Arcada University of Applied Sciences, Helsinki, Finland.
Clin Orthop Relat Res. 2013 May;471(5):1555-63. doi: 10.1007/s11999-012-2723-7. Epub 2012 Dec 1.
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.
QUESTIONS/PURPOSES: 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.
孤立性胸大肌神经病的自然病程尚不清楚。据报道，有一半的患者会出现残余的翼状肩、肌肉无力和易疲劳。因为我们认为孤立性胸大肌神经病的自然病程可能比之前认为的要好，所以我们评估了我们的长期记录。
问题/目的：我们确定了症状的持续时间，以及在没有任何特殊治疗的情况下，孤立性胸大肌神经病患者的肩胛骨翼状、ROM 和疼痛是否会恢复或持续存在。
我们回顾性分析了 37 例接受观察治疗而未使用支具或手术的孤立性胸大肌神经病患者。我们确定了肩胛骨翼状的程度、ROM 和疼痛。症状出现后，最小随访时间为 2 年（中位数 18 年；范围 2-31 年）。
肩胛骨翼状的平均持续时间为 16 个月（范围 2-30 个月）。29 例（78%）患者的翼状肩胛骨消失，30 例（82%）的肩关节前屈和 33 例（89%）的肩关节外展恢复正常。37 例患者中，11 例（30%）无疼痛；17 例（46%）患者无静息性疼痛，7 例（19%）患者疼痛很少发生，12 例（32%）患者疼痛为暂时性；1 例患者持续存在静息性疼痛。没有患者希望接受其他治疗，如支具或手术。
临床上轻度孤立性胸大肌神经病的自然病程并不像我们预期的那样有利。症状大多在 2 年内恢复，但至少有四分之一的患者会出现长期症状，尤其是疼痛。我们无法确定哪些因素可以让我们适当地选择仅接受观察治疗的胸大肌神经病患者。
