Medial scapular muscle detachment: clinical presentation and surgical treatment

Background: This study describes the clinical presentation and preliminary outcomes in a cohort of patients treated for detachment of the medial scapular stabilizing muscles. Methods and methods: The study included 72 patients who underwent reattachment of the lower trapezius and rhomboid muscles. Patients presented with a history of a high level of medial scapular border pain during activity and inability to perform overhead or forward flexion activities. Clinical examination demonstrated palpable tenderness along the medial scapular border, palpable defect along the medial border muscles, scapular dyskinesis, decreased scapular/rotator cuff strength, and modification of symptoms by manual scapular repositioning. Surgical exploration revealed detachment of the lower trapezius muscle or rhomboid muscles, requiring muscle reattachment to the scapula. Clinical outcomes were measured by the American Shoulder and Elbow Surgeons (ASES) self-report form, with comparisons made between the overall scores and subcomponents obtained at initial evaluation, discharge from active care, and postdischarge follow-up. Results: Time from injury to treatment averaged 52 months, and time from surgery to discharge was 7.4 months. ASES scores significantly improved from initial evaluation (39 +/- 16) to discharge (63 +/- 21) (P < .001). At medium-term follow-up (n = 23), ASES scores significantly improved from initial evaluation (38 +/- 14) to discharge (69 +/- 20) (P < .001). Conclusions: Scapular muscle detachment appears to be a clinically identifiable syndrome with a homogeneous set of history and physical findings. Surgical treatment can significantly reduce pain and improve functional outcomes. Level of evidence: Level IV, Case Series, Treatment Study. (C) 2014 Journal of Shoulder and Elbow Surgery Board of Trustees.