Muskeltransfers rund um die Skapula

Scapula alata, commonly referred to as “scapula winging,” is a scapular dysfunction frequently caused by paralysis of the serratus anterior or trapezius muscle. These paralyses lead to visible shoulder asymmetry and significant limitations in arm movement. Diagnosis is often challenging and easily overlooked. A thorough clinical examination and specific tests are essential. Imaging techniques like X‑rays, computed tomography (CT), and magnetic resonance imaging (MRI) are valuable for ruling out other causes, including structural abnormalities. Electromyography remains the only objective method to confirm muscle paralysis. In cases of acute nerve injuries, immediate surgical exploration and nerve repair is indicated. If treatment is delayed, complex procedures like nerve reconstruction are less likely to succeed. In most chronic cases, conservative therapy is the preferred approach. This includes targeted physiotherapy, transcutaneous nerve stimulation, and the use of orthoses to stabilize the scapula and protect the affected muscles from overstretching. If conservative treatment fails, surgical interventions such as muscle transfers are recommended. The pectoralis major transfer has shown effectiveness for serratus anterior paralysis, while the modified Eden-Lange transfer is effective for trapezius paralysis. For more severe cases, particularly in patients with combined muscle injuries or after failed soft tissue surgeries, scapulothoracic fusion may be considered, although this method is associated with high complication rates. Given the complexity of these surgical procedures, they should be performed by experienced specialists.

Level of evidence: V