Objective

Winging of the scapula has a variety of causes and a variable prognosis. It contributes to a disruption of the scapulohumeral rhythm with a decreased flexion and abduction of the upper extremity and a source of a considerable pain. This condition can affect the ability to perform activities of daily living. The most common cause of scapula winging is serratus anterior paralysis resulting from a lesion of the long thoracic nerve. The rupture of the muscle itself remains uncommon.

Observations

Six patients presented to the department of Physical Medicine and Rehabilitation complaining of shoulder pain and great difficulties performing activities of daily living. Five women and a man, with a mean age of 44 years (14 to 58). Physical examination found drooping and a moderate decrease of range of motion of the shoulder. A winged scapula was seen in all cases. A soft mass was palpable at the level of the lower half of the vertebral border of the left scapula in a woman. In this case, US and CT were performed, they showed a rupture of the serratus anterior along the vertebral border of the left scapula with a fatty degeneration of the muscle. In the other cases, ENMG was performed, showing partial denervation of the long thoracic nerve.

Discussion–conclusion

Although rare, a good number of cases of paralysis of the long thoracic nerve are reported in the literature, but only a few concerning the muscle injury. The early differentiation between a nerve injury and a muscle injury is important. In most cases, nerve paralysis was due to traction of the nerve. Isolated serratus anterior rupture is a rare condition that is secondary to direct trauma or overuse. In all cases, the most common symptoms reported by patients are inability to elevate the arm above the level of the shoulder, pain about the shoulder and varying degrees of stiffness of the shoulder. The most striking thing noted on physical examination was the winged scapula. Rehabilitative treatment with specific exercises allows reducing the scapula winging, decreasing pain, consistent with a good functional improvement.