Isolated serratus anterior paralysis: a simple surgical procedure to reestablish scapulo-humeral dynamics

We present an original surgical technique for the treatment of an isolated paralysis of the serratus anterior muscle. We used this technique on six patients in whom nonoperative treatment failed. We fixed the inferior angle of the scapula at approximately 35 degrees of lateral position with synthetic ribbon: not to the rib behind the inferior scapular angle but to the next lower rib, usually the eighth. Therefore the scapula was not fixed directly to the pectoral cage, but over a loop of 2-2.5 cm in length. This is the crux of the procedure, because this "loose" fixation enables lateral movement of the scapula and complete painless arm elevation without scapular winging. The follow-up period was 1-7 years (mean, 4 years and 9 months). The clinical results were "excellent" for five patients and "very good" in one patient. We recommend this procedure for its excellent restoration of shoulder function.