Relapsing and remitting scapular winging in a pediatric patient

Scapular winging (scapula alata) is a condition in which the scapula is rotated or displaced away from the body. The nature of this rotation or displacement can vary depending on the origin. There are many different causes of scapular winging including neurogenic, structural, muscular, and bursal (Frontera, Silver, Essentials of Physical Medicine and Rehabilitation. Philadelphia, Hanley and Belfus, 2002, pp 99-102). Structural causes are not frequently at the top of a clinician's differential diagnosis, but they must always be considered. We review the case of a teenage boy who developed intermittent scapular winging after tackling his brother in a backyard football game. His symptoms resolved and recurred over a period of 9 mos. Approximately 1 yr after the initial episode of winging, during a recurrence of his symptoms, a repeat shoulder x-ray was ordered. This study revealed a previously undetected osteochondroma. The patient subsequently underwent resection of the inferior angle of his right scapula and had complete resolution of his symptoms.