The Natural Course of Serratus Palsy at 2 to 31 Years

Abstract

The natural course of isolated serratus palsy is obscure. Residual winging, muscle weakness, and fatigability reportedly occur in half of the patients. Because we believed isolated serratus palsy might have a better natural course than earlier thought, we evaluated our long-term records. We determined duration of symptoms and whether scapular winging, ROM, and pain recover or persist after isolated serratus palsy without any particular treatment. We retrospectively reviewed 37 patients with isolated serratus palsy treated by observation without any brace or surgery. We determined the degree of scapular winging, ROM, and pain. The minimum followup was 2 years (median, 18 years; range, 2-31 years) after onset of symptoms. The duration of scapular winging averaged 16 months (range, 2-30 months). Winging of the scapula disappeared in 29 (78%) of the patients, flexion recovered to normal in 30 (82%) and abduction in 33 (89%). Of the 37 patients, 11 (30%) were pain-free; pain at rest was absent from 17 (46%), occurred seldom in seven (19%), and was temporary in 12 (32%); one patient had pain at rest continuously. None of the patients desired other treatment such as a brace or surgery. The natural course of isolated serratus palsy in clinically mild cases is not as favorable as we had expected. Symptoms mostly recover in 2 years, but at least one-fourth of the patients will have long-lasting symptoms, especially pain. We could identify no factors to allow us to appropriately choose patients with serratus palsy for observation only.