Treatment of scapular winging with modified Eden-Lange procedure in patient with pre-existing glenohumeral instability.

Primary scapular winging typically results from palsies of the serratus anterior, trapezius, and rhomboid muscles, which are caused by injury to the long thoracic nerve, spinal accessory nerve, and dorsal scapular nerve, respectively. The Eden-Lange procedure has become the surgical treatment of choice for scapular winging from trapezius palsy because other surgical procedures have high failure rates. In this procedure the levator scapulae muscle is transferred laterally to the scapular spine, and the rhomboid minor and major are both transferred laterally to the infraspinous fossa. The modification of this procedure by Bigliani and coworkers includes transfer of the levator scapulae muscle laterally to the scapular spine and lateral transfer of the rhomboid minor and major to the supraspinous and infraspinous fossae, respectively. The modified and standard Eden-Lange procedures have been shown to be successful in eliminating scapular winging by restoring the major actions of the trapezius muscle. Our review of the English-language literature revealed only one report of a patient who had an Eden-Lange procedure for scapular winging performed in the setting of glenohumeral instability. The purpose of this case report is to describe the use of the Eden-Lange procedure to treat a patient with scapular winging who had pre-existing multidirectional glenohumeral instability. The scapular winging