The Rhomboids are two muscles - Rhomboid Major & Rhomboid Minor. The two rhomboids lie deep to trapezius to form parallel bands that pass inferolaterally from the vertebrae to the medial border of the scapula. Rhomboid Major is thin and flat and twice as wide as the thicker Rhomboid Minor which lies superior to it. Usually there is.
Released online 2006 Jun 21.doi: 10.3346/jkms.2006.21.3.581
PMID: 16778411
This write-up has long been reported by other articles in PMC.
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Subjective
We experienced a uncommon situation of winged scapula that had been triggered by the split of the rhomboideus major and the lower trapezius muscles without any sensation problems injury in a 12 yr aged women after she got transported a large back pack. Electrodiagnostic research uncovered that the onset latencies, amplitudes and conduction velocities were regular in the lengthy thoracic sensation problems, the spinal accessory sensation problems and the dorsal scapular sensation problems. The needle EMG results were normal as properly. An explorative operation was performed and the break of the rhomboideus major and lower trapezius muscle tissue was detected. Direct surgical repair of the ruptured muscle tissue was transported out there and the deformity has been adjusted. The physiological and functional restoration has been satisfactorily accomplished.
Keywords:Scapula, Muscle, Skeletal, Injuries and Accidental injuries, Rhomboideus Muscle tissue, Trapezius Muscle tissue Make
INTRODUCTION
Winged scapula is one of the more common scapulothoracic disorders, and it is certainly caused by a quantity of pathologic situations. It can be classified as principal and secondary; principal winged scapula may be expected to neurologic damage, pathologic modifications in the bone tissue or because of periscapular soft-tissue abnormalities. Supplementary winged scapula occurs as a outcome of glenohumeral and subacromial conditions, and it resolves after the primary pathologic problem has become attended to. Traumatic winged scapula is not a common malady, and only rarely offers winged scapula been credited to buff damage. We survey here on a individual with winged scapula that has been caused by rhomboideus and trapezius muscle tissues rupture connected with repetitive minor trauma.
Situation REPORT
![Rhomboideus Major And Minor Rhomboideus Major And Minor](/uploads/1/2/4/0/124091394/594542875.png)
A 12-yr-old woman introduced to our outpatient division with a right winged scapula. Her height was 139 cm and her weight had been 38 kg. This situation abruptly created after hiking a hill for 2 hr with a rucksack/back-pack evaluating about 20 kg at 2 months previous to her hospital check out. At a specific time, she experienced the drooping make with a going audio. She has been given birth to via spontaneous full-term vaginal delivery with a normal APGAR score. She experienced no particular family background of sensation problems or muscles diseases. Her growth and developing history had been nonspecific before the beginning of winged scapula. Upon the actual physical examination, a winging deformity of the right scapula has been noticed with the horizontal change and upwards turn of the inferior angle, as observed on the erect neutral position (Fig. 1A). This abnormality had been not detected when both shoulder blades were abducted (Fig. 1B), but it had been aggravated by make flexion (Fig. 1C). The motor and sensory functions of the upper extremities had been regular and no aspect to side differences were uncovered. The serious tendon reflexes of the biceps and triceps muscle tissues had been normoactive and shaped. No substantial muscle atrophy in the make girdles and the upper extremities has been noticed. On the lab exams, the routine complete bloodstream count with differential counting, erythrocyte sedimentation rate, C-reactive protein, rheumatoid arthritis factor and urinalysis had been normal, and the muscle tissue enzyme checks, including serum creatine kinase, lactate dehydrogenase and transaminase, were also normal. Simple radiological studies, like the chest posterior-anterior view, both the shoulder anterior-posterior views and the scapular look at, had been nonspecific except for the minor scapular asymmetry.
Winged scapula caused by the split of the right rhomboideus major and lower trapezius muscle tissue: (A) shows the lateral deviation and up turn of the second-rate angle of the correct scapula, as examined with the patient in an set up neutral position. (W) shows no detectable asymmetry on make abduction. (C) displays a even more prominent winging of the correct scapula on shoulder flexion.
We examined the nerves by conducting an electrodiagnostic exam that integrated the long thoracic sensation problems, the dorsal scapular sensation problems and the spinal accessory nerves and the muscle tissue like serratus anterior, levator scapula, trapezius and rhomboideus and therefore on; there had been no definitive evidences that pointed out any neuropathy or myopathy on electrodiagnosis.
When the discomfort and useful impairment persisted, operative intervention then became appropriate. An explorative procedure was accomplished. A posterior longitudinal skin incision has been made parallel to the vertebral boundary of the scapula. The subcutaneous tissues was split. We can noticed that the rhomboidius major has been ruptured and trapezius lower thoracic bunch displayed thinning hair (Fig. 2A, C). The right scapula has been volatile to the chest walls. Rhomboideus major and trapezius muscle mass maintenance and reefing were performed. After the muscle mass restoration, the scapula had been steady to chest wall at the period of the procedure.
(A) The intraoperative results revealed the rupture of some servings of the perfect rhomboideus major and lower trapezius muscle groups (white arrow). (T) Postoperative example of the rhomboideus major and lower trapezius fix and reefing. (Chemical) Postoperative findings showed recovery of scapular symmetry with the patient in a natural erect position.
Postoperatively, she attained the anatomical restoration of her correct shoulder and she obtained rehabilitative treatment for 2 days including variety of movement workout of the make and building up workout of the rhomboideus muscle tissues. On the follow up evaluation, at 2 a few months after the procedure, there had been no a weakness or deformity of the impacted make and no pain nor limitation of shoulder movement. She had been satisfied with the recovery of her make function (Fig. 2C).
Dialogue
Winged scapula can be defined as a prominence of the medial boundary of the scapula and it can be the almost all typical scapulothoracic condition. The causes of this condition are well-known, and they consist of brachial plexus injuries (,), separated paralysis of the serratus anterior , fascioscapulohumeral buff dystrophy or injuries to the long thoracic sensors that occurs during resection of the very first rib for decompression of thoracic wall plug compression symptoms. This condition can also develop due to subscapular osteochonroma. The position of the winged scapula is dependent on the specific nerve injury and the resulting design of muscle mass paralysis. The nearly all common lead to is certainly the paralysis of the serratus anterior muscles that is certainly innervated by the lengthy thoracic sensors. The reported anecdotal cases of traumatic winged scapula had been almost often related with grip injury to the long thoracic lack of feeling (-), trapezius muscle mass paralysis that generally lead from damage to the spinal accessory sensors (,13) and a disordered rhomboideus muscle mass that generally lead from injury to the dorsal scapular sensors. Until right now, winged scapula caused by immediate break of rhomboideus and trapezius muscle tissue, especially without scapular stress fracture, has not been documented on. In our case, we verified that the winged scapula was caused by the rupture of rhomboideus major muscle mass and the lower trapezius muscles, and this was most likely connected with the severe 'popping' injuries, structured on the history and the surgical results. We believed that the winged scapula lead from the downwards traction pressure on the left arm by her weighty back-pack and the recurring minor trauma to the muscle groups.
A winged scapular in a patient with normal electromyograms had been reported by Sanitate and Jurist in 1995 , and they insisted on the probability of an undetected incomplete neuropraxic lesion. They also stated that buff damage should end up being regarded as a really rare lead to of winged scapula. The same as their situation results, the electrodiagnostic results of our case were nonspecific. We thought that there were two opportunities to explain these results. The very first, it takes some period for an abnormal electrical possible to show up (i.age., fibrillation and beneficial sharp influx) after sensation problems injury. Abnormal electrical potentials were noticed both proximal and distal to the sensors injury 7 times after the injury, and they appeared in the proximal part by day 14 and in the distal component by time 21. Our case had sufficient time not really to observe abnormal findings on electrodiagnostic examinations. The 2nd chance would become a specialized mistake of the electrodiagnostic exams. Nardin et al. reported that the precision of electrodiagnostic assessment had been 91% in patients who introduced with muscle mass weakness. Further, we could not rule among bodybuilders out the probability of inappropriate placing of the fine needles on the electrodiagnostic tests.
Postoperatively, the physiological restoration was attained and useful recovery of the right shoulder had been satisfactorily accomplished by rehabilitative measures that incorporated range of motion exercises for the shoulder and building up exercise for the rhomboideus and trapezius muscle tissues.
Footnotes
This study was financially supported by Regional Analysis Centers Plan from the Ministry of Education and learning and Human being Resources Development.
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