The disabled throwing shoulder: spectrum of pathology Part III: The SICK scapula, scapular dyskinesis, the kinetic chain, and rehabilitation.
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We describe two patients with neuraligic amyotrophia of the shoulder: a 15 year old boy and a girl which was 6 years old at the time of primary manifestation. Mostly adolescent patients are concerned. Beginning is acute, the etiology unclear. The patients initially feel intensive pain in one shoulder, which typically is followed by motorical weekness of the proximal upper arm and the shoulder. Nearly all patients reach a restitutio ad integrum after some months. As differential diagnosis we have to take into account the facio-scapulo-humeral muscular dystrophy, pareses of single or various nerves or a neurititis of infectious origin.
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Fifteen patients (9 male and 6 female) with a mean age of 32.8 years (range, 17-44 years) were examined at a mean follow-up of 64 months (range, 33-118 months) after undergoing pectoralis major transfer with a fascia lata autograft for scapular winging. Ten patients were treated as part of a worker's compensation claim. Twelve reported that they would undergo the procedure again. The mean Rowe score was 66 (range, 41-92), the mean Constant-Murley score was 74 (range, 32-95), the mean Simple Shoulder Test score was 8 of 12 positive responses, and the mean American Shoulder and Elbow Surgeons score was 63 (range, 10-87). Pain decreased in 11 patients, whereas function improved in 10 patients. According to the Rowe scoring system, the results were excellent in 2 patients, good in 5, fair in 4, and poor in 4. Better results occur in patients attaining at least 60 degrees of external rotation postoperatively. Although complete relief of pain and full function were not always achieved, most patients returned to their preoperative level of activity with minor adaptations.
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