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Clin Shoulder Elbow > Volume 18(4); 2015 > Article
Clinics in Shoulder and Elbow 2015;18(4):229-236.
DOI:    Published online December 31, 2015.
Dynamic Stabilization of the Scapula for Serratus Anterior Dysfunction: A Retrospective Study of Functional Outcome and Results
Soo Tai Chung, Jon J P Warner
1Department of Orthopaedic Surgery, Catholic Kwandong University International St. Mary's Hospital, Incheon, Korea.
2Harvard Shoulder Service, Massachusetts General Hospital, Boston, MA, USA.
Received: 30 September 2015   • Revised: 11 November 2015   • Accepted: 30 November 2015
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.
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.
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 108degrees (range, 20degrees-165degrees) preoperatively to 151degrees (range, 125degrees-170degrees) 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.
Most patients with severe symptomatic scapular winging showed functional improvement and pain relief with resolution of scapular winging.
Key Words: Split pectoralis major tendon transfer; Serratus anterior dysfunction; Scapular winging; Long thoracic nerve palsy
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