Time again for #NeuromuscularQandA? RT. #neurology #medtwitter #MedEd #medstudent #neurologyresident Join me in discussing/learning/educating with #passion and #humor @WNGtweets @MonicaDhakar @MadSattinJ @NinaRiggins @AaronLBerkowitz @RachelSalasMD
Let’s do one on scapular winging. It’s a common neuromuscular condition. Consider it by the company it keeps - a good history and exam will save you time.
Q: Doc doc, my patient got scapular winging after cervical LN biopsy. What’s going on?
A: Posterior triangle of neck procedures can injure the spinal accessory nerve - remember it has C3/4 branches. Check for shoulder depression - trapezius is weak.
A: A muscular condition which causes scapular winging with wasting of scapular muscles and a polyhill sign is? neurologiaspedalicivili.blogspot.com/2013/07/discov…
Q: Doc, another patient got the flu then 2 weeks of severe arm pain then scapular winging.
A: Think parsonage-turners affecting the long thoracic nerve. EMG/NCS will show a predilection for upper trunk derived nerves. Luckily most patients recover in 2 years.
A: Note that there are patients who have an inherited recurrent form of this disease - hereditary neuralgic amyotrophy. What’s the gene involved? They have dystrophic features including close set eyes. n.neurology.org/content/54/3/5…
Q: Another one has scapular winging and shortness of breath?
A: Think Pompe’s disease - this is a classical presentation. Get dried blood spot for GAA activity.
A: Also check for UMN signs - could it be ALS? While scapular winging isn’t a common presentation, wasting of periscapular muscles might occur if upper limbs are involved.
Q: How about long-standing weakness and family history of scapular winging?
A: Think inherited muscular dystrophies LGMD, FSHD, EDMD and congenital myopathies like centronuclear myopathies.
Alright let’s summarize. Think muscles which fix the scapula - the trapezius, serratus anterior, rhomboids - and nerves which innervate them - spinal accessory, long thoracic and dorsal scapular. Any and all can be affected. Localize n consider the cause. Over and out.
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