An unusual case of scapula winging

Abstract

Acute or subacute unilateral winging of the scapula is a relatively uncommon cause of referral to a paediatric neurologist. Lesions such as neuralgic amyotrophy, long thoracic nerve injury, injury to the spinal accessory nerve causing loss of trapezius function, or weakness of all the scapula stabilisers caused by a primary muscle disorder are likely to be at the top of the list of differential diagnoses. Differentiation between these causes is usually relatively straightforward clinically. Damage to the long thoracic nerve can be differentiated from damage to the spinal accessory nerve as serratus anterior paralysis results in medial winging of the scapula with prominence of the vertebral border while trapezius paralysis causes lateral winging with downward rotation.