1. Teaching NeuroImages Neurology Resident and Fellow Section © 2013 American Academy of Neurology Two sisters with scapular winging

2. Patient 1: presented with lateral displacement of the superior angle of both scapulae, accentuated by arm abduction. Patient 2: presented with medial and superior shift of the left scapula, with the inner border lifted off the thoracic wall, and a lateral displacement of the upper angle. Monforte M et al. Clinical Vignette

3. Monforte M et al.

5. Complicated scapular winging Scapular winging (SW) is a common sign in neuromuscular disorders. Besides “pure” phenotypes due to single muscle weakness, complicated SW can occur when a combination of different scapular fixators is involved by a myopathy. Patient 1 and 2 are affected by facioscapulohumeral muscular dystrophy. – Patient 1: isolated trapezius weakness – Patient 2: combined serratus anterior and trapezius weakness Both clinical diagnoses were confirmed by muscle MRI, a useful tool in identifying single muscle involvement even in complex clinical situations. Monforte M et al.