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A Patient with Clavicle Fracture and Recurrent Scapular Winging with Spontaneous Resolutions

DOI: 10.1155/2012/603726

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Injury to the long thoracic nerve with resulting serratus anterior palsy is a typical cause of medial scapular winging. We report a case of a 70-year-old female with scapular winging in the setting of a mildly comminuted midshaft clavicle fracture. The winging persisted for three months after the fracture, which became a nonunion. The winging spontaneously resolved prior to open reduction and internal fixation of the nonunion. The winging recurred after this surgery. The recurrence was attributed to transient irritation and/or inflammatory neuropathy of the brachial plexus caused by the surgical manipulation. This second episode of winging again spontaneously resolved. There are few reported cases of scapular winging in the setting of a clavicle fracture and only one case of recurrent scapular winging. In that case, which was in the setting of an acromioclavicular joint separation, the second episode of winging required long-term use of a brace. By contrast, our patient did not require bracing because the recurrent winging spontaneously resolved, making this a novel case. This case is important because it illustrates that recurrent scapular winging can occur, and spontaneously resolve, in the setting of a mid-shaft clavicle fracture after subsequent reconstruction of a fracture nonunion. 1. Introduction Damage to the long thoracic nerve is a classic cause of medial scapular winging [1, 2]. This injury, which results in palsy of the serratus anterior muscle, can be caused by a variety of acute trauma events and chronic repetitive activities. In some cases, the winging is not associated with electrodiagnostic evidence of injury to the long thoracic nerve or cervical nerve roots that contribute to it (C-5, C-6, and C-7) [1–3]. With respect to fractures of the shoulder girdle, there are reports of medial scapular winging in association with (1) malunions and nonunions of acromion fractures [2, 4], (2) malunions and nonunions of clavicle fractures [1–3], (3) clavicle fractures with other associated injuries [3, 5], (4) glenoid fractures [1], and (5) malunions of scapular body fractures [2]. Although our review of the English literature revealed a few cases of ipsilateral medial scapular winging in the setting of clavicle fractures prior to being considered nonunions [3, 5], we could only locate one case describing recurrent winging. In that case the patient did not sustain a clavicle fracture, but had an acromioclavicular separation and required a brace to keep working because the winging did not resolve after the recurrence [4]. We report the case of a


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