Driving is an essential occupation for many people around the globe, and it is one of the methods we use to mobilize in our communities, go to work, take our children to schools, go to the supermarkets to buy groceries, visit our loved ones, travel somewhere, or head to where we want to be. In the field of healthcare and rehabilitation, people who sustain a medical injury or become disabled might lose their ability to drive a car temporarily or permanently. Yet, some of us might find it hard to clinically judge the patients’ future ability to return to driving, hold on driving temporarily, retire from driving, or perhaps find another method to maintain the patient’s engagement in community mobility, but how? There is more to be explored beyond what we might expect to address driving rehabilitation in our services, and specialized occupational therapy can have an effective role in addressing your patient's concerns about their ability to drive through evidence-based practice and clinical reasoning skills
Winging of the scapula affects the scapulo-humeral rhythm, resulting in decreased strength and limitation in motion, particularly flexion and abduction. It can be a source of considerable pain and can be incapacitating enough to affect the ability to lift, pull, and push heavy objects, as well as to perform daily activities of living, such as brushing one’s hair, dressing, and carrying grocery bags.
Currently, no treatment method is considered to be the first line for the resolution of scapular winging. The recommended treatment for initial treatment is pain control. Management is either conservative, thru physical therapy, or surgical. However, some studies prefer a non-operative treatment especially in case of older patients who are sedentary and with minimal symptoms. But if intervention is not initiated early on in the progression of the condition, patients can develop subsequent issues such as adhesive capsulitis, subacromial impingement, and other pathogenesis involving the brachial plexus.
Surgically, there are three methods available - Split Pectoralis Major Transfer, Modified version of the Eden-Lange Procedure, and Scapuloplexy. The case we are discussing today is surgical management of scapular winging using the Split Pectoralis major Transfer