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The Modified Eden-Lange Procedure for Lateral Scapular Winging Due to Spinal Accessory Nerve Palsy

March 15, 2015

Contributors: Derik Geist, MD; Richard J Hawkins, MD; Richard J Hawkins, MD

Spinal accessory nerve palsy can be a devastating injury that can lead to scapular dysfunction through detriment of the trapezius. Common mechanisms of injury stem from trauma (i.e., blunt trauma; potential for nerve recovery) or iatrogenesis (i.e., surgical complications; usually not recoverable). The resulting injury leads to lateral scapular winging as defined by the direction that the inferior edge of the scapula points during the dyskinesis. The ensuing unbalanced shoulder girdle can result in shoulder pain and dysfunction due to muscle fatigue/overuse, as well as shoulder impingement and tendinopathy. Initial treatment of the disorder includes physical therapy to strengthen balancing muscle groups, as well as NSAIDs and pain medications. Failure of a prolonged and well-guided regimen of physical therapy presents a crossroads for the patient and providers regarding therapy.

The Modified Eden Lange procedure was developed to address trapezial dysfunction through compensatory muscle transfers around the posterior scapula. A dual-incision posterior approach is demonstrated, which provides a lateral transfer of the rhomboids to the suprascapular and infrascapular fossas (through a medial border approach) and a tunneled lateral transfer of the levator scapula to the scapular spine (through an accessory incision) using fleck osteotomies. As has been demonstrated in limited prior case series, the patient in our case also demonstrates excellent function and a significant reduction in periscapular and shoulder pain within six months of surgery.

Results for "Shoulder: Neurovascular"