Treatment for Medial and Lateral Scapular Winging: Tendon Transfers

Abstract

Although rare, scapular winging can be a painful and disabling condition. Scapular winging has been categorized as medial or lateral winging, with medial being the more common type. Medial winging is the result of serratus anterior paralysis from injury to the long thoracic nerve. The most common etiology is neuropraxia after blunt or stretch injury. Lateral winging, from trapezius paralysis with injury to the spinal accessory nerve, is most likely iatrogenic from procedures involving the posterior cervical triangle. Recovery of nerve function can take up to 2 years. For those cases that do not have return of nerve function, operative treatment is an option. Tendon transfers were introduced in the early 1900s and have been met with satisfactory results in small case series. The purpose of this article is to describe the indications, operative technique, postoperative rehabilitation, and results of tendon transfer for medial and lateral scapular winging.