Advanced SearchSearch Tips
Dynamic Stabilization of the Scapula for Serratus Anterior Dysfunction: A Retrospective Study of Functional Outcome and Results
facebook(new window)  Pirnt(new window) E-mail(new window) Excel Download
  • Journal title : Clinics in Shoulder and Elbow
  • Volume 18, Issue 4,  2015, pp.229-236
  • Publisher : Korean Shoulder and Elbow Society
  • DOI : 10.5397/cise.2015.18.4.229
 Title & Authors
Dynamic Stabilization of the Scapula for Serratus Anterior Dysfunction: A Retrospective Study of Functional Outcome and Results
Chung, Soo Tai; Warner, Jon J.P.;
  PDF(new window)
Background: Twenty-six patients (12 male and 14 female) with symptomatic scapular winging caused by serratus anterior dysfunction were managed by split pectoralis major tendon transfer (sternal head) with autogenous hamstring tendon augmentation from 1998 to 2006. Methods: Twenty-five patients showed positive results upon long thoracic nerve palsy on electromyography. The mean duration of symptoms until surgery was 48 months (range, 12-120 months). Four patients had non-traumatic etiologies and 22 patients had traumatic etiologies. On follow-up assessment for functional improvement, a Constant-Murley score was used. Twenty-one patients were completely evaluated, while five patients who had less than 12 months of follow-up were excluded. Results: Pain relief was achieved in 19 of the 21 patients, with 20 patients showing functional improvement. The pain scores improved from 6.0 preoperatively to 1.8 postoperatively. The mean active forward elevation improved from (range, ) preoperatively to (range, ) postoperatively. The mean Constant-Murley score improved from 57.7 (range, 21-86) preoperatively to 86.9 (range, 42-98) postoperatively. A recurrence developed in one patient. Of the 21 patients, ten had excellent results, six had good results, four had fair results, and one had poor results. Conclusions: Most patients with severe symptomatic scapular winging showed functional improvement and pain relief with resolution of scapular winging.
Split pectoralis major tendon transfer;Serratus anterior dysfunction;Scapular winging;Long thoracic nerve palsy;
 Cited by
Kuhn JE, Plancher KD, Hawkins RJ. Scapular winging. J Am Acad Orthop Surg. 1995;3(6):319-25.

Fery A. Results of treatment of anterior serratus paralysis. In: Post M, Morey BF, Hawkins RJ, eds. Surgery of the shoulder. St. Louis: Mosby-Year; 1990. 325-29.

Foo CL, Swann M. Isolated paralysis of the serratus anterior. A report of 20 cases. J Bone Joint Surg Br. 1983;65(5):552-6.

Gozna ER, Harris WR. Traumatic winging of the scapula. J Bone Joint Surg Am. 1979;61(8):1230-3.

Misamore GW, Lehman DE. Parsonage-Turner syndrome (acute brachial neuritis). J Bone Joint Surg Am. 1996;78(9):1405-8.

Vastamaki M, Kauppila LI. Etiologic factors in isolated paralysis of the serratus anterior muscle: a report of 197 cases. J Shoulder Elbow Surg. 1993;2(5):240-3. crossref(new window)

Wood VE, Frykman GK. Winging of the scapula as a complication of first rib resection: a report of six cases. Clin Orthop Relat Res. 1980;(149):160-3.

Jobe C. Gross anatomy of the shoulder. In: Rockwood C, Matsen F, eds. The shoulder. Philadelphia: W.B. Saunders Company; 1998. 34-97.

Wiater JM, Flatow EL. Long thoracic nerve injury. Clin Orthop Relat Res. 1999;(368):17-27.

Dickson F. Fascial transplants in paralytic and other conditions. J Bone Joint Surg Am. 1937;19(2):405-12.

Hawkins R, Willis R, Litchfield R. Scapulothoracic arthrodesis for scapular winging. In: Post M, Morey BF, Hawkins RJ, eds. Surgery of the shoulder. St. Louis: Mosby-Year; 1990. 356-9.

Lindstrom N, Danielsson L. Muscle transposition in serratus anterior paralysis. Acta Orthop Scand. 1962;32:369-73. crossref(new window)

Post M. Pectoralis major transfer for winging of the scapula. J Shoulder Elbow Surg. 1995;4(1 Pt 1):1-9. crossref(new window)

Tubby A. A case illustrating the operative treatment of paralysis of the serratus magnus by muscle grafting. British Med J. 1904; 2:1159-60.

Warner JJ, Navarro RA. Serratus anterior dysfunction. Recognition and treatment. Clin Orthop Relat Res. 1998;(349):139-48.

Whitman A. Congenital elevation of scapula and paralysis of serratus magnus muscle. J Am Med Asso. 1932;99(16):1332-4. crossref(new window)

Connor PM, Yamaguchi K, Manifold SG, Pollock RG, Flatow EL, Bigliani LU. Split pectoralis major transfer for serratus anterior palsy. Clin Orthop Relat Res. 1997;(341):134-42.

Iceton J, Harris WR. Treatment of winged scapula by pectoralis major transfer. J Bone Joint Surg Br. 1987;69(1):108-10.

Noerdlinger MA, Cole BJ, Stewart M, Post M. Results of pectoralis major transfer with fascia lata autograft augmentation for scapula winging. J Shoulder Elbow Surg. 2002;11(4):345-50. crossref(new window)

Perlmutter GS, Leffert RD. Results of transfer of the pectoralis major tendon to treat paralysis of the serratus anterior muscle. J Bone Joint Surg Am. 1999;81(3):377-84. crossref(new window)

Steinmann SP, Wood MB. Pectoralis major transfer for serratus anterior paralysis. J Shoulder Elbow Surg. 2003;12(6):555-60. crossref(new window)

Constant CR, Murley AH. A clinical method of functional assessment of the shoulder. Clin Orthop Relat Res. 1987;(214): 160-4.

Clavert P, Warner JJ. Scapular winging caused by serratus anterior dysfunction: recognition and treatment. In: Warner JJ, Iannotti JP, Flatow EL, eds. Complex and revision problems in shoulder surgery. Philadelphia: Lippincott Williams & Wilkins; 2005. 583-97.

Simovitch RW, Lavery KP, Chung ST, Warner JJ. Pectoralis major transfer for scapular winging. Tech Should Elbow Surg. 2006;7(4):191-9. crossref(new window)

Novak CB, Mackinnon SE. Surgical treatment of a long thoracic nerve palsy. Ann Thorac Surg. 2002;73(5):1643-5. crossref(new window)

Narakas AO, Hentz VR. Neurotization in brachial plexus injuries. Indication and results. Clin Orthop Relat Res. 1988;(237): 43-56.

Chaves JP. Pectoralis minor transplant for paralysis of the serratus anterior. J Bone Joint Surg Br. 1951;33(2):228-30.

Herzmark MH. Traumatic paralysis of the serratus anterior relieved by transplantation of the rhomboidei. J Bone Joint Surg Am. 1951;33(1):235-8.

Povacz P, Resch H. Dynamic stabilization of winging scapula by direct split pectoralis major transfer: a technical note. J Shoulder Elbow Surg. 2000;9(1):76-8. crossref(new window)

Noyes FR, Butler DL, Grood ES, Zernicke RF, Hefzy MS. Biomechanical analysis of human ligament grafts used in kneeligament repairs and reconstructions. J Bone Joint Surg Am. 1984;66(3):344-52.