Clinical Picture

Paralysis of the serratus anterior may come on immediately after a hard blow or after a chronic strain of the neck and shoulder regions. Frequently it may appear insidiously and sometimes even painlessly. In general, however, there is first noted an aching or "burning" discomfort of varying degrees of severity in the neck and shoulder, localized vaguely in the region of the scaleni. The pain may radiate down the arm or around toward the scapular area. This is followed, perhaps a day or two later, by inability to raise the arm properly and by winging of the scapula. After the weakness has been well established, the patient complains of a fleeting ache relieved by rest, inability to elevate the arm satisfactorily, and rapid tiring, as well as the deforming effect of a winged scapula.

The fully developed case of paralysis of the serratus anterior shows the classical picture of posterior winging of the scapula. This is usually accompanied by an inability

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close to che wa

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scapula permitted to rotate toward midline and wing out \

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Figure 1A: Normal position of the scapula at rest. Figure 1B: In serratus weakness the scapula rotates backward and upward, stretching the lower fibers of the trapezius. The rhomboids are shortened and contracted.

Figure 2B:The brace holds the lower portion of the scapula in forward rotation and abduction and presses it against the chest wall to limit winging; almost complete abduction of the arm is possible.

Figure 2A: Paralysis of the serratus anterior on the right. Note the winging and rotation of the scapula. There is inability to abduct the scapula and hence inability to abduct the arm.

Figure 2B:The brace holds the lower portion of the scapula in forward rotation and abduction and presses it against the chest wall to limit winging; almost complete abduction of the arm is possible.

Figure 2C: Photograph showing the brace in a position of rest. The cup fits snugly over the lower two thirds of the scapula, holding it in a position of abduction and preventing drooping of the shoulder or chronic stretch of the serratus anterior.

Figure 2D: View of the brace from the front. By counterpressure against the chest wall, the padded disks give firm stabilization of the scapular cup posteriorly.

to abduct the arm beyond 90 degrees (Fig. 2A). During attempts to do push-up exercises or efforts to perform other exercises which require strong anterior scapular fixation to the chest wall, the winging becomes very marked. Generally the shoulder is displaced forward and droops to some extent. There is frequently secondary weakness of some protagonist muscles, particularly the inferior portion of the trapezius, often accompanied by a tightness, sometimes painful, of certain antagonist muscles such as the rhomboids and pectoralis minor.

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