Injuries to the long thoracic and spinal accessory nerves present challenges in diagnosis and treatment. Palsies of the serratus
anterior and trapezius muscles lead to destabilization of the scapula with medial and lateral scapular winging, respectively.
Although nonoperative treatment is successful in some patients, failures have led to the evolution of surgical techniques
involving various combinations of fascial graft and/or transfer of adjacent muscles. Our preferred method of reconstruction
for serratus anterior palsy is a two-incision, split pectoralis major transfer without fascial graft. For trapezius palsy,
we prefer a modified version of the Eden-Lange procedure. At a minimum followup of 16 months (mean, 47 months), six patients
who underwent the Eden-Lange procedure showed improvement in mean American Shoulder and Elbow Surgeons Shoulder scores (33.3–64.6),
forward elevation (141.7–151.0), and visual analog scale (7.0–2.3). At a minimum followup of 16 months (mean, 44 months),
10 patients (11 shoulders) who underwent split pectoralis transfer also improved American Shoulder and Elbow Surgeons Shoulder
scores (53.3–63.8), forward elevation (158.2–164.5), and visual analog scale (5.0–2.9). We encountered two complications,
both superficial wound infections. These tendon transfers were effective for treating scapular winging in patients who did
not respond to nonoperative treatment.
Level of Evidence: Level IV, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.
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