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Scapular Winging following Sports-Related Injury in a Rugby Player. Case Rep Orthop 2021; 2021:4511538. [PMID: 34745675 PMCID: PMC8564197 DOI: 10.1155/2021/4511538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Accepted: 10/18/2021] [Indexed: 11/18/2022] Open
Abstract
The most common cause of medial scapular winging is long thoracic nerve palsy (LTN) and subsequent serratus anterior muscle dysfunction. A 16-year-old right-handed male high-school rugby player developed severe right-sided neck and shoulder pain after tackling an opponent while playing rugby. Six weeks after initial injury, the patient observed shoulder muscle weakness when performing his daily activities. On physical examination, limited active elevation of the right shoulder in the scapular plane and scapular winging was observed. Magnetic resonance imaging revealed atrophy of both the SA and subclavius muscles on the right side, and we initially suspected an LTN injury sustained. However, while detailing his history, the patient explained that he also had noted difficulty sucking high viscosity drinks such as shakes and smoothies since childhood. In addition, physical examination showed weakness of the orbicularis oculi muscle. Considering the facial muscle weakness, facioscapulohumeral dystrophy (FSHD) was also suspected, and genetic testing showed chromosome 4q35 deletion with restriction fragments 17 kb and 3 tandem repeated DNA confirming the diagnosis of FSHD. Clinicians should be aware that FSHD could be one of the differential diagnoses of scapular winging after sports injury, and surgeons should rule out the diagnosis of FSHD before performing any surgical treatment for SA palsy.
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Varada SL, Popkin CA, Hecht EM, Ahmad CS, Levine WN, Brown M, Wong TT. Athletic Injuries of the Thoracic Cage. Radiographics 2021; 41:E20-E39. [PMID: 33646909 DOI: 10.1148/rg.2021200105] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
A variety of sports require exposure to high-impact trauma or characteristic repetitive movements that predispose to injuries around the thorax. Appropriate prognostication and timely management are vital, as untreated or undertreated injuries can lead to pain, disability, loss of playing time, or early termination of sports participation. The authors review common athletic injuries of the thoracic cage, encompassing muscular, osseous, and vascular conditions, with an emphasis on mechanism, imaging features, and management. The authors also review pertinent soft-tissue and bony anatomy, along with relevant sports biomechanics. Generalized muscle trauma and more specific injuries involving the pectoralis major, latissimus dorsi, teres major, pectoralis minor, lateral abdominal wall and intercostals, serratus anterior, and rectus abdominis muscles are discussed. Osseous injuries such as stress fractures, sternoclavicular dislocation, costochondral fractures, and scapular fractures are included. Finally, thoracic conditions such as snapping scapula, thoracic outlet syndrome, and Paget-Schroetter syndrome are also described. Specific MRI protocols are highlighted to address imaging challenges such as the variable anatomic orientation of thoracic structures and artifact from breathing motion. Athletes are susceptible to a wide range of musculoskeletal thoracic trauma. An accurate imaging diagnosis of thoracic cage injury and assessment of injury severity allow development of an adequate treatment plan. This can be facilitated by an understanding of functional anatomy, sports biomechanics, and the unique injuries for which athletes are at risk. ©RSNA, 2021.
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Affiliation(s)
- Sowmya L Varada
- From the Department of Radiology, Division of Musculoskeletal Radiology (S.L.V., E.M.H., M.B., T.T.W.), and Department of Orthopedic Surgery, The Center for Shoulder, Elbow, and Sports Medicine (C.A.P., C.S.A., W.N.L.), New York-Presbyterian Hospital, Columbia University Medical Center, 622 W 168th St, MC-28, New York, NY 10032
| | - Charles A Popkin
- From the Department of Radiology, Division of Musculoskeletal Radiology (S.L.V., E.M.H., M.B., T.T.W.), and Department of Orthopedic Surgery, The Center for Shoulder, Elbow, and Sports Medicine (C.A.P., C.S.A., W.N.L.), New York-Presbyterian Hospital, Columbia University Medical Center, 622 W 168th St, MC-28, New York, NY 10032
| | - Elizabeth M Hecht
- From the Department of Radiology, Division of Musculoskeletal Radiology (S.L.V., E.M.H., M.B., T.T.W.), and Department of Orthopedic Surgery, The Center for Shoulder, Elbow, and Sports Medicine (C.A.P., C.S.A., W.N.L.), New York-Presbyterian Hospital, Columbia University Medical Center, 622 W 168th St, MC-28, New York, NY 10032
| | - Christopher S Ahmad
- From the Department of Radiology, Division of Musculoskeletal Radiology (S.L.V., E.M.H., M.B., T.T.W.), and Department of Orthopedic Surgery, The Center for Shoulder, Elbow, and Sports Medicine (C.A.P., C.S.A., W.N.L.), New York-Presbyterian Hospital, Columbia University Medical Center, 622 W 168th St, MC-28, New York, NY 10032
| | - William N Levine
- From the Department of Radiology, Division of Musculoskeletal Radiology (S.L.V., E.M.H., M.B., T.T.W.), and Department of Orthopedic Surgery, The Center for Shoulder, Elbow, and Sports Medicine (C.A.P., C.S.A., W.N.L.), New York-Presbyterian Hospital, Columbia University Medical Center, 622 W 168th St, MC-28, New York, NY 10032
| | - Marc Brown
- From the Department of Radiology, Division of Musculoskeletal Radiology (S.L.V., E.M.H., M.B., T.T.W.), and Department of Orthopedic Surgery, The Center for Shoulder, Elbow, and Sports Medicine (C.A.P., C.S.A., W.N.L.), New York-Presbyterian Hospital, Columbia University Medical Center, 622 W 168th St, MC-28, New York, NY 10032
| | - Tony T Wong
- From the Department of Radiology, Division of Musculoskeletal Radiology (S.L.V., E.M.H., M.B., T.T.W.), and Department of Orthopedic Surgery, The Center for Shoulder, Elbow, and Sports Medicine (C.A.P., C.S.A., W.N.L.), New York-Presbyterian Hospital, Columbia University Medical Center, 622 W 168th St, MC-28, New York, NY 10032
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Abstract
ABSTRACT Trunk pain is a common cause of performance limitation and time away from sport in athletes. However, atraumatic trunk injuries are underrepresented in medical literature and underrecognized clinically. Delays in diagnosis and initiation of appropriate treatment can increase injury morbidity and return-to-play time. Currently, evidence-based guidelines for diagnosis and treatment of trunk pain in athletes are limited. Thus, we provide an overview of atraumatic sport-related injuries to the thoracic spine (disc herniation, scoliosis, kyphosis), ribcage (bone stress injury, costochondritis, Tietze syndrome, slipping rib syndrome, costovertebral or costotransverse joint dysfunction), and chest and abdominal wall musculature (intercostal, serratus anterior, oblique strains, regional myofascial pain), highlighting sport-specific biomechanical considerations. We aim to increase awareness of these causes of trunk pain among sports medicine providers in an effort to guide diagnostic and treatment recommendations that will ultimately improve overall musculoskeletal health in athletes.
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Affiliation(s)
- Alexandra Gundersen
- Department of PM&R, Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, MA
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Tomas X, Facenda C, Vaz N, Castañeda EA, Del Amo M, Garcia-Diez AI, Pomes J. Thoracic wall trauma-misdiagnosed lesions on radiographs and usefulness of ultrasound, multidetector computed tomography and magnetic resonance imaging. Quant Imaging Med Surg 2017; 7:384-397. [PMID: 28932697 DOI: 10.21037/qims.2017.08.02] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Blunt injuries to the chest wall are an important chapter on emergency room (ER) departments, being the third most common injuries in trauma patients which ominous complications could appear. This article describes different types of traumatic events affecting the chest wall, which maybe misdiagnosed with conventional X-ray. Special emphasis has been done in computed tomography (CT) and multidetector CT (MDCT) imaging. This technique is considered the "gold-standard" for those traumatic patients, due to its fast acquisition covering the whole area of interest in axial plane, reconstructing multiplanar (2D, 3D) volume-rendered images with a superb quality and angiographic CT capabilities for evaluating vascular damage. Complementary techniques such as ultrasonography (US) and magnetic resonance imaging (MRI) may improve the diagnostic accuracy due to its great capacity in visualising soft-tissue trauma (muscle-tendinous tears) and subtle fractures. All these imaging methods have an important role in quantifying the severity of chest wall trauma. The findings of this study have been exposed with cases of our archives in a didactic way.
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Affiliation(s)
- Xavier Tomas
- Department of Radiology, The Clinical Diagnostic Imaging Centre (CDIC), Hospital Clinic, Universitat de Barcelona (UB), Villarroel 170, 08036 Barcelona, Spain
| | - Catherine Facenda
- Department of Radiology, Hospital Universitari Arnau de Vilanova, Av. Alcalde Rovira Roure, 80, Lleida 25198, Spain
| | - Nuno Vaz
- Department of Radiology, The Clinical Diagnostic Imaging Centre (CDIC), Hospital Clinic, Universitat de Barcelona (UB), Villarroel 170, 08036 Barcelona, Spain
| | - Edgar Augusto Castañeda
- Department of Radiology, Hospital Universitari General de Catalunya-Grupo Quirónsalud, Pedro i Pons, 1, Sant Cugat del Vallés Barcelona 08190, Spain
| | - Montserrat Del Amo
- Department of Radiology, The Clinical Diagnostic Imaging Centre (CDIC), Hospital Clinic, Universitat de Barcelona (UB), Villarroel 170, 08036 Barcelona, Spain
| | - Ana Isabel Garcia-Diez
- Department of Radiology, The Clinical Diagnostic Imaging Centre (CDIC), Hospital Clinic, Universitat de Barcelona (UB), Villarroel 170, 08036 Barcelona, Spain
| | - Jaime Pomes
- Department of Radiology, The Clinical Diagnostic Imaging Centre (CDIC), Hospital Clinic, Universitat de Barcelona (UB), Villarroel 170, 08036 Barcelona, Spain
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Carr JB, John QE, Rajadhyaksha E, Carson EW, Turney KL. Traumatic Avulsion of the Serratus Anterior Muscle in a Collegiate Rower: A Case Report. Sports Health 2016; 9:80-83. [PMID: 27655830 PMCID: PMC5315254 DOI: 10.1177/1941738116670636] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
A 19-year-old female collegiate rower presented with a new, painful mass along her right anterolateral chest wall after competition. The patient was diagnosed with a rupture of the serratus anterior muscle from its costal attachments, as confirmed by magnetic resonance imaging. The patient fully recovered after a period of rest followed by a graduated 2-month physical therapy regimen consisting of stretching and scapulothoracic and core strengthening. A traumatic rupture of the serratus anterior muscle should be suspected in athletes who present with a painful chest wall mass after exertion of large forces through the scapulothoracic region. Athletes can return to play after nonoperative management.
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Affiliation(s)
- James B Carr
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, Virginia
| | - Quincy E John
- College of Medicine, Howard University, Washington, DC
| | - Evan Rajadhyaksha
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, Virginia
| | - Eric W Carson
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, Virginia
| | - Kelly L Turney
- Department of Sports Medicine, University of Virginia, Charlottesville, Virginia
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Min KD, Hwang SH, Kim JB, Cho SH, Lee BI. Treatment of Scapula Fractures of the Inferior Angle Causing Pseudowinging Scapula. ACTA ACUST UNITED AC 2014. [DOI: 10.4055/jkoa.2014.49.2.165] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Kyoung-Dae Min
- Department of Orthopedic Surgery, Soonchunhyang University College of Medicine, Seoul, Korea
| | - Seok-Ha Hwang
- Department of Orthopepic Surgery, Sungae Hospital, Seoul, Korea
| | - Jun-Bum Kim
- Department of Orthopedic Surgery, Soonchunhyang University College of Medicine, Seoul, Korea
| | - Sang-Hyuck Cho
- Department of Orthopedic Surgery, Soonchunhyang University College of Medicine, Seoul, Korea
| | - Byung-Ill Lee
- Department of Orthopedic Surgery, Soonchunhyang University College of Medicine, Seoul, Korea
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