Which muscle paralysis can cause ‘Winging of scapula’?
**Core Concept**
The 'winging of the scapula' is a clinical sign characterized by the protrusion of the scapula from the thoracic wall due to weakness or paralysis of the muscles that stabilize it. The primary muscle responsible for this phenomenon is the serratus anterior, which is essential for scapular rotation and stabilizing it against the thoracic wall.
**Why the Correct Answer is Right**
The serratus anterior muscle originates from the superior border of the first to ninth ribs and inserts into the costal surface of the scapula, specifically the medial border. When this muscle is paralyzed, the scapula loses its medial support, leading to its winging. This is because the serratus anterior plays a crucial role in the upward rotation of the scapula during arm abduction and in stabilizing the scapula against the thoracic wall. The resulting weakness can lead to the characteristic winging of the scapula.
**Why Each Wrong Option is Incorrect**
**Option B:** Supraspinatus is a muscle of the rotator cuff that assists in abduction of the arm at the shoulder joint, but it does not contribute to the stabilization of the scapula against the thoracic wall. Therefore, paralysis of the supraspinatus would not lead to winging of the scapula.
**Option C:** Teres minor is another muscle of the rotator cuff that assists in adduction and external rotation of the arm. Like the supraspinatus, it does not play a significant role in scapular stabilization.
**Option D:** Deltoid muscle is involved in shoulder abduction, flexion, and extension, but it does not contribute to the stabilization of the scapula against the thoracic wall.
**Clinical Pearl / High-Yield Fact**
The 'winging of the scapula' is a classic clinical sign of serratus anterior paralysis, often seen in patients with long-standing neurological conditions such as amyotrophic lateral sclerosis (ALS) or spinal muscular atrophy (SMA). It is essential to recognize this sign to identify the underlying muscle weakness and initiate appropriate management.
**✓ Correct Answer: A. Serratus anterior**