Teaching Video Neuro Images : Complicated scapular winging

Scapular winging (SW) is a common sign in neuromuscular disorders. Besides “pure” phenotypes due to single muscle weakness often secondary to nerve injuries or dysfunctions,1,2 the phenotype can be complicated when a combination of different scapular fixators is involved by a myopathy. We show an example of 2 sisters with facioscapulohumeral muscular dystrophy (video 1 on the Neurology® Web site at www.neurology.org). In patient 1, the SW is caused by an isolated trapezius weakness. Conversely, in patient 2, the left SW can be attributed on clinical grounds to a combined serratus anterior and trapezius weakness. Both hypotheses are confirmed by muscle MRI (figure 1).