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Scapular Winging: A Great Masquerader of Shoulder Disorders: AAOS Exhibit Selection.
[thoracic outlet syndrome]
The
incidence
of
scapular
winging
is
unclear
,
but
it
may
be
more
common
than
previously
thought
.
It
can
be
difficult
to
diagnose
because
the
presenting
complaint
and
physical
examination
may
direct
the
practitioner
toward
more
common
shoulder
and
neck
conditions
.
Ongoing
scapular
dysfunction
may
result
in
inappropriate
or
failed
surgery
.
Our
goals
were
to
(
1
)
describe
the
common
misdiagnoses
(
instability
,
labral
abnormality
,
impingement
,
and
cervical
spine
disease
)
,
the
clinical
scenarios
and
examination
findings
leading
to
diagnostic
difficulty
,
the
definitive
treatment
options
available
,
and
the
clinical
outcomes
and
complications
;
and
(
2
)
review
the
important
aspects
of
the
patient
history
,
physical
examination
of
the
scapula
,
and
associated
studies
necessary
to
make
the
correct
diagnosis
of
scapular
winging
.
METHODS
:
We
reviewed
the
literature
relative
to
,
and
our
own
experience
with
,
the
treatment
of
scapular
winging
and
identified
a
series
of
patients
with
this
condition
who
were
initially
misdiagnosed
with
other
shoulder
or
spine
abnormalities
.
In
our
literature
search
,
only
nine
clinical
studies
reported
on
a
series
of
patients
with
scapular
winging
that
was
initially
misdiagnosed
or
had
a
delay
in
diagnosis
(
n
=
53
patients
)
.
We
examined
these
cases
for
presenting
or
preexisting
diagnoses
and
for
surgical
procedures
that
had
been
performed
before
the
diagnosis
of
scapular
winging
.
RESULTS
:
For
patients
ultimately
diagnosed
with
scapular
winging
,
initial
presentations
and
diagnoses
included
rotator
cuff
disorders
(
20
%
)
,
glenohumeral
instability
(
8
%
)
,
peripheral
nerve
disorders
(
6
%
)
,
cervical
spine
disease
(
6
%
)
,
acromioclavicular
disorders
(
6
%
)
,
thoracic
outlet
syndrome
(
4
%
)
,
and
unknown
or
unspecified
(
41
%
)
.
The
most
common
surgical
procedures
performed
before
definitive
scapular
winging
treatment
were
rotator
cuff
(
22
%
)
,
instability
(
22
%
)
,
nerve
(
14
%
)
,
acromioclavicular
(
12
%
)
,
cervical
spine
(
5
%
)
,
and
thoracic
outlet
(
4
%
)
procedures
.
CONCLUSIONS
:
Clinically
,
scapular
winging
often
mimics
more
common
shoulder
abnormalities
and
can
result
in
unnecessary
or
unsuccessful
surgical
procedures
.
Diagnosis
can
be
readily
achieved
with
simple
physical
examination
and
specific
provocative
maneuvers
in
conjunction
with
electromyography
and
nerve
conduction
studies
.
Prompt
diagnosis
and
recognition
can
avoid
substantial
shoulder
dysfunction
.
Diseases
Validation
Diseases presenting
"specific provocative maneuvers in conjunction with electromyography and nerve conduction studies"
symptom
thoracic outlet syndrome
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