Upper Limb Unit, Wrightington Hospital, Appley Bridge, Wigan, UK.
Department of Orthopaedics, University Hospitals Birmingham, Birmingham, UK.
J Shoulder Elbow Surg. 2021 Oct;30(10):2336-2343. doi: 10.1016/j.jse.2021.02.012. Epub 2021 Mar 4.
This study aimed to establish the relative incidence of etiologies causing serratus anterior (SA) dysfunction in patients with proven abnormality on needle electromyography.
This was a retrospective review of patients with scapular winging secondary to SA dysfunction. Each patient underwent a detailed clinical, radiological, and neurophysiological assessment to arrive at the precise etiological diagnosis. Patients with atypical clinical features were referred for a neurologist's assessment. Hematological and genetic testing were requested at the discretion of the neurologist. A scapular winging severity score based on clinical signs was devised to aid clinical grading.
Between 2014 and 2020, a consecutive series of 108 patients with suspected SA dysfunction were assessed, of whom 96 met the inclusion criteria. There were 34 females and 62 males, with a mean age of 38 years (range, 15-77 years). Winging affected the right scapulae in 69 patients, the left scapulae in 17 patients, and was bilateral in 10 patients. This was caused by a myopathic disorder in 12 (12%) patients. Eighty-four (88%) patients had a long thoracic nerve lesion, caused by cervical pathology (2), iatrogenic injury (2), trauma (33), and neuralgic amyotrophy (NA) (47). Among those with NA, winging resolved spontaneously within 3 years of onset in 22 patients (mean duration, 16 months; range, 3-36 months). No patients recovered fully if their duration of winging lasted longer than 3 years. Patients with palsy secondary to NA tended to have a worse severity of winging than those due to a traumatic cause (P = .04).
NA accounted for approximately half of the patients with SA dysfunction; therefore, it is essential to also consider the differentials of myopathy, trauma, iatrogenic injury, and spinal pathology. We recommend the judicious employment of ancillary tests and a low threshold of referral to a neurologist, in order to arrive at the exact diagnosis to accurately guide patient treatment.
本研究旨在确定在肌电图证实前锯肌（SA）功能障碍的患者中，导致 SA 功能障碍的病因的相对发生率。
这是一项对继发于 SA 功能障碍的肩胛骨翼状畸形患者的回顾性研究。每位患者均接受详细的临床、放射学和神经生理学评估，以确定确切的病因诊断。具有非典型临床特征的患者被转介给神经科医生进行评估。根据神经科医生的判断，请求进行血液学和遗传学检测。根据临床体征设计了一个基于肩胛骨翼状畸形严重程度的评分，以辅助临床分级。
在 2014 年至 2020 年间，连续评估了 108 例疑似 SA 功能障碍的患者，其中 96 例符合纳入标准。其中 34 例为女性，62 例为男性，平均年龄 38 岁（范围，15-77 岁）。有 69 例患者的肩胛骨右侧、17 例患者的肩胛骨左侧、10 例患者的双侧出现翼状畸形。12 例（12%）患者由肌病引起。84 例（88%）患者存在长胸神经病变，由颈椎病变（2 例）、医源性损伤（2 例）、创伤（33 例）和神经痛性肌萎缩（NA）（47 例）引起。在患有 NA 的患者中，22 例（平均病程 16 个月；范围 3-36 个月）在发病后 3 年内自发性缓解。如果翼状畸形持续时间超过 3 年，则无患者完全恢复。继发于 NA 的瘫痪患者比继发于创伤性原因的患者的翼状畸形严重程度更差（P =.04）。
NA 约占 SA 功能障碍患者的一半；因此，还必须考虑肌病、创伤、医源性损伤和脊柱病变等不同病因。我们建议明智地使用辅助检查，并降低转介给神经科医生的门槛，以便明确诊断，准确指导患者治疗。
