Isolated paralysis of the serratus anterior. A report of 20 cases.

A description is given of 20 patients with winging of the scapula. The majority had suffered spontaneous severe pain in the region of the shoulder followed about two weeks later by the deformity and associated loss of function. Only in three patients was there a clear history of trauma. Some patients may have strained the arm, but in the majority no single factor heralded the problem. Most of the patients were followed up for more than two years and it became clear that functional recovery could take up to this time to be complete. However, careful examination revealed that often a slight degree of winging remained. No specific treatment apart from gentle physiotherapy was prescribed and certainly no operative procedures. It is considered that a number of these cases were examples of neuralgic amyotrophy.