title: Scapular Bracing is Effective in Some Patients but Symptoms Persist in Many Despite Bracing.
abstract: BACKGROUND
  A scapular-protecting brace is one option for treating patients with a winging scapula in isolated serratus palsy. However, outcomes after brace treatment have been reported in only a few studies, and to our knowledge, none has results reported at long-term beyond 10 years.
  
  
  OBJECTIVE
  We asked: (1) What was the average length of time patients wore the brace? (2) Did scapular winging and ROM improve with brace treatment? (3) Was pain decreased? (4) Did the duration of symptoms before brace treatment influence the outcome?
  
  
  METHODS
  Between 1980 and 1999, we treated 110 patients with a scapular-protecting brace. General indications for this treatment included electroneuromyography-verified isolated serratus palsy, 3 cm or greater scapular winging, and limited ROM. For patients with scapular winging less than 3 cm we used observation and avoidance of all heavy work or lifting. Of the patients treated with a brace, 55 (50%) were available at a minimum followup of 10 years (mean, 22 years; range, 10-28 years). Mean patient age was 30 years at the onset of symptoms (range, 15-52 years). Brace use was based on patient self-report, and we determined the degree of scapular winging and ROM clinically and level of pain by chart review before and after treatment.
  
  
  RESULTS
  The brace was applied a mean 6 months (median, 5 months) after onset of symptoms. Mean duration of brace use was 10 months for 12 hours per day. Winging of the scapula, measured in 90° flexion without resistance, disappeared in 35 patients (64%) with brace use. Flexion averaged 153° and abduction 168°. Ten patients (18%) were pain-free during exertion and 18 (33%) at rest. Pain at rest was present in 37 patients (67%); of those, it was present only seldom in 15 (27%), sometimes present in 21 (38%), and one patient (2%) experienced continuous pain at rest despite brace treatment. With the number of patients available, there were no differences between patients who started brace treatment early (within 6 months of onset of symptoms) and those who started later (more than 6 months after symptom onset) in terms of improvement of scapular winging in flexion at 90° with resistance (mean, 1.2±2.0 cm vs 1.7±2.3 cm; p=0.415; 95% CI, -1.6 to 0.7), better flexion (mean, 156°±17° flexion vs 149°±28° flexion; p<0.253; 95% CI, -5 to 19), or improvement in other parameters that we measured.
  
  
  CONCLUSIONS
  Compliance was high for scapular-protecting brace treatment in patients with serratus palsy but recovery was incomplete for many patients, most of whom still had some pain and a large proportion still had some degree of scapular winging. We continue to use scapular bracing for treating patients who have 3 cm or more scapular winging and limited ROM, and whose work or hobbies demand motions causing winging, although we counsel our patients that recovery is likely to be incomplete.
  
  
  METHODS
  Level IV, therapeutic study.
authors.affiliation: Research Institute Orton, Invalid Foundation and Orton Orthopaedic Hospital, Tenholantie 10, 00280, Helsinki, Finland, martti.vastamaki@invalidisaatio.fi.
authors.forename: Martti
authors.initials: M
authors.lastname: Vastamäki
authors.forename: Veera
authors.initials: V
authors.lastname: Pikkarainen
authors.forename: Heidi
authors.initials: H
authors.lastname: Vastamäki
authors.forename: Leena
authors.initials: L
authors.lastname: Ristolainen
mesh_terms: D000293:Adolescent; D000328:Adult; D064131:Back Muscles / Q000503:physiopathology*; D001696:Biomechanical Phenomena; D001915:Braces; D004867:Equipment Design; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D010243:Paralysis / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D010349:Patient Compliance; D016059:Range of Motion, Articular; D020127:Recovery of Function; D012189:Retrospective Studies; D012540:Scapula / Q000503:physiopathology*; D012785:Shoulder Joint / Q000503:physiopathology*; D020069:Shoulder Pain / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult