Differential Diagnosis for Scapular Winging with Atrophy and Neurological Symptoms
Single Most Likely Diagnosis
- Long Thoracic Nerve Palsy: This condition is characterized by winging of the scapula due to weakness of the serratus anterior muscle, which is innervated by the long thoracic nerve. Atrophy over the scapula, pain, and numbness along the medial border, especially with activities like lateral pulldowns, can occur due to nerve compression or injury.
Other Likely Diagnoses
- Spinal Accessory Nerve Palsy: This condition affects the trapezius muscle, leading to scapular winging. While the primary symptom is weakness and atrophy of the trapezius, it can also cause pain and discomfort, especially with movements involving the scapula.
- Thoracic Outlet Syndrome: This syndrome involves compression of the nerves and/or blood vessels that pass into the thoracic outlet (the space between your collarbone and first rib). It can cause pain, numbness, and weakness in the neck and shoulder, which might be exacerbated by activities like lateral pulldowns.
Do Not Miss Diagnoses
- Cervical Radiculopathy: Although less likely, cervical radiculopathy (nerve root compression in the cervical spine) can cause pain, numbness, and weakness in the shoulder and scapular area. Missing this diagnosis could lead to prolonged suffering and potential worsening of neurological symptoms.
- Tumor or Mass Compressing Nerves: A tumor or mass in the thoracic or cervical region could compress nerves, leading to the described symptoms. This is a critical diagnosis not to miss due to the potential for serious underlying conditions requiring prompt medical intervention.
Rare Diagnoses
- Poland Syndrome: A rare congenital condition characterized by underdevelopment or absence of the chest muscle (pectoralis major) on one side of the body and webbing of the fingers of the hand on the same side. It can also involve the serratus anterior muscle, potentially leading to scapular winging.
- Neurogenic Thoracic Outlet Syndrome Due to Rare Causes: Certain rare conditions, such as a cervical rib or abnormal first rib, can cause neurogenic thoracic outlet syndrome, leading to the symptoms described. These are less common but should be considered in the differential diagnosis to ensure comprehensive evaluation.