Adult with brachial plexus birth injury and scapular winging: case report of successful treatment using decompression surgery

Paulius Dobrovolskis1*, Kristina Reimerytė1, Mindaugas Minderis2

1Vilnius University, Faculty of Medicine, Vilnius, Lithuania

2Vilnius University Hospital Santaros Klinikos, Centre of Plastic and Reconstructive Surgery. Vilnius, Lithuania


Introduction. Winged scapula is a rare condition limiting upper limb function. It is often caused by a weakness of m. serratus anterior, m. trapezius and/or mm. rhomboidei due to an injured nerve or a brachial plexus. The usual surgical treatment is reconstruction of injured nerves or tendon transfer surgery.

Case report. The 25-year-old female presented with a lifelong winged scapula and impaired abduction of her right arm. As a newborn, she was diagnosed with birth trauma and paralysis of the right arm, which resolved during infancy. Visual investigation revealed a winged and laterally displaced right scapula, while active abduction of the right arm was limited. There was a weakness of mm. rhomboidei and m. trapezius dex. The hypotrophy of affected muscles was confirmed by magnetic resonance imaging. There was a clinical suspicion of compressive plexopathy, therefore a decision to perform surgical decompression of the brachial plexus was made. After the surgery, patient was followed-up: thirty months after the surgery the active range of motion of the shoulder was normal, but the previous deformity remained present.

Conclusions. Winged scapula is caused by a weakness of at least one of the muscles that stabilize the scapula. The exact cause of that weakness is usually unknown. In the treatment of this case of winged scapula, decompression of brachial plexus was effective in increasing the range of motion of the shoulder joint. Winged scapula might be an atypical manifestation of a thoracic outlet syndrome.

Keywords: thoracic outlet syndrome; winged scapula; obstetric palsy.

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