title: Medial scapular muscle detachment: clinical presentation and surgical treatment.
abstract: 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
  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.
authors.affiliation: Shoulder Center of Kentucky, Lexington, KY, USA.
authors.forename: W Ben
authors.initials: WB
authors.lastname: Kibler
authors.affiliation: Shoulder Center of Kentucky, Lexington, KY, USA. Electronic address: ascia@lexclin.com.
authors.forename: Aaron
authors.initials: A
authors.lastname: Sciascia
authors.affiliation: Department of Rehabilitation Sciences, University of Kentucky, College of Health Science, Lexington, KY, USA.
authors.forename: Tim
authors.initials: T
authors.lastname: Uhl
mesh_terms: D000328:Adult; D001134:Arm Injuries / Q000601:surgery; D019567:Back Injuries / Q000601:surgery; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D018482:Muscle, Skeletal / Q000293:injuries* / Q000601:surgery*; D016059:Range of Motion, Articular; D012189:Retrospective Studies; D012540:Scapula / Q000293:injuries / Q000601:surgery*; D012782:Shoulder; D020069:Shoulder Pain / Q000209:etiology; D055815:Young Adult
keywords: Case Series; Level IV; Scapula; Treatment Study; chronic injury; muscle detachment; outcomes; scapula surgery; scapular pain