Dr. Kevin Yip

Dr Kevin Yip
Orthopaedic Surgeon
MBBS(UK), FRCS(EDIN), FAM(SING), FHKCOS(ORTHO)

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Scapulothoracic Dysfunction, Burners, Stingers, Thoracic Outlet Syndrome, and Miscellaneous Nerve Injuries

Key Points

  • The scapula is a triangular, flat bone that lies along the posterior thoracic wall. The stability of the scapula depends mainly on the 17 muscles that are attached to it.
  • The scapula is an essential structure for proper biomechanics for the shoulder, because it offers a stable foundation for movement. Disorders of the scapula and the nerves surrounding the glenohumeral joint can result in significant dysfunction and pain involving the shoulder.
  • Scapular “dyskinesis” describes loss of the normal motion and positioning of the scapula.
  • The patient with a scapular problem often presents with a history of shoulder impingement or pain. Common complaints among throwing athletes are difficulties generating force and pain over the posterior aspect of the shoulder.
  • Blunt trauma or repetitive microtrauma from nerve traction or compression are the common causes of neurogenic winging encountered in athletes. The long thoracic nerve is vulnerable to direct injury because of its subcutaneous location as it exits the pectoralis muscle at the fourth and fifth ribs and travels along the rib cage.
  • Brachial plexus neuropathy presents with temporary burning, stinging, or tingling that occurs when the head is forcefully bent sideways. These injuries are commonly referred to as stingers or burners. Symptoms typically last for seconds to minutes, but in 5% to 10% of cases, a neurological deficit can last for hours, days, or even weeks. When treating the symptoms, it is important to rule out underlying factors that may predispose the athlete to more serious injury.
  • Nerve compression, nerve traction, or a direct blow to the brachial plexus are the three main mechanisms for a stinger or burner.
  • Thoracic outlet syndrome (TOS) refers to a symptom complex of upper extremity pain and paresthesias involving compressions of neurovascular structures.
  • A subtle cause of shoulder pain and weakness involves compression or traction of the suprascapular nerve. Overhead and throwing athletes often are affected because of repetitive trauma. A diagnosis of suprascapular nerve entrapment often is made clinically, based on a thorough history and physical examination.

Apart from the pathology of the glenohumeral joint, disorders of the surrounding nerves and scapula can result in significant dysfunction and pain involving the shoulder. The scapula is an essential structure for proper biomechanics of the shoulder, because it offers a stable foundation for movement. Proper coordination and positioning of the scapula and glenohumeral joint is necessary for efficient and effective shoulder motion.

Nerve injuries around the shoulder can cause weakness of the scapular stabilizers and the rotator cuff muscles, which can result in improper and symptomatic mechanics of the shoulder. This chapter reviews problems involving the scapula and the nerves around the shoulder that often are overlooked and, possibly, underdiagnosed. The concept of scapulothoracic dysfunction or dyskinesis is introduced, and specific nerve injuries around the neck and shoulder are discussed.

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