Reinforcement Reconstruction using Fascia Lata Autograft for Rhomboid Paralysis-Induced Scapular Winging

Summary

Here, we present a protocol outlining a unique approach to achieving a stable scapulothoracic joint and restoring the dynamics of the rhomboid muscle.

Abstract

Scapular winging caused by paralysis of the rhomboid muscle is a relatively uncommon condition in shoulder outpatient. Despite the paucity, it presents as a debilitating condition with sequelae of poor function and deconditioning. Reinforcement reconstruction and restoring the rhomboid muscle dynamic presents a biomechanical treatment option for patients because of paralyzed rhomboids. Building upon our previous research demonstrating successful myointegration of autologous fascia lata grafts, we introduce an innovative reconstruction surgical technique utilizing these grafts to address rhomboid muscle paralysis. We performed reinforcement reconstruction using fascia lata autograft on a patient for painful scapular winging caused by paralyzed rhomboids and aimed to achieve a normal rhythm of the scapulothoracic joint. The procedure achieved functional restoration and scapular stabilization through reinforcement reconstruction. Postoperative assessment at 6 weeks revealed a full shoulder range of motion, absence of scapulothoracic discomfort, and resolution of scapular winging confirmed by clinical testing. This advancement provides shoulder orthopedic surgeons with a novel biomechanical solution for managing refractory scapular winging.

Introduction

The scapular winging was first described in 1723¹, and this disease was a rare scapulothoracic disorder characterized by altered motion and positioning of the scapula, known as scapular dyskinesis. This condition manifested as the prominence of the medial border of the scapula relative to the thorax, both at rest and during movement^2,3. Abnormal scapular motion arises from the inability of the scapulothoracic muscles to stabilize the scapula against the thorax, and potential causes included neurologic injury, soft tissue and bone abnormalities, or secondary effects from other shoulder j....

Protocol

This study was approved by the Ethics Committee of the First Affiliated Hospital of Army Medical University (BIIT2025060)

NOTE: The patient is a 21-year-old male presenting with right scapular pain and a disorder of mobility for over 2 years, during which conservative treatment has proven ineffective (Figure 1A). Preoperative CT scans of the patient's spine and scapula revealed no significant bony abnormalities (Figure 2A).

1. Patient preparation

1. Provide standard pre-surgical preparation. Verify the patient's informat....

Results

At 6 weeks postoperatively, the patient had normal shoulder joint mobility, with flexion at 180°, abduction at 180°, internal rotation reaching T7, and external rotation at 75°. There was no pain or discomfort in the scapulothoracic region, and the scapular wing test showed normal results (Figure 1B, Table 1, Table 2).

Discussion

Scapular winging was most commonly associated with serratus anterior muscle paralysis, while cases caused by rhomboid muscle paralysis were relatively uncommon. The rhomboid muscle paralysis could lead to winging of the medial border and lateral rotation of the inferior angle of the scapula. Therefore, the surgery technique aimed to restore the stretch of the rhomboid muscle by reconstruction of the paralyzed rhomboid using fascia lata autograft.

Scapular winging was commonly seen in the serra.......

Materials

List of materials used in this article

Name	Company	Catalog Number	Comments
Absorbable Lupine anchor	DePuy Mitek	210712	For insertion into the vertebral body and scapula, and for fixation of the graft
C-shaped X-ray imaging device	General Electric Company	https://www.gehealthcare.com/zh-cn/products/surgical-imaging/oec-one-cfd	The C-arm is utilized for intraoperative pedicle localization and pedicle screw placement
Orthocord	DePuy Synthes	https://www.jnjmedtech.com/en-US/product/orthocord-high-strength-suture#jnj-64e8f507470cb
WilSuture	Rejoin Medical	800648300	For braided suture grafts