What is it about ?
In the event of a detachment of the scapula, the scapula is found in an abnormal position. The anomaly occurs when one of the muscles that connect the arm to the spine (shoulder girdle) no longer works properly. This can happen when the nerve that controls that muscle is damaged. Usually the nerve involved is the long thoracic nerve which innervates the serratus anterior muscle; this muscle allows the scapula to rest against the chest. This nerve can be damaged by injury to the shoulder during sudden downward pulling, carrying an unusually heavy load, operations (for example for a breast cancer or by inflammation of the nerve). The problem can also be with the accessory nerve that innervates the trapezius muscle and allows the scapula to rotate outward and inward. This nerve can be affected after surgery on the neck or when the nerve is compressed by a suture or scar.
How to recognize it?
The most obvious sign is the change in the position of the scapula. The scapula is normally triangular in shape; the upper edge is more or less horizontal, and the point is directed downwards. When the scapula is lifted off, the lower tip points more inward (towards the vertebrae), while the upper edge tilts and is oriented outward. The scapula is detached, it is a little more distant from the vertebrae. You can see it clearly when you compare it with the other shoulder blade. If the scapula is detached, it may be difficult to lift your arm, the last part of this movement may even be impossible to do. This makes it harder to do everyday things like dressing or washing your hair. When you press both hands against a wall, the scapula pulls apart. Shoulder movements can be painful because the scapula no longer stabilizes them. Sometimes you have a throbbing pain in the shoulder, around the scapula and in the neck, which can radiate into the hand. Pain in the chest and armpit occurs when the serratus anterior muscle is affected.
How is the diagnosis made?
The doctor determines the condition during an examination of the shoulder. He will examine your neck, armpits and chest for a possible tumor. A electromyography (EMG) allows to evaluate the functioning of the nerve, by measuring the electrical activity in the muscles. After an accident, an x-ray of the shoulder will also be taken.
What can you do ?
Through exercises under the supervision of a physiotherapist, you can strengthen other muscles active in shoulder movements. These exercises help to recover some of the functioning of your arm.
What can your doctor do?
In the event of an injury or blow to the shoulder, the doctor will wait a maximum of two years to see how the lesions progress. Partial or complete recovery is indeed possible. If the nerve is severely affected, a splint is placed on the shoulder to facilitate movement of the shoulder and arm. In rare cases, in the event of damage to the long thoracic nerve, it is possible to consider a muscle transplant after several years. A lesion of the accessory nerve causes great limitations; in this case, it is not possible to count on a spontaneous recovery. An operation is possible if it is performed within 6 months of the onset of the lesion.
Want to know more?
- Shoulder bones (image) – Larousse
- The radiography, here, Where to find on this page of Cliniques St Luc UCL
- Electromyography – Erasme Hospital
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