SERRATUS ANTERIOR DYSFUNCTION - RECOGNITION AND TREATMENT

Recognition of scapular winging may be difficult, and potential errors in treatment can result. Such treatment errors may cause morbidity fo r the patient. Tn addition, electrical evidence of long thoracic nerve injury usually is required to confirm the etiology of scapular wingin g as being caused by serratus anterior dysfunction, Although various c onditions may result in scapular winging, primary serratus anterior dy sfunction can be treated effectively by transfer of the pectoralis maj or tendon; however, this surgical approach sometimes may give an unacc eptable cosmesis, and there may be local morbidity to the donor site o f the iliotibial band graft that is used to augment the tendon transfe r, The authors report eight patients with primary chronic scapulothora cic winging refractory to conservative treatment. Five of these patien ts had an incorrect diagnosis, and this resulted in 17 surgical proced ures without resolution of their pain or improvement of function. Of t he eight patients who required additional surgery to stabilize the sca pula, only five patients had an electromyographic study that showed lo ng thoracic nerve palsy, although all patients had profound scapulotho racic winging. All patients underwent a modified pectoralis major tran sfer with autogenous semitendinosus and gracilis tendon augmentation u sing two small incisions. Although one patient had a postoperative inf ection develop, the remaining seven patients had resolution of their w inging, improved function, and satisfactory cosmesis.