Ishizuka Shinya, Kobayakawa Akinori, Hiraiwa Hideki, Oba Hiroki, Sakaguchi Takefumi, Idota Masaru, Haga Takahiro, Mizuno Takafumi, Kawashima Itaru, Kuriyama Kanae, Imagama Shiro
Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan.
Case Rep Orthop. 2021 Oct 26;2021:4511538. doi: 10.1155/2021/4511538. eCollection 2021.
The most common cause of medial scapular winging is long thoracic nerve palsy (LTN) and subsequent serratus anterior muscle dysfunction. A 16-year-old right-handed male high-school rugby player developed severe right-sided neck and shoulder pain after tackling an opponent while playing rugby. Six weeks after initial injury, the patient observed shoulder muscle weakness when performing his daily activities. On physical examination, limited active elevation of the right shoulder in the scapular plane and scapular winging was observed. Magnetic resonance imaging revealed atrophy of both the SA and subclavius muscles on the right side, and we initially suspected an LTN injury sustained. However, while detailing his history, the patient explained that he also had noted difficulty sucking high viscosity drinks such as shakes and smoothies since childhood. In addition, physical examination showed weakness of the orbicularis oculi muscle. Considering the facial muscle weakness, facioscapulohumeral dystrophy (FSHD) was also suspected, and genetic testing showed chromosome 4q35 deletion with restriction fragments 17 kb and 3 tandem repeated DNA confirming the diagnosis of FSHD. Clinicians should be aware that FSHD could be one of the differential diagnoses of scapular winging after sports injury, and surgeons should rule out the diagnosis of FSHD before performing any surgical treatment for SA palsy.
肩胛内侧缘翼状肩胛最常见的原因是胸长神经麻痹（LTN）及随后的前锯肌功能障碍。一名16岁右利手男性高中橄榄球运动员在橄榄球比赛中擒抱对手后出现严重的右侧颈部和肩部疼痛。初始损伤六周后，患者在进行日常活动时发现肩部肌肉无力。体格检查发现右侧肩胛骨平面主动抬高受限及肩胛翼状肩胛。磁共振成像显示右侧前锯肌和锁骨下肌萎缩，我们最初怀疑是胸长神经损伤。然而，在详细询问病史时，患者解释说自童年起他就注意到喝如奶昔和思慕雪等高粘度饮料有困难。此外，体格检查显示眼轮匝肌无力。考虑到面部肌肉无力，也怀疑是面肩肱型肌营养不良（FSHD），基因检测显示4号染色体q35缺失，限制性片段为17 kb，3个串联重复DNA，确诊为FSHD。临床医生应意识到FSHD可能是运动损伤后肩胛翼状肩胛的鉴别诊断之一，外科医生在对前锯肌麻痹进行任何手术治疗前应排除FSHD的诊断。
