Medial scapular winging following trauma--a case report.

© 2015 The Author(s). Published by Taylor & Francis on behalf of the Nordic Orthopedic Federation. This is an Open Access article distributed under the terms of the Creative Commons Attribution-Non-Commercial License (https://creativecommons.org/licenses/by-nc/3.0) DOI 10.3109/17453674.2015.1117370 A 51-year-old right-handed man sustained a direct injury to his right shoulder, falling from a staircase and hitting the edge of the step with the inferior angle of his right scapula. He was initially treated with muscle strengthening and range-ofmotion exercises for several weeks. Although pain and swelling at the lower edge of his right scapula had receded, with full range of motion, he had persistent shoulder weakness. Subsequently, the patient complained of winging of the right scapula, which he experienced as being pushed out of his chair by the protruding scapula during active forward flexion of the arm in a seated position, e.g. when driving a car. The patient was seen for the first time in our outpatient clinic 2 months after the injury. On initial examination, medial winging of the right scapula was noted, which was aggravated during forward flexion of the arm against resistance (Figure 1). There was a slight tenderness over the inferior medial border of the scapula. The patient had a full active range of motion in the glenohumeral joint without signs of cuff pathology. However, he had a disturbed scapulothoracic rhythm. Plain radiographs did not show any abnormalities. Injury to the long thoracic nerve was suspected, but was excluded by neurophysiological studies. An ultrasound investigation showed a defect of the serratus anterior muscle at the insertion on the scapula. Magnetic resonance imaging revealed a small hematoma at the anatomic insertion region of the serratus anterior muscle on the scapula, with retraction and incipient atrophy of the muscle (Figure 2). A computed tomography with 3D reconstruction showed a small osseous fragment of the inferior angle of the scapula with dislocation in the direction of the retracted serratus anterior muscle (Figure 3).