Scapular Winging in a Young Tennis Player: A Case Report

Abstract

BACKGROUND: Facioscapulohumeral muscular dystrophy (FSHD) is often characterized by weakness of the scapular stabilizing muscles. FSHD is a genetic disorder in which skeletal muscles of the face (facio), the shoulder blades (scapulo), arms (humeral), and other muscles progressively weaken over time. 5 CASE PRESENTATION: A 13-year-old tennis player developed progressive right shoulder pain and limited range of motion. He did not have a precedent injury and his symptoms were exacerbated by tennis. His exam was notable for medial scapular winging. An electromyogram was read as a long thoracic nerve palsy, presumed to be a tennis-related traction injury. He was treated with aggressive therapy, taping, and bracing to improve scapulothoracic and glenohumeral biomechanics for optimal upper extremity strength and range of motion. OUTCOME AND FOLLOW-UP: His pain and motion improved, but he was unable to return to his prior level of tennis competition. Eighteen months after the initial diagnosis, the patient presented with similar symptoms and findings on the contralateral side, raising concern for a neuromuscular etiology. DISCUSSION: A repeat electromyogram and genetic tests were consistent with FSHD, rather than a sport-related peripheral nerve injury. JOSPT Cases 2023;3(2):96–99. Epub: 13 March 2023. doi:10.2519/josptcases.2023.10887