Hi XXXXXXX thanks for writing to XXXXXXX

So, you are struck with one of the rarest conditions in orthopedics for which the treatment is suboptimal - THE WINGING SCAPULA.

All the MRI findings are the result of degenerative changes & Post operative sequelae occuring in the rotator cuff, AC joint & Gleno-humeral joint.

This is just to let you know that winging of scapula is caused by injury to one of the three nerves
* Trapezius winging resulting from spinal accessory nerve injury
* Serratus anterior winging resulting from long thoracic nerve injury
* Rhomboideus winging resulting from dorsal scapular nerve injury

SO, AN EMG (ELECTRO MYOGRAPHICAL TESTING) STUDY OF ALL THE SCAPULOTHORACIC MUSCLES IN ESSENTIAL FOR MAKING THE CORRECT DIAGNOSIS AND KNOWING THE CAUSE OF WINGING. Before taking up a case of winging scapula for surgery, it is essential to know the exact involved motor unit (the muscle involved) otherwise surgery will end in disaster. Because as stated above, apart from Trapezius winging is also caused by serratus anterior and rhomboid paralysis also.

The fact that you were taken up for EDEN-LANGE TRANSFER indicates that your winging resulted due to trapezius paralysis. And this surgery would have offered you a good outcome and improved functional range of motion.

There are a few complications that can be attributed to surgery such as PAIN, INFECTION, NERVE INJURY, STIFFNESS etc and inability to return to preinjury status.

As you still have severe pain & weakness, I suspect paralysis of other motor units like serratus anterior or rhomboids.
MARMOR-BECHTOL PROCEDURE is indicated for serratus anterior paralysis in which sterno costal head of pectoralis major is transferred to inferior corner of scapula.

If everything else fails, then the last option is SCAPULO-THORACIC FUSION which aims at providing STABILITY AT THE COST OF MOBILITY.

Hope I have addressed your issues. Happy to help for any more clarifications.

Good day

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Hi XXXXXXX I have already mentioned about the MRI findings in the 2nd paragraph of my answer (May be, you might not have noticed it).

Anyway, I will explain once again about your MRI findings -

* There is minimal fluid collection near the rhomboids minor muscle which indicates some inflammation or infection
* Distal supraspinatus tendinopathy indicates that this tendon is also inflammed and diseased. This supraspinatus muscle helps in abduction of the arm. If it is diseased, then there will be limitation of abduction
* Small articular surface (tear facing the joint side) in the distal supraspinatus tendon - this sentence is self explanatory
* Hypertrophic changes in the Acromioclavicular joint (AC joint)- indicates "arthritic" or damaged AC joint
* Mild glenohumeral joint effusion - indicates fluid collection in the shouder joint proper.

Its practically impossible to tell whether you need another surgery based on your symptoms & MRI findings. A detailed physical examination is needed to make a decision.

Regards

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