Treatment Risks

The prognosis is pretty good although recovery takes time. The injury mechanism is not clear; in many cases, these injuries are idiopathic. No specific exercise has been found to predispose patients to scapular winging, but perhaps the pads on some machines that rest on the shoulders (ie, calf raises, leg presses) could contribute to injury.

Scapular winging from long thoracic nerve palsy is typically more prominent at the inferior medial border of the scapula with shoulder flexion, whereas accessory nerve palsies cause superior medial scapular winging.

The diagnosis should include laboratory tests to screen for infectious and inflammatory causes, as well as EMG and nerve conduction studies to establish the level of injury. Treatment consists of relative rest and close follow-up--scapular winging often resolves spontaneously within 3 to 24 months.

Direct compression can result in long thoracic nerve palsy. Incorrect use of axillary crutches can damage the nerve. Lying comatose with the nerve compressed against the chest wall is another possible cause. This is sometimes referred to as "Saturday Night Palsy". It is unlikely, but can not be totally discounted, that this type of compression could occur during lengthy surgical procedures when the patient is under a general anaesthetic. Prolonged bed rest, particularly if the arm is abducted to prop the head up while reading, have caused the palsy!