case_images: PMC10729626_01
case_images: Clinical photograph of the scapula. The inferior pole of the right scapula (arrow) was more lateral than the left scapula, and a dent suggestive of muscle rupture was observed on the medial scapula border (A). Magnetic resonance image of the periscapular muscles. The image with short inversion time inversion recovery technique shows a tear of the right rhomboid major at its insertion (arrow) with surrounding fluid retention (B).
case_images: 10.1177_11795441231219009-fig1.jpg
case_images: PMC10729626_01_10.1177_11795441231219009-fig1.jpg
case_images: fig1-11795441231219009
case_images: Constant score   was 78, and the visual analogue scale (VAS) was 2.5 cm. Compared with the left scapula, the inferior pole of the right scapula was more lateral, and a dent suggestive of muscle rupture was observed on its medial border (Figure 1A). Magnetic resonance imaging (short inversion time inversion recovery sequence) revealed a tear in the right rhomboid major at its insertion, with surrounding fluid retention (Figure 1B).
case_images: Intraoperative findings of the rhomboid major repair. In the supine position, a skin incision was made along the medial scapular border from the scapular spine to the inferior angle (A). When the lower trapezius muscle (dagger) was retracted using a muscle retractor, the torn rhomboid major (double asterisk) was observed, and there was a gap from the tear (arrowheads) between the torn rhomboid major and its insertion (asterisk) (B). After creating bone holes on the medial border of the scapula, we threaded 3 fiber wires and applied them to the torn rhomboid muscle using the Krackow stitch technique through the bone holes (C). Fiber wires were fastened with the torn rhomboid major muscle reduced at its insertion (D). Schematic illustration of the rhomboid major repair using Krackow sutures (E).
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case_images: PMC10729626_01_10.1177_11795441231219009-fig2.jpg
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case_images: A skin incision was made along the medial scapular border from the scapular spine to the inferior angle (Figure 2A). After soft tissue dissection, the lower trapezius muscle was retracted using a muscle retractor to expose the rhomboid major tear (Figure 2B). Three no. 2 FiberWire  nonabsorbable sutures (Arthrex, Naples, FL, USA) were passed from the rhomboid major tear site to the musculotendinous junction using the Krackow stitch technique   to reduce the torn rhomboid major muscle to its insertion (Figure 2C). We then threaded these sutures through the bone holes and tied them on the medial border of the scapula (Figure 2D and E).
case_images: Magnetic resonance T2-weighted image at 8 months postoperatively showed no findings suggesting a retear of the rhomboid major.
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case_images: PMC10729626_01_10.1177_11795441231219009-fig3.jpg
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case_images: Magnetic resonance imaging performed 8 months postoperatively showed no findings suggesting a rhomboid major retear (Figure 3).