Isono Tomomi, Mori Shigeshi, Kusumoto Hidenori, Shiono Hiroyuki
General Thoracic Surgery, Kindai University Nara Hospital, Ikoma, Nara, Japan
Orthopaedics and Rheumatology, Kindai University Nara Hospital, Ikoma, Nara, Japan.
BMJ Case Rep. 2020 Feb 19;13(2):e232970. doi: 10.1136/bcr-2019-232970.
Winged scapula is a rare condition caused by injuries to the long thoracic nerve (LTN) and accessory nerves. A 69-year-old man underwent surgery for right lung cancer. Video-assisted thoracic surgery was converted to axillary thoracotomy at the fourth intercostal space. The latissimus dorsi was protected, and the serratus anterior was divided on the side anterior to the LTN. Two months after discharge, he presented with difficulty in elevating his right arm and protrusion of the scapula from his back. Active forward flexion of the right shoulder was limited to 110° and abduction to 130°. He was diagnosed with winged scapula. After 6 months of occupational therapy, the symptoms improved. The LTN may have been overstretched or damaged by the electric scalpel. We recommend an increased awareness of the LTN, and to divide the serratus anterior at a site as far as possible from the LTN to avoid postoperative winged scapula.
翼状肩胛是一种由胸长神经（LTN）和副神经损伤引起的罕见病症。一名69岁男性接受了右肺癌手术。电视辅助胸腔镜手术在第四肋间间隙转换为腋下开胸术。背阔肌得到保护，在胸长神经前方一侧切断前锯肌。出院两个月后，他出现右臂上举困难以及肩胛骨从背部突出的症状。右肩主动前屈受限至110°，外展受限至130°。他被诊断为翼状肩胛。经过6个月的职业治疗，症状有所改善。胸长神经可能被电刀过度牵拉或损伤。我们建议提高对胸长神经的认识，并尽可能在远离胸长神经的部位切断前锯肌，以避免术后出现翼状肩胛。
