Winged scapula caused by dorsal scapular neuropathy combined with suprascapular neuropathy: A case report

RATIONALE: Scapular winging is caused by neuromuscular dysfunction of shoulder stabilizer muscles. Clinically, a winged scapula can be easily diagnosed by typical physical findings. We report a case of atypical winged scapula caused by dorsal scapular neuropathy combined with suprascapular neuropathy, which has rarely been reported. PATIENT CONCERNS: A 25-year-old right-handed male was admitted to the clinic due to right arm weakness for 1 year. On physical examination, right winged scapula with medially rotated inferior angle was observed on flexion. DIAGNOSES: Under the diagnostic impression of a winged scapula due to long thoracic nerve injury based on physical examination, electrodiagnostic study was performed. However, the results showed right dorsal scapular neuropathy combined with suprascapular neuropathy. INTERVENTIONS: Neck and right shoulder MRI were also performed to rule out other causes of winged scapula, but these showed only a partial thickness tear of the rotator cuff tendon. The patient received rehabilitation. OUTCOMES: The symptoms have not improved. LESSONS: In this case, combined suprascapular neuropathy might contribute to scapular winging and can confuse the diagnosis of winged scapula based on physical findings. This is the first report that indicates suprascapular neuropathy as a contributing factor of scapular winging.