Responses Winging Scapula
Cheryl Lewis
Description
Collection
Title:
Responses Winging Scapula
Creator:
Cheryl Lewis
Date:
8/21/2014
Text:
Hello All,
Thanks to everyone who has responded - it is clear I am not the only one who has struggled with this. I have posted all the responses below.
I plan to try my own design to see if I can improve his situation somewhat - it sounds like solving the problem isn't really an option - any improvement would be considered a success in the case of this problem. I am going to try a square steel tube curved over the shoulder and connected to pectoral and scapular pads. I will also have an axillary round rod connecting the pads as well with a pressure pad to prevent lateral migration of the scapula - I suspect that the winging increases with increased lateral migration/rotation so I am hopeful that this second pressure point will help. There will be a contralateral axillary strap and pad to hold the entire thing in position. I am also considering a belt connection to prevent upward migration.
I will keep people posted on my success or failure with this! My Plan B is to try a DMO elastic shoulder orthosis. If he was smaller I would try the OTS device I saw - if you google Winging scapula orthosis and check out the images you will see an OTS shoulder pad device that looks like football pads - I think it is for BMX biking? It has promise for a bilateral case.
Here are the other responses ....
Just
thinking a bit out of the box here, but have you considered an SDO or DMO
shirt? The lycra can be applied in such a way that when it is zipped up
you can get correction on double major scoliosis curves. He is a large
man and may be out of the capacity of the materials, but may be worth a
conversation with the guys at SDO (Sensory Dynamic Orthosis from Pro Tech).
There is an article in JPO from a few
years ago with a design and how to fabricate. It was
helpful at least to see an idea.
I had
a similar case a few years ago and many articles I can't across were
outdated. The key is compressive forces anterior my and
posteriorly while having a point of anchor. The first attempt would
continuely rotate because I was entirely focused on compressing the
scapula.
I did
a body jacket style decreasing the AP measurement on the affected
scapula. I also had plastic from previous devise that
rotated so was able to utilize that when casting the second device.
I also involved prosthetist for a y strap over the shoulder. I had
to additional straps to maintain depressed scapula. I
believe I used a copolymer plastic with aliplast liner.
If I
am able to find pics I will try to forward. If nothing else might
spark some ideas.
I published a case study on this in JPO a few years ago
- <URL Redacted> I
have done one other device since then, a little different design.
Maintaining the scapula when the humerus is above the shoulder we have
not been able to achieve. Some patients have contacted me since the
article. One reported success with a Japanese orthotist who modified a TL
orthosis to the patients satisfaction. I would be happy to send photos to
your email address.
Don McGovern, CPO, FAAOP
PS You may want to check the references on the
article, some of them used the steel
Have you thought about
fabricating a Pectus Carinatum type device to apply a corrective force to the
scapula?
How ironic. I just had the same case in my office yesterday. There is an article on the oandp.com website that lists design parameters and materials that were used on a particular patient. Your gentleman is a great deal larger than the patient in the article and a little bit bigger than my patient. He may not get total correction but if he regains ROM and improves, then you did a good job. I was able to correct my patient with moderate A/P pressure over the chest and scapula.
My dilemma now is finding a lab to make the device for me, leaning towards Spinal Tech (no lab in my facility). I will send you a link for the article when I get into the office later.--------------
Cheryl, short of surgical stabilization, which may not even be possible, I don't believe there is any orthotic intervention that can be helpful. I haven't seen one of these in years, but that was the case back then and I doubt things have changed. Unfortunate, but likely the truth. If there is something out there that works, I'd love to see it. Thanks.
Cheryl Lewis BSc(HK), CO(c)
Certified Orthotist
Owner, CK Ortho Inc
Ph 519-436-9670
Thanks to everyone who has responded - it is clear I am not the only one who has struggled with this. I have posted all the responses below.
I plan to try my own design to see if I can improve his situation somewhat - it sounds like solving the problem isn't really an option - any improvement would be considered a success in the case of this problem. I am going to try a square steel tube curved over the shoulder and connected to pectoral and scapular pads. I will also have an axillary round rod connecting the pads as well with a pressure pad to prevent lateral migration of the scapula - I suspect that the winging increases with increased lateral migration/rotation so I am hopeful that this second pressure point will help. There will be a contralateral axillary strap and pad to hold the entire thing in position. I am also considering a belt connection to prevent upward migration.
I will keep people posted on my success or failure with this! My Plan B is to try a DMO elastic shoulder orthosis. If he was smaller I would try the OTS device I saw - if you google Winging scapula orthosis and check out the images you will see an OTS shoulder pad device that looks like football pads - I think it is for BMX biking? It has promise for a bilateral case.
Here are the other responses ....
Just
thinking a bit out of the box here, but have you considered an SDO or DMO
shirt? The lycra can be applied in such a way that when it is zipped up
you can get correction on double major scoliosis curves. He is a large
man and may be out of the capacity of the materials, but may be worth a
conversation with the guys at SDO (Sensory Dynamic Orthosis from Pro Tech).
There is an article in JPO from a few
years ago with a design and how to fabricate. It was
helpful at least to see an idea.
I had
a similar case a few years ago and many articles I can't across were
outdated. The key is compressive forces anterior my and
posteriorly while having a point of anchor. The first attempt would
continuely rotate because I was entirely focused on compressing the
scapula.
I did
a body jacket style decreasing the AP measurement on the affected
scapula. I also had plastic from previous devise that
rotated so was able to utilize that when casting the second device.
I also involved prosthetist for a y strap over the shoulder. I had
to additional straps to maintain depressed scapula. I
believe I used a copolymer plastic with aliplast liner.
If I
am able to find pics I will try to forward. If nothing else might
spark some ideas.
I published a case study on this in JPO a few years ago
- <URL Redacted> I
have done one other device since then, a little different design.
Maintaining the scapula when the humerus is above the shoulder we have
not been able to achieve. Some patients have contacted me since the
article. One reported success with a Japanese orthotist who modified a TL
orthosis to the patients satisfaction. I would be happy to send photos to
your email address.
Don McGovern, CPO, FAAOP
PS You may want to check the references on the
article, some of them used the steel
Have you thought about
fabricating a Pectus Carinatum type device to apply a corrective force to the
scapula?
How ironic. I just had the same case in my office yesterday. There is an article on the oandp.com website that lists design parameters and materials that were used on a particular patient. Your gentleman is a great deal larger than the patient in the article and a little bit bigger than my patient. He may not get total correction but if he regains ROM and improves, then you did a good job. I was able to correct my patient with moderate A/P pressure over the chest and scapula.
My dilemma now is finding a lab to make the device for me, leaning towards Spinal Tech (no lab in my facility). I will send you a link for the article when I get into the office later.--------------
Cheryl, short of surgical stabilization, which may not even be possible, I don't believe there is any orthotic intervention that can be helpful. I haven't seen one of these in years, but that was the case back then and I doubt things have changed. Unfortunate, but likely the truth. If there is something out there that works, I'd love to see it. Thanks.
Cheryl Lewis BSc(HK), CO(c)
Certified Orthotist
Owner, CK Ortho Inc
Ph 519-436-9670
Citation
Cheryl Lewis, “Responses Winging Scapula,” Digital Resource Foundation for Orthotics and Prosthetics, accessed November 6, 2024, https://library.drfop.org/items/show/236685.
