Modified Eden-Lange procedure for trapezius paralysis with ipsilateral rotator cuff-tear arthropathy: a case report.

S capular winging typically results from serratus anterior dysfunction caused by injury to the long thoracic nerve or from trapezius dysfunction caused by injury to the spinal accessory nerve. The surgical treatment of choice for scapular winging caused by trapezius palsy is the Eden-Lange procedure. This procedure, as modified by Bigliani et al., includes transfer of the levator scapulae muscle laterally to the scapular spine, and lateral transfer of the rhomboid minor and major muscles to the supraspinatus and infraspinatus fossae, respectively. (In the ‘‘standard’’ procedure, the rhomboid minor and major muscles are both transferred to the infraspinatus fossa.) Many studies have documented the success of the modified and standard Eden-Lange procedures in eliminating scapular winging by restoring the major actions of a flaccid trapezius. However, to our knowledge, there are no reports of patients who had an Eden-Lange procedure performed in the setting of a concurrent chronic, large rotator cuff tear with glenohumeral arthritis (rotator cuff-tear arthropathy [RCTA]). We report on a patient with RCTA that evolved from minimally symptomatic to substantially symptomatic after he developed ipsilateral trapezius palsy as the result of a radical neck dissection for thyroid cancer; we describe the use of the Eden-Lange procedure in this patient with advanced rotator cuff disease. The patient was informed that data concerning his case would be submitted for publication, and he provided his consent.