Traumatic winging of the scapula.

Fourteen patients with traumatic winging of the scapula were reviewed, all of whom had had injuries producing sudden depression of the shoulder girdle from either a direct blow to the top of the shoulder or downward traction on the arm. The diagnosis was commonly missed for a considerable interval. Seven patients recovered spontaneously within six months of injury. Three of the other seven patients were treated by reattachment of the insertion of the sternal portion of the pectoralis major muscle via a fascia lata graft to the lower pole of the scapula. In one of these patients a reoperation was needed, but all three ultimately recovered satisfactory function of the shoulder. Anatomical studies suggested that the injury results from compression of the long thoracic nerve against the second rib and not from entrapment of the nerve by the scalenus medius muscle.