Abstract
IntroductionAlthough palsy of the long thoracic nerve is the classical pathogenesis of winging scapula, it may also be caused by osteochondroma. This rare etiopathology has previously been described in pediatric patients, but it is seldom observed in adults.Case presentationWe describe three cases of static scapular winging with pain on movement.Case 1 is a Caucasian woman aged 35 years with a wing-like prominence of the medial margin of her right scapula due to an osteochondroma originating from the ventral omoplate. Histopathological evaluation after surgical resection confirmed the diagnosis. The postoperative course was unremarkable without signs of recurrence on examination at 2 years.Case 2 is a Caucasian woman aged 39 years with painful scapula alata and neuralgic pain projected along the left ribcage caused by an osteochondroma of the left scapula with contact to the 2nd and 3rd rib. Following surgical resection, the neuropathic pain continued, demanding neurolysis of the 3rd and 4th intercostal nerve after 8 months. The patient was free of symptoms 2 years after neurolysis.Case 3 is a Caucasian woman aged 48 years with scapular winging due to a large exostosis of the left ventral scapular surface with a broad cartilaginous cap and a large pseudobursa. Following exclusion of malignancy by an incisional biopsy, exostosis and pseudobursa were resected. The patient had an unremarkable postoperative course without signs of recurrence 1 year postoperatively.Based on these cases, we developed an algorithm for the diagnostic evaluation and therapeutic management of scapula alata due to osteochondroma.ConclusionsOrthopedic surgeons should be aware of this uncommon condition in the differential diagnosis of winged scapula not only in children, but also in adult patients.
Highlights
Palsy of the long thoracic nerve is the classical pathogenesis of winging scapula, it may be caused by osteochondroma
Scapula alata caused by serratus anterior palsy with insufficiency of retaining the omoplate to the thorax is the prototype of dynamic winging [2]
We report on three cases of static scapular winging caused by osteochondroma in adult patients between 35 and 48 years of age (Table 1)
Summary
Winging of the scapula (scapula alata) is defined as the prominence of the medial (vertebral) border of the scapula. We report on three cases of static scapular winging caused by osteochondroma in adult patients between 35 and 48 years of age (Table 1). These patients are presented to illustrate the clinical course and radiographic findings for this rare condition. On examination after 2 years, the patient was doing well, free of pain, the wing-like prominence of her right scapula had disappeared and no signs of a recurrence were present on radiographs. On clinical examination, her left scapula showed a winglike prominence of the medial margin but could be moved freely without local tenderness.
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