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Related Experiment Videos

Serratus anterior dysfunction. Recognition and treatment

J J Warner1, R A Navarro

  • 1Harvard Shoulder Service, Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, USA.

Clinical Orthopaedics and Related Research
|May 19, 1998
PubMed
Summary

Scapular winging diagnosis can be challenging, leading to ineffective treatments. A modified pectoralis major transfer effectively resolved chronic winging in most patients, improving function and cosmesis.

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Area of Science:

  • Orthopedic Surgery
  • Neuromuscular Disorders
  • Biomedical Engineering

Background:

  • Scapular winging diagnosis is often difficult, potentially leading to treatment errors and patient morbidity.
  • Serratus anterior dysfunction is a common cause of scapular winging, typically confirmed by electrical evidence of long thoracic nerve injury.
  • Traditional surgical treatment involves pectoralis major tendon transfer, which can result in poor cosmetic outcomes and donor site morbidity.

Purpose of the Study:

  • To evaluate the efficacy of a modified pectoralis major transfer with autogenous tendon augmentation for chronic scapulothoracic winging.
  • To address diagnostic challenges and treatment failures in patients with refractory scapular winging.
  • To improve functional outcomes and cosmetic results in patients with scapular winging.

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Main Methods:

  • Retrospective review of eight patients with chronic scapulothoracic winging refractory to conservative treatment.
  • All patients underwent a modified pectoralis major transfer augmented with semitendinosus and gracilis autografts via two small incisions.
  • Pre- and post-operative assessments included evaluation of winging resolution, functional improvement, and cosmetic satisfaction.

Main Results:

  • Five of the eight patients initially received incorrect diagnoses, undergoing multiple ineffective surgical procedures.
  • Despite only five patients showing electromyographic evidence of long thoracic nerve palsy, all presented with profound scapular winging.
  • Seven of the eight patients experienced resolution of scapular winging, improved function, and satisfactory cosmesis after the modified procedure; one patient developed a postoperative infection.

Conclusions:

  • A modified pectoralis major transfer with autogenous tendon augmentation offers an effective solution for chronic scapular winging, particularly in cases with diagnostic ambiguity or previous treatment failures.
  • This technique provides improved functional and cosmetic outcomes compared to traditional methods, with minimal invasiveness.
  • Accurate diagnosis and timely surgical intervention are crucial for managing scapular winging and preventing long-term morbidity.