Hi all these are the replies to my inquiry on an orthosis for scapula winging. I ended up incorporating a scapula pad and trimline into a TLSO that wrapped along her rib cage under her arm and up to her shoulder with a sternal pad to offer counter pressure and straps to keep everything in place. We shall see in the days to follow how this works for her. Thank you to everyone who replied.
I did one of these last year and it was quite effective. having a TLSO attached would work quite well I expect. It does take a huge force to keep the scapula from winging – theratogs or any soft brace won’t be enough. My patient was a very large man with an isolated long thoracic nerve injury so all he needed was the Shoulder Orthosis. I made it with 2 rigid panels (posterior over scapula and anterior over pectorals) and then a more flexible (LDPE) contralateral axillary pad which wrapped around the contralateral rib cage for pressure distribution. The anterior and posterior rigid shell curved slightly under the axilla but did not touch. There are 2 rigid bars – one over the top of the shoulder and one under the axilla – these bars connect the ant/post panels and form a rigid ring that the arm has to go through to don. (Comment: I did incorporate a modified version of this into my TLSO. Thanks! Paula)
I have a solution, I can discuss with you. I casted a female, similar to ashort transhumeral socket casting created a ring, vivak she wore it with achest strap kept scapula in place even during forward arm raise! Its takesa tremendous amount of compressive forces to hold scapula in place that thisis the ONLY thing that I have found to work – and it worked well.
I would definitely not use a hard TLSO on a YOUNG WOMAN. Its just notgoing to work for her mentally and sounds cruel. If your looking atdistal fixation just try a “mild” gentle posterior fixation perhapsequal contact distal rib contours shared with the trunk. Perhapsstraps and pad a “soft” MEDI compression fracture orthosis. I hope youget better suggestions than mine since I do believe less is best.S3 Shoulder stabilizer.It’s a tight fitting lycra-spandex type material with 2 1/2″ neoprene and Velcro strips that can be applied over the shoulder and offending scapula. It uses the low load, long exposure method to coax the scapula into position.It can be worn under the Scoli TLSO if you decide to go that route.I just ordered a SpinalQ brace for a patient from JG Medical at the request of a Physical Therapist. Our purposes are for posture but the company advertises that it works for scapula winging too. The brace claims to use “scapular retractor strap” technology. I haven’t got the brace yet or ever used one before, but it looks like it might work. Again thanks to everyone who wrote! Paula Martinek, LPO, Port Saint Lucie Fl
