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Chest tube insertion is generally considered a safe procedure. We describe a patient who developed winging of the scapula following chest tube insertion. This complication has not been documented before.
An example of stress fracture of the coracoid process of the scapula in a trapshooter is presented. The value of the axillary view of tbe shoulder is emphasized.
Snapping scapula is a painful crepitus of the scapulothoracic articulation. This crepitus is a grinding or snapping noise with scapulothoracic motion that may or may not accompany pain. This condition is commonly seen in overhead-throwing athletes. Treatment of patients with this syndrome begins with nonoperative methods; when nonoperative treatment fails, several surgical options exist. This article will discuss both nonoperative and operative management of this common shoulder condition.
Of forty-six patients with congenital elevation of the scapula, diastematomyelia was confirmed in four and was probably present in five others. Possible reasons for the previously unsuspected association are presented.
We have used a modified technique in five patients to correct winging of the scapula caused by injury to the brachial plexus or the long thoracic nerve during transaxillary resection of the first rib. The procedure stabilises the scapulothoracic articulation by using strips of autogenous fascia lata wrapped around the 4th, 6th and 7th ribs at least two, and preferably three, times. The mean age of the patients at the time of operation was 38 years (26 to 47) and the mean follow-up six years and four months (three years and three months to 11 years). Satisfactory stability was achieved in all patients with considerable improvement in shoulder function. There were no complications.
BACKGROUND: Internal fixation of one or both bones is the recommended treatment for floating shoulder injuries (ipsilateral fractures of the scapula and clavicle). Perceived risks of nonoperative treatment include abduction weakness, decreased range of motion, chronic pain, malunion, and nonunion. None of these problems, however, have been confirmed by clinical studies. The purpose of this retrospective study was to analyze the clinical and radiographic results of nonoperative treatment of floating shoulder injuries. METHODS: Twenty patients with a floating shoulder injury were treated with either a sling or a shoulder immobilizer. Eleven clavicular fractures were displaced ten millimeters or more, and five scapular fractures were displaced more than five millimeters. Physical therapy was begun three days to two weeks after the injury. Patients were evaluated with three separate scoring systems: those of Herscovici et al., Rowe, and Constant and Murley. Shoulder abduction and flexion were measured, and abduction strength was evaluated by clinical examination and comparison with the uninjured extremity. The duration of follow-up averaged twenty-eight months (range, nine to seventy-nine months). RESULTS: Nineteen of the twenty pairs of fractures united uneventfully. One clavicular nonunion occurred secondary to segmental bone loss from a gunshot wound. On the basis of the Herscovici rating system, seventeen patients had an excellent result and three had a good result. According to the Rowe system, eighteen patients had an excellent result, one had a good result, and one had a fair result. The average Rowe score was 95. The average Constant score was 96. In all twenty patients, the strength of the injured extremity was equal to that of the uninjured extremity. Eighteen patients had a full, symmetrical range of shoulder motion, one lost 15 degrees of flexion, and one lost 20 degrees of abduction. CONCLUSIONS: Nonoperative treatment of floating shoulder injuries, especially those with less than five millimeters of fracture displacement, can achieve satisfactory results that are probably equal or superior to those reported after operative treatment, without the risk of operative complications.
The scapular musculature is often neglected in designing a rehabilitation protocol for the shoulder. Weakness of the scapular stabilizers and resultant altered biomechanics could result in: 1) abnormal stresses to the anterior capsular structures of the shoulder, 2) increased possibility of rotator cuff compression, and 3) decreased performance. This article presents known facts about the biomechanics of the scapula and surrounding muscles and suggests methods for evaluation of scapular muscle weakness. Exercise techniques to maximally strengthen the scapular musculature are also described. As our ability to document strength of these muscles improves, we will be able to determine the effect of scapular strengthening on improving symptoms related to impingement and instability. Scapular strengthening exercises are usually nonstressful to the rotator cuff and are easily implemented into a rehabilitation program for the shoulder.
Three children with winged scapula due to subscapular osteochondromata are reported. One case with multiple osteochondromatosis had two subscapular lesions. After resection, our cases became normal immediately and had no recurrence.
We experienced a rare case of winged scapula that was caused by the rupture of the rhomboideus major and the lower trapezius muscles without any nerve injury in a 12 yr old female after she had carried a heavy backpack. Electrodiagnostic study revealed that the onset latencies, amplitudes and conduction velocities were normal in the long thoracic nerve, the spinal accessory nerve and the dorsal scapular nerve. The needle EMG findings were normal as well. An explorative operation was performed and the rupture of the rhomboideus major and lower trapezius muscles was detected. Direct surgical repair of the ruptured muscle was carried out and the deformity was corrected. The anatomical and functional restoration was satisfactorily accomplished.
A lateral approach to the shoulder joint via a longitudinal myotomy of the supraspinatus muscle was used in the surgical treatment of four cases involving avulsion fractures of the supraglenoid tubercle of the scapula. This approach was developed using cadaver specimens and was compared to previously reported approaches to the supraglenoid tubercle. This approach gave excellent, visualized exposure and permitted accurate reduction and fixation for this type of fracture. Excellent results were achieved in four clinical cases.
As osteosynthesis of fractures ofthe scapula in the dog and cat have so far been almost completely ignored, personally observed cases are reported including 14 treated by osteosynthesis and one by ostectomy.
This article reports a case of a 38-year-old woman suffering from erythema infectiosum (slap-cheek disease) complicated by arthritis and severe brachial plexus neuritis resulting in scapula winging.
Fractures may be observed in the scapulae of those pigs intended for slaughter, which have undergone electrical stunning. These fractures may be classified into three types. That type in which the fracture is localized in the glenoid cavity is the most injurious one as it is accompanied by haemorrhage and therefore will result in loss of meat. This is liable to cause injuries to the employees engaged in boning out. It was concluded from an inquiry as well as from experimental exposure to stress that fractures of the shoulder are due to the marked tonic contractions of mainly antagonistic muscles, resulting in excessive strain on the shoulder blade and its joints. It is a striking fact that fractures of the shoulder were not observed in pigs stunned electrically while they were in a restraining apparatus.
Osteoid osteoma in the base of the coracoid process of the scapula is very rare and diagnosis and treatment often is delayed. A lesion in this atypical location may seem surgically unreachable. This report is of a case of osteoid osteoma in the base of coracoid process in a 14-year-old female. The lesion had been diagnosed as a nontumorous condition and overlooked for four years. Computed tomography and magnetic resonance imaging revealed a nidus in the base of the coracoid process. The en bloc excision of the osteoid osteoma was managed by an anterior approach using an osteotomy of the coracoid process. A 12-month follow-up examination revealed no symptoms and computed tomography showed bone healing with no recurrence of the tumor.
A twenty-three-year-old male patient developed winging of the scapula after a combined nerve injury following a gun-shot. Scapulothoracic arthrodesis was considered in order to relieve the patient's complaints. Stabilization of the scapulothoracic joint was performed using a hitherto undescribed method with the use of a cable-grip system (Doll-Miles Trochanter&Cable Grip System-Howmedica). After a seven-month follow-up, union was accomplished without any malposition; the patient's complaint of pain disappeared, shoulder imbalance was restored with an improvement in shoulder abduction from 70 degrees to 100 degrees and in flexion from 110 degrees to 160 degrees.
Tuberculosis (TB) of the scapula is an extremely rare presentation of osteoarticular tuberculosis. In a tuberculosis endemic setting with a rising burden of acquired immunodeficiency syndrome, this rare presentation may become more frequent. The common presentation is with longstanding Complaints of pain and swelling in the shoulder region, typically in young adults. Classic radiographic features include a well defined radiolucent lesion with minimal sequesteration. The erythrocyte sedimentation rate is usually elevated and initially these patients are frequently mis-diagnosed and thus a high index of clinical suspicion is required. Medical therapy with antituberculous drugs is the standard modality of treatment. This case serves to higlight the salient features of scapular TB.
We introduced a new scapulothoracic arthrodesis technique in 6 patients (2 bilaterally) with winging of the scapula due to facioscapulohumeral muscular dystrophy from 1984 to 2000. The procedure involved a combination of plating and wiring techniques. The indications were symptomatic winging, limitation of active shoulder motion, pain, and impaired daily living activity. Our objective was to improve motion, strength, and performance of activities of daily living, as well as to provide pain relief. As a result of the technique, active motion improved in all patients, flexion improved from 64 degrees to 104 degrees, and abduction improved from 67.5 degrees to 112.5 degrees. The only complication was a hemothorax in a bilateral case that was easily treated. The length of follow-up averaged 32.5 months (14-55 months), and results did not change with time.
A case of a comminuted fracture of the scapula, following electric shock, is reported. Recovery was uneventful, and normal function returned after conservative treatment.