Immediate effects of scapular stabilizing exercise in chronic stroke patient with winging and elevated scapula: a case study

Scapula alata: diagnosis and treatment by nerve surgery and tendon transfers

Scapula alata, also known as winged scapula, can lead to severe upper limb impairment. The shoulders' function is altered because the scapula, which supports the upper limb, is no longer stable. Typical scapula alata is described for serratus anterior palsy; however, any scapulothoracic muscle impairment may lead to scapular winging, particularly trapezius palsy, which is easy to miss, thus needed to be considered as a differential diagnosis. The diagnosis is difficult and based on various clinical tests and a thorough examination as well as electroneuromyography and MRI. The treatment ranges from conservative treatments for spontaneous recovery, nerve surgery including neurolysis, nerve transfers and nerve grafts for acute cases, to tendon transfers for more chronic cases and when nerve procedures are no longer feasible. Tendon transfers in serratus anterior palsy produce excellent results with a high rate of patient satisfaction and are described with the sternal or clavicular head of the pectoralis major; we describe our preferred technique in this article. Tendon transfers in trapezius palsy are performed with the levator scapulae, rhomboid minor and major muscles. Our preferred method is the Elhassan triple transfer. Scapula alata is a frequent and often misdiagnosed condition. Appropriate management can yield excellent results. Patients should be referred right away to specialized centers for surgery if recovery is not spontaneous.

The effect of scapular dyskinesia on the scapular balance angle and upper extremity sensorimotor function in stroke patients with spasticity

Background

Post-stroke scapular dyskinesia is a predisposing factor for the affection of motor and somatosensory functions of the hemiparetic upper extremity.

Objective

The purpose of the study was to investigate the effect of scapular dyskinesia on the scapular balance angle and upper extremity sensorimotor function in stroke patients with spasticity.

Subjects and methods

Sixty patients with spasticity post-stroke participated in this study. The patients were assigned to one of the two groups as determined by the lateral scapular slide test (LSST) using the palpation meter (PALM); group A with scapular dyskinesia and group B stroke patients without scapular dyskinesia. The scapular position was determined by a measurement of scapular balance angle (SBA), and the upper extremity sensorimotor function was evaluated using Fugl-Meyer Assessment upper extremity (FMAUE) scale. The scapular balance angle and Fugl-Meyer upper extremity scores were compared between groups.

Results

There was a significant increase in the scapular balance angle of group A compared with that of group B (p < 0.001). Also, there was a significant decrease in sensory and motor functions of group A as measured by Fugl-Meyer upper extremity compared with that of group B (p < 0.001).

Conclusion

Scapular dyskinesia had a significant effect on the scapular balance angle and upper extremity sensorimotor function in stroke patients with spasticity. Management of scapular dyskinesia should be emphasized in the rehabilitation program for stroke patients with spasticity.