Scapular winging: anatomical review, diagnosis, and treatments

Scapular winging is a rare debilitating condition that leads to limited functional activity of the upper extremity. It is the result of numerous causes, including traumatic, iatrogenic, and idiopathic processes that most often result in nerve injury and paralysis of either the serratus anterior, trapezius, or rhomboid muscles. Diagnosis is easily made upon visible inspection of the scapula, with serratus anterior paralysis resulting in medial winging of the scapula. This is in contrast to the lateral winging generated by trapezius and rhomboid paralysis. Most cases of serratus anterior paralysis spontaneously resolve within 24 months, while conservative treatment of trapezius paralysis is less effective. A conservative course of treatment is usually followed for rhomboid paralysis. To allow time for spontaneous recovery, a 6–24 month course of conservative treatment is often recommended, after which if there is no recovery, patients become candidates for corrective surgery

Lakeside View: Sociocultural Responses to Changing Water Levels of Lake Turkana, Kenya

Throughout the Holocene, Lake Turkana has been subject to drastic changes in lake levels and the subsistence strategies people employ to survive in this hot and arid region. In this paper, we reconstruct the position of the lake during the Holocene within a paleoclimatic context. Atmospheric forcing mechanisms are discussed in order to contextualize the broader landscape changes occurring in eastern Africa over the last 12,000 years. The Holocene is divided into five primary phases according to changes in the strand-plain evolution, paleoclimate, and human subsistence strategies practiced within the basin. Early Holocene fishing settlements occurred adjacent to high and relatively stable lake levels. A period of high-magnitude oscillations in lake levels ensued after 9,000 years BP and human settlements appear to have been located close to the margins of the lake. Aridification and a final regression in lake levels ensued after 5,000 years BP and human communities were generalized pastoralists-fishers-foragers. During the Late Holocene, lake levels may have dropped below their present position and subsistence strategies appear to have been flexible and occasionally specialized on animal pastoralism. Modern missionary and government outposts have encouraged the construction of permanent settlements in the region, which are heavily dependent on outside resources for their survival. Changes in the physical and cultural environments of the Lake Turkana region have been closely correlated, and understanding the relationship between the two variables remains a vital component of archaeological research

Microneurolysis and decompression of long thoracic nerve injury are effective in reversing scapular winging: Long-term results in 50 cases

<p>Abstract</p> <p>Background</p> <p>Long thoracic nerve injury leading to scapular winging is common, often caused by closed trauma through compression, stretching, traction, direct extrinsic force, penetrating injury, or neuritides such as Parsonage-Turner syndrome. We undertook the largest series of long thoracic nerve decompression and neurolysis yet reported to demonstrate the usefulness of long thoracic nerve decompression.</p> <p>Methods</p> <p>Winging was bilateral in 3 of the 47 patients (26 male, 21 female), yielding a total of 50 procedures. The mean age of the patients was 33.4 years, ranging from 24–57. Causation included heavy weight-lifting (31 patients), repetitive throwing (5 patients), deep massage (2 patients), repetitive overhead movement (1 patient), direct trauma (1 patient), motor bike accident (1 patient), and idiopathic causes (9 patients). Decompression and microneurolysis of the long thoracic nerve were performed in the supraclavicular space. Follow-up (average of 25.7 months) consisted of physical examination and phone conversations. The degree of winging was measured by the operating surgeon (RKN). Patients also answered questions covering 11 quality-of-life facets spanning four domains of the World Health Organization Quality of Life questionnaire.</p> <p>Results</p> <p>Thoracic nerve decompression and neurolysis improved scapular winging in 49 (98%) of the 50 cases, producing "good" or "excellent" results in 46 cases (92%). At least some improvement occurred in 98% of cases that were less than 10 years old. Pain reduction through surgery was good or excellent in 43 (86%) cases. Shoulder instability affected 21 patients preoperatively and persisted in 5 of these patients after surgery, even in the 5 patients with persistent instability who experienced some relief from the winging itself.</p> <p>Conclusion</p> <p>Surgical decompression and neurolysis of the long thoracic nerve significantly improve scapular winging in appropriate patients, for whom these techniques should be considered a primary modality of functional restoration.</p