Lee Sung Young, Lee Hyeok Dong, Cho Young-Shin, Han Seung Hoon
Department of Rehabilitation Medicine, Hanyang University College of Medicine, Seoul, Republic of Korea.
Medicine (Baltimore). 2018 Oct;97(40):e12515. doi: 10.1097/MD.0000000000012515.
Scapular winging is caused by neuromuscular dysfunction of shoulder stabilizer muscles. Clinically, a winged scapula can be easily diagnosed by typical physical findings. We report a case of atypical winged scapula caused by dorsal scapular neuropathy combined with suprascapular neuropathy, which has rarely been reported.
A 25-year-old right-handed male was admitted to the clinic due to right arm weakness for 1 year. On physical examination, right winged scapula with medially rotated inferior angle was observed on flexion.
Under the diagnostic impression of a winged scapula due to long thoracic nerve injury based on physical examination, electrodiagnostic study was performed. However, the results showed right dorsal scapular neuropathy combined with suprascapular neuropathy.
Neck and right shoulder MRI were also performed to rule out other causes of winged scapula, but these showed only a partial thickness tear of the rotator cuff tendon. The patient received rehabilitation.
The symptoms have not improved.
In this case, combined suprascapular neuropathy might contribute to scapular winging and can confuse the diagnosis of winged scapula based on physical findings. This is the first report that indicates suprascapular neuropathy as a contributing factor of scapular winging.
肩胛翼状畸形是由肩部稳定肌的神经肌肉功能障碍引起的。临床上，典型的体格检查结果可轻松诊断出翼状肩胛。我们报告一例由肩胛背神经病变合并肩胛上神经病变引起的非典型翼状肩胛病例，此类病例鲜有报道。
一名25岁右利手男性因右臂无力1年就诊。体格检查发现，屈曲时右侧肩胛呈翼状，下角向内旋转。
基于体格检查，初步诊断为因胸长神经损伤导致的翼状肩胛，遂进行了电诊断检查。然而，结果显示为右侧肩胛背神经病变合并肩胛上神经病变。
还进行了颈部和右肩部MRI检查以排除翼状肩胛的其他病因，但仅显示肩袖肌腱部分厚度撕裂。患者接受了康复治疗。
症状未改善。
在此病例中，合并肩胛上神经病变可能导致肩胛翼状畸形，并可能使基于体格检查结果对翼状肩胛的诊断产生混淆。这是首篇指出肩胛上神经病变是肩胛翼状畸形一个促成因素的报告。
