We experienced a case of serratus anterior paralysis due to long thoracic nerve palsy which was treated by pectoralis major muscle transfer. The aim of this paper is to report the analysis of pre- and post- operative scapulo-humeral rhythm of this case.
The patient is an 18-year-old girl. Before surgery she could abduct her arm only 90 degrees with a prominent winged scapula and her scapulo-humeral rhythm was markedly disturbed. We performed pectoralis major muscle transfer. After surgery, abduction improved to 180 degrees and her scapulo-humeral rhythm was improved, however, the winged scapula persisted.
The anatomical size of the scapula was determined by taking two anterio-posterior view roentgenograms from a distance of one and two meters respectively. The pre- and post- operative scapulo-humeral rhythm was recorded on a video recorder by use of a large image intensifier and then analyzed.
Before surgery, with abduction, the inferior angle scapula moved medially and the vertebral border of the scapula moved upward even with optimum abduction. Moreover, the upward rotation angle was small during this process. After surgery, the abnormal motion of the inferior angle and the vertebral border was minimized and became close to the normal rhythmic pattern with an increase in the upward rotation angle.