What sign is shown here ?Where is the lesion ?
What are the possible causes ?
What investigation can you perform ?
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6 comments:
Sign : winging of the scapula
Lesion : long thoracic nerve/nerve to serratus anterior
Possible causes : birth injury,FSH muscle dystrophy,sports trauma etc.
Investigations :
Muscular biopsy,nerve conduction studies,X ray to rule out fractures, etc.r
1. Winging of the scapula(more prominent on left side), there seems to be trapezius muscle wasting of the left side??not sure..:)
2. (a) Damage of the long thoracic nerve(serratus anterior muscle)
(b) Lesion of the accessory nerve(cranial nerve XI)-trapezius muscle
(c)Brachial plexus injury??
3. (a) Damage of long thoracic nerve maybe due to trauma, pressure lesions to the nerve and neuritis.
(b) accessory nerve lesion- surgery, tumour??
(c) brachial plexus injury- trauma, brachial neuritis(parsonage-turner-syndrome)
(d) others- Fascioscapulohumeral dystrophy(FSHD)
4. trapezius muscle- ask patient to shrug shoulders, lift hand over head.
serratus anterior muscle- wall test?
EMG, muscle biopsy, DNA analysis, X-ray
"WINGED SCAPULA"
Damaged long thoracic nerve which cause paralysis of serratus anterior muscle. :)
Sign: Winged scapula.
The winging is intensified by abduction of arm against resistance(from the third to the first picture). with the abduction of arms, both of the scapula seems to be winged. This is more suggestive of trapezius palsy.
The possible lesion and the possible causes:
1. serratus anterior weakness or paralysis which maybe due to damage to long thoracic nerve, brachial plexus injury, infection of or injury to the nerve roots of the 5th, 6th and 7th cervical nerve roots and
certain types of muscular dystrophy eg Fascioscapulohumeral dystrophy
2. Trapezius palsy
Investigations: EMG, Nerve conduction study, muscle biopsy
plus atrophy of trapezius muscle on the right side
Yes, it is wing ing of the scapula. This picture was taken rather long ago. If I remember correctly, he had facioscapulohumeral dystrophy. Congrats to NoobDoc who mentioned it rather precisely. Well done to others as well !
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