MICRONEUROLYSIS AND DECOMPRESSION OF LONG THORACIC NERVE INJURY
ARE EFFECTIVE IN REVERSING SCAPULAR WINGING: LONG TERM RESULTS IN 50 CASES
Scapular Winging is a condition where the shoulder blade protrudes from a person's back in an abnormal position to make it look like a "wing". This condition is commonly the result of damage to the Long Thoracic Nerve (LTN) as well as the upper brachial plexus most often by injury (stretching, traction, direct force or penetrating injury); from a tightening of the tissue that surrounds the nerve (compression); or as a result of damage to the nerve caused by positioning; from inflammation (Parsonage- Turner syndrome leading to scarring of the long thoracic nerve and the brachial plexus). Along with the bony protrusion, there may also be paralysis of varying degree, pain, and loss of function of the affected shoulder joint.
We studied a large group of patients to demonstrate the usefulness of Long Thoracic Nerve Microneurolysis and Decompression Surgery performed by Dr. Nath. Microneurolysis is micro-surgery that involves cleaning up scar tissue outside and inside the affected nerves. Decompression is the removal of any other type of tissue (connective or vascular, etc.) that forms around the nerve, constricting and impeding it from functioning correctly.
Our group of patients included 47 patients (26 male, 21 female with 3 individuals who had scapular winging on both sides). Their ages ranged from 24-57. The causes of the scapular winging was varied and is listed below:
31 patients - heavy weight lifting
5 patients - repetitive throwing
2 patients - deep massage
1 patient - repetitive overhead movement
1 patient - direct trauma
1 patient - motorbike accident
9 patients - unknown cause
In total, 50 procedures were performed (3 patients had both sides done).
Follow-up over the next +/- 2 years consisted of physical examination and phone conversations. The degree of winging was measured by the operating surgeon (Dr. Rahul K. Nath). Patients were also asked to answer 11 questions pertaining to their quality of life from the World Health Organization's Quality of Life Questionnaire.
The results of this study showed that the Microneurolysis and Decompression of the Thoracic Nerve improved Scapular Winging in 49 of the 50 cases. 46 cases showed produced "good" or "excellent" results. At least some improvement occurred in 98% of the cases that were less than 10 years past the onset. A reduction of pain was good or excellent in 43 patients.
Shoulder instability affected 21 patients before surgery. After the surgery the instability only continued in 5 patients. However, even with the 5 patients who had instability, they still experienced some relief from the winging itself.
We concluded that for appropriate patients, surgical Microneurolysis and Decompression of the Long Thoracic Nerve, significantly improved Scapular Winging. This surgery should be considered the primary method for restoring functional health.
A recent paper [Laulan, J., Lascar, T., Saint-Cast, Y., Chammas, M., Le Nen, D: Isolated Paralysis of the Serratus Anterior Muscle Successfully Treated by Surgical Release of the Distal Portion of the Long Thoracic Nerve, Chirugie De La Main, 2011] showed that removal of scar tissue from the long thoracic nerve when it is in the chest was also useful and we now typically will work on the nerves both in the neck as well as in the side of the chest at the same time. This has added significant benefit to our patients and their outcomes.
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