Fourteen patients with traumatic winging of the scapula were reviewed,
all of whom had had injuries producing sudden depression of the shoulder
girdle from either a direct blow to the top of the shoulder or downward
traction on the arm. The diagnosis was commonly missed for a considerable
interval. Seven patients recovered spontaneously within six months of
injury. Three of the other seven patients were treated by reattachment of
the insertion of the sternal portion of the pectoralis major muscle via a
fascia lata graft to the lower pole of the scapula. In one of these
patients a reoperation was needed, but all three ultimately recovered
satisfactory function of the shoulder. Anatomical studies suggested that
the injury results from compression of the long thoracic nerve against the
second rib and not from entrapment of the nerve by the scalenus medius
muscle.