Scapulothoracic fusion for serratus anterior paralysis

Paralysis of the serratus anterior may lead to severe disability. Many surgical options are available, from soft-tissue procedures to scapulothoracic fusion. We report the results of 10 consecutive scapulothoracic fusions in 10 patients (7 men and 3 women) treated between 1980 and 1997. The mean age at surgery was 39 years (range, 22-57 years). Paralysis of the serratus anterior was isolated in five patients. One patient was lost to follow-up, and one patient died from an unrelated cause. Fusion was not achieved in three patients, two of whom had successful revision within 1 year postoperatively. One patient with an excellent result had a traumatic arthrodesis fracture and underwent successful revision. Results were assessed in 8 patients, including 3 who had reoperation. At a mean follow-up of 6.2 years (range, 1-15 years), 6 patients had a very good or good result and returned to manual labor. The mean active mobility was limited to 93 degrees in abduction and 101 degrees in forward elevation but was well tolerated. Two patients had a poor result because of nonunion and frozen shoulder, respectively. Scapulothoracic fusion may not be recommended as a primary procedure in the treatment of winging of the scapula due to serratus anterior paralysis. However, with the use of a careful technique, this method may be an alternative to muscle transfer, especially in patients in whom a previous soft-tissue procedure has failed or in patients with strenuous activities or combined muscular lesions.