case_images: PMC4812086_01
case_images: Medial scapular winging on the right side preoperatively (A, C) and normal scapular position 3 months postoperatively (B, D). The patient is pushing both hands against the wall with his arms in 90 degrees of anteflexion.
case_images: iort-87-203.01.jpg
case_images: PMC4812086_01_iort-87-203.01.jpg
case_images: F1
case_images: On initial examination, medial winging of the right scapula was noted, which was aggravated during forward flexion of the arm against resistance (Figure 1). Gentle muscle strengthening together with active and passive range-of-motion exercises of the shoulder was started 6 weeks after surgery. 3 months after surgery, the patient had regained full strength and a normal range of motion of the right shoulder without any sign of scapular winging (Figure 1).
case_images: A T2-weighted magnetic resonance image showing focal fluid collection at the anatomic insertion region of the retracted serratus anterior muscle (black arrowhead) at the inferior angle of the scapula (white arrow).
case_images: iort-87-203.02.jpg
case_images: PMC4812086_01_iort-87-203.02.jpg
case_images: F2
case_images: Magnetic resonance imaging revealed a small hematoma at the anatomic insertion region of the serratus anterior muscle on the scapula, with retraction and incipient atrophy of the muscle (Figure 2).
case_images: Computed tomography with 3D reconstruction showing the dislocated fragment of the inferior angle of the right scapula.
case_images: iort-87-203.03.jpg
case_images: PMC4812086_01_iort-87-203.03.jpg
case_images: F3
case_images: A computed tomography with 3D reconstruction showed a small osseous fragment of the inferior angle of the scapula with dislocation in the direction of the retracted serratus anterior muscle (Figure 3).   