle activity required to maintain shoulder stability in the absence of serratus anterior function is associated with pain, spasm, and tendonitis around the shoulder joint. The long thoracic nerve itself is small in diameter and fragile-appearing, making it susceptible to injury. Perhaps the most important anatomic feature associated with injury is its course through the fibers of the middle scalene muscle. Several patients sustain an insult to the nerve through direct compression by the middle scalene muscle while weight lifting or exercising. Other patients sustain a direct extrinsic crush to the nerve. 


Long Thoracic Nerve Decompression 

  • Compression of the nerve is released by a partial resection of the middle scalene muscle.
  • Scar tissue that may have built up around the nerve itself is surgically removed to further relieve pressure on the nerve. 
  • The forces pinching the nerve are surgically removed, and like a garden hose that has been unkinked, the flow of power to the serratus anterior improves and results in return of function and shoulder stability. 

Recovery and Results

  • Stay in Houston is 2-3 days.
  • Return to work in 1-2 weeks (although heavy lifting and weight bearing activities are off-limits for some months and depending on the individual injury). 
  • Function returns immediately in some cases and over a few months in others. 
  • Therapy will be prescribed to help rebuild the serratus anterior and rebalance the shoulder muscles.
  • 95% of patients have increased                                                                                movement and decreased winging after surgery.

METHODS OF EVALUATION

  • Evaluation in Houston office (no charge for initial consulatation)
  • Video evaluation: submit all medical records to the office with video 
  • Outreach Event evaluation for in person evaluation free of charge( must bring documentation if required for condition)

Video Evaluation: If you do not locate a outreach even near your town you visit Dr. Nath’s website and send us a contact form that describes your injury briefly. In order for Dr. Nath to evaluate please send a video to our office showing the following motions. Please have someone film you from behind without a shirt, so that the shoulder blade is visible.


Movement 1: Raise your arms straight in front of you at a right angle to your body and then as high as possible. Return them to resting position in the same way.


Movement 2: Raise your arms to the side through a “T position” and then as high as possible. Return them to the resting position through the same “T” position.


Movement series 3: Facing a wall, raise your arms to the front at a right angle to your body. Continue to as high as possible above your head (as in movement 1). Take them down to the side through a “T” position (as in movement 2). Without bringing your arms completely down, return them to the front. Then, perform a press-up against a wall.


Visit our website  for video upload: http://www.drnathbrachialplexus.com/en/files/add.php


We also need to see a recent EMG report (nerve conduction study). This testing may be done by a neurologist in your area. If you have not had an EMG performed, please refer to your primary care physician or general practitioner for a reputable neurologist in your area. The EMG should include testing for the serratus anterior, biceps, supraspinatus, infraspinatus, and the deltoid muscles. Please send all medical records with the EMG Report.