September 2015 Case Challenge: Scapular Winging After Cervical Lymph Node Biopsy

By Aziz Shaibani, MD, FACP, FAAN

A 37-year-old woman who had a cervical lymph node biopsy three months earlier presented with pain and stiffness of the right upper back muscles that did not respond to gabapentin. She developed tingling of the right little fingers a couple of weeks earlier. A chiropractic manipulation gave her a temporary relief.

EMG is expected to show denervation of:

Serratus anterior
Levator scapulae

Tingling of the right little finger that developed later was:

Not related to the scapular winging,
Due to a related thoracic outlet syndrome
Due to a related focal ulnar neuropathy at the elbow
Due to an incidental C8 radiculopathy
Is associated with reduced media CMAP reduction

Read the October 2015 edition of Practical Neurology® for the Solution.


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Launched in January 2002, Practical Neurology strives to enhance quality of care and improve the daily operation of neurology practices. Each month, our experts explain the real-world significance of recent advances in neurologic science and offer step-by-step advice on how to overcome the clinical and business challenges neurologists face. Our straightforward, how-to articles give neurologists tools they can put into practice right away.