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There are a variety of classifications for winged scapula, and likewise several treatment options. Strength training, particularly of the serratus anterior, may be recommended as this muscle is responsible for holding the medial scapula close to the rib cage. In more severe cases, physical therapy can help by strengthening related muscles.
Facioscapulohumeral muscular dystrophy (FSHD) is a type of muscular dystrophy, a group of heritable diseases that cause degeneration of muscle and progressive weakness. Per the name, FSHD tends to sequentially weaken the muscles of the face, those that position the scapula, and those overlying the humerus bone of the upper arm.
A winged scapula is the most common symptom. [7] Shoulder pain may occur. [7] It causes weakness in rhomboid major muscle, rhomboid minor muscle, and levator scapulae muscle. [7] The range of motion of the shoulder may be limited. [7] Treatment is usually conservative. [7]
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There are several options of treatment when iatrogenic (i.e., caused by the surgeon) spinal accessory nerve damage is noted during surgery. For example, during a functional neck dissection that injures the spinal accessory nerve, injury prompts the surgeon to cautiously preserve branches of C2, C3, and C4 spinal nerves that provide supplemental innervation to the trapezius muscle. [3]
Scapular winging due to trapezius muscle (spinal accessory nerve) palsy can be treated with an Eden-Lange procedure. Scapular winging due to facioscapulohumeral muscular dystrophy can be treated with a scapulopexy or scapulothoracic fusion .
Surgery is usually only used if the non-surgical treatments have failed. Bone abnormalities may need surgical attention. The most common surgery for snapping scapula requires the surgeon to "take out a small piece of the upper corner of the scapula nearest to the spine." [citation needed]
Additional muscle deficits can contraindicate tendon transfer, namely the serratus anterior muscle or the muscles-to-be-transferred themselves. Serratus anterior muscle deficit is another cause of scapular winging and decreases the efficacy of an Eden–Lange procedure, but it can be overcome with a simultaneous pectoralis major transfer .
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