- 期刊
外傷性斜方肌失用性萎縮所致翼狀肩胛：病例報告
Winging Scapula Due to Traumatic Trapezius Muscle Disuse Atrophy: A Case Report
摘要
翼狀肩胛在臨床上實不多見，且常常被忽略。可是一旦產生除了會影響上肢的活動範圍度，造成功能的受限，也會影響美觀。而臨床上造成翼狀肩胛的原因甚多，包括外傷、感染、醫源性傷害、先天異常、以及肩胛周圍神經、肌肉、骨骼、關節的問題。而外傷造成的翼狀肩胛常常是因為長胸神經、脊副神經、或肩胛背神經因拉扯、壓迫而受損，造成所支配的前鋸肌、斜方肌、及菱形肌萎縮無力。但外傷造成單純斜方肌失用性萎縮而導致翼狀肩胛更為罕見，但預後甚佳。 本病例為二十八歲男性病人，因騎機車摔倒造成左側肢體擦傷、左上臂活動受限，初步X光檢查無骨折之發現。受傷一年後，理學檢查發現左側有翼狀肩胛情形，且合併有肌力減弱及肩關節活動受限，懷疑有臂神經叢或其他周邊神經的損傷，經一系列影像學檢查、神經肌電圖之檢查，排除周邊神經病變。確定為外傷後斜方肌失用性萎縮所致翼狀肩胛。經積極之復健治療後，病患之肩關節活動大為改善，翼狀肩胛的情形也消失。 所以臨床上對於懷疑有翼狀肩胛的病人，除了詳細病史詢問、理學檢查及影像學檢查外、神經肌電圖的檢查更可以幫助臨床醫師區分是否合併有神經的損傷，並對翼狀肩胛造成的原因做正確的診斷，以利治療計畫的安排。
並列摘要
Winging scapula is uncommon clinically and easily ignored. It not only leads to a limited range of motion of the upper extremities, but impairs functional activity and body appearance as well. Many etiologies can induce winging scapula, including trauma, infection, iatrogenic injury, congenital abnormality, and the impairment of periscapular nerves, muscles, bones and joints. Traumatic winging scapula is often the result of long thoracic nerve, spinal accessory nerve, or dorsal scapula nerve stretch or compression, which causes weakness and atrophy of the serratus anterior muscle, trapezius muscle, or rhomboid muscle. Winging scapula due to disuse atrophy of the traumatic trapezius muscle is rare, but the prognosis is good. This report presents the case of a 28-year-old male who suffered from multiple abrasion wounds on the left-side limbs and a limitation of range of motion (ROM) of the left upper arm due to a motorcycle accident. There was no evidence of any bony abnormality in the initial X-ray checkup. One year later, physical examination revealed a left winging scapula with persistent left arm weakness, and an associated ROM limitation of the left shoulder, so brachial plexopathy or another peripheral neuropathy was suspected. A series of image studies and electrophysiological examinations were performed, but peripheral neuropathy was excluded. Winging scapula secondary to traumatic trapezius muscle disuse atrophy was diagnosed. After aggressive rehabilitation, the ROM of the left shoulder was much improved and the winging scapula also disappeared. Thus, for the patient suspected of having winging scapula, a detailed history-taking, physical examination, and image study are very important. Furthermore, nerve conduction studies and electromyography examinations can help physicians define the correct etiology of the winging scapula, and whether it is combined with nerve injury. An appropriate rehabilitation program is essential to improve the patient's functional activity and body appearance.