title: Scapular Winging Secondary to Apparent Long Thoracic Nerve Palsy in a Young Female Swimmer.
abstract: BACKGROUND
  In neurological diseases, winging of the scapula occurs because of serratus anterior muscle dysfunction due to long thoracic nerve palsy, or trapezius muscle dysfunction due to accessory nerve palsy. Several sports can cause long thoracic nerve palsy, including archery and tennis. To our knowledge, this is the first report of long thoracic nerve palsy in an aquatic sport.
  
  
  OBJECTIVE
  The present study is a rare case of winging of the scapula that occurred during synchronized swimming practice.
  
  
  METHODS
  The patient's history with the present illness, examination findings, rehabilitation progress, and related medical literature are presented.
  
  
  RESULTS
  A 14-year-old female synchronized swimmer had chief complaints of muscle weakness, pain, and paresthesia in the right scapula. Upon examination, marked winging of the scapula appeared during anterior arm elevation, as did floating of the superior angle. After 1 year of therapy, right shoulder girdle pain and paresthesia had disappeared; however, winging of the scapula remained.
  
  
  CONCLUSIONS
  Based on this observation and the severe pain in the vicinity of the second dorsal rib, we believe the cause was damage to the nerve proximal to the branch arising from the upper nerve trunk that innervates the serratus anterior.
authors.affiliation: Department of Judo Seifuku and Health Sciences, Faculty of Health Promotional Sciences, Tokoha University, Hamamatsu City, Shizuoka-ken, Japan.
authors.forename: Shiro
authors.initials: S
authors.lastname: Nawa
keywords: accessory nerve palsy; long thoracic nerve palsy; synchronized swimming; winging of the scapula