Causes, symptoms and treatment of the syndrome of wing-like blades

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The left and right blades that are included with the upper body of a man serve to connect the clavicle and the humerus and to attach several of the chest muscles.

Through the clavicular-acromial joint achieves full range of motion in the shoulder joint, elevation, retraction, rotation of hands.

With the rear surface of the chest and spine of the scapula connects with the muscles and fascia. Only the power of the front gear and rhomboid muscles holds them in a normal physiological position.

The weakening of the muscles, for various reasons, the violation of their innervation due to damage of long thoracic nerve give rise to the syndrome of wing-like blades.

The distance between the edge of the blade facing the spine, the bottom corner and edges is greatly increased. It drops slightly lower and sticks out from the skin, resembling a bird’s wing.

Limited range of motion in the shoulder joint, the difficulty of the climb, pulling forward and abduction of the shoulder combined with aching pain, loss of ability to work.

Causes of pterygium syndrome blades

There are only about a few dozen cases of wing-like blades, this is a relatively rare pathology. The causes of the syndrome can be divided into two groups: congenital and acquired.

Congenital winged scapula cause anatomical defects, impaired development and innervation of the muscles that support the normal position of the scapula (serratus anterior, trapezius, rhomboid).

Syndrome, acquired during life, may occur in the pathology of muscles, and in lesions of the long thoracic nerve.

This happens with injuries, breaks and sprains, and inflammations (neuritis, myositis), the hereditary syndrome of progressive muscular dystrophy, when polio (very rare cause, as nearly all vaccinated against this infection).

Trauma is the most frequent starting point, it can be sporting or home. Long wearing heavy weights on the shoulder ends inflammation of the long thoracic nerve or the sclera and a sharp rise in the load can lead to rupture of the muscles.

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Diagnostic methods

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Diagnosis of the syndrome of wing-like blades placed on the basis of the patient’s complaints, clinical and additional methods of research, laboratory and instrumental.

If you experience syndrome caused by injury or inflammation of the first appeal becomes the pain. Its location – scapular region radiating to the clavicle or shoulder joint, the character of the pain – aching, aggravated by movement.

The second and the typical complaint is limitation of movement in the shoulder. If reason is congenital factors, this complaint comes first.

On examination, the patient pterygoid blade is impossible to miss. Characterized by explicit asymmetry of the left and right of the blade

areas, a bulging inner edge of the blade, increasing when lifting arm, with the help of the assistant, the impossibility of full range of motion. The first test in the diagnosis – characteristic appearance of the blade while focusing patient’s outstretched arms into the wall.

Despite the specificity of the complaints and clinical picture, differential diagnosis of the syndrome with other diseases is always carried out laboratory and instrumental examination.

It is necessary to exclude a radiculopathy shoulder, various bone pathology and neurological syndromes. Radiographs will help to exclude the lesions of the scapula, electromyography and MRI will help in diagnosis of long thoracic nerve.

The purposes and methods of treatment

The goal of therapy is to lock the blade in the desired position, to provide motion of the shoulder joint in all planes, relieve pain, to arrest the inflammatory process, to ensure the normal blood supply and innervation of the affected area, to prevent the disability in the patient and his disability.

Treatment pterygoid blades can be long, requiring repeated courses of conservative, the ineffectiveness of which is assigned to surgical intervention.

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You need to get rid of the factors causing constant trauma to the long thoracic nerve or muscle (carrying a burden on the shoulder, frequent repetitive movements of the shoulder joint).

To stabilize the scapula are recommended orthopedic fixators.

During pain and inflammatory syndrome are assigned analgesics, nonsteroidal anti-inflammatory drugs (Diclofenac intramuscular).

Good result is observed when using physiotherapy:

  • electrophoresis with drugs;
  • heat and cold application;
  • massage;
  • the use of electric current;
  • magnetic fields;
  • laser.

Therapeutic gymnastics are designed to strengthen blood flow and metabolic processes in the muscles that hold the scapula to increase their power potential.

Surgery for pterygium syndrome of the scapula is required for the ineffectiveness of repeated courses of conservative therapy.

Surgical intervention may be functional in nature, consisting in the replacement of the affected serratus anterior in healthy (muscles, plastic), or stabilizing, in which the blade is fixed to the rib.

In the second method the amount of movement is not fully recovered.

Complications after surgery

The functional and stabilizing methods of operation, possible complications as with any surgical procedure.

18% of all operated patients after 1-3 days develop General or specific complications. To common include wound infection, pulmonary atelectasis, thrombosis.

Specific complications characteristic of specific interventions. In the treatment of winged scapula possible violation of the innervation of the transplanted muscle, damage to tendons or neurovascular bundles.

Rehabilitation after surgery is carried out in specialized sanatoriums primarily on their climate zone. Often requires repeated courses of rehabilitation treatment.

The sanatorium-resort stage provides a comprehensive and individual approach to each patient, ensures a positive effect.

Features of pathology in children

The most common cause of the syndrome of wing-shaped blades in children is violations of posture.

Scoliosis of different degrees leads to a weakening of the chest muscles holding the scapula.

A curved spine causes a deformation of the entire shoulder girdle, makes it difficult to supply the muscles with oxygen and nutrients.

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Muscles lose their strength, partially atrophied, with the weakening of immunity or improperly worn school bags can join myositis or inflammation of the long thoracic nerve. In this situation, the development of the syndrome of wing-like blades is very possible.

Diagnose pathology should as early as possible to start treatment in time. Attentive parents easily identify the problem.

Visual inspection of pupils in the annual examination, the direction of the survey and subsequent control are functional duties of the school doctor.

The less expressed the posture, the more likely that winged scapula can be cured. In childhood a huge positive effect observed with repeated courses of massage, and therapeutic exercises.

Manual massage flexing the chest muscles, increases blood circulation in them, the recovery of muscle fibers. Physical activity trains the muscles, restores the statics of all supporting apparatus.

It is recommended to do as much sports: swimming, skiing, skating, Biking. The child needs to sit at the computer or in front of the TV, he needs to move, jump and run.

Congenital winged scapula are diagnosed at birth or in the first months of a child’s life. Depending on the nature of the pathology is possible a specific treatment, conservative or surgical.

Early diagnosis of the syndrome, timely and correct choice of treatment play a critical role in maintaining the working capacity of the person and his usual lifestyle.