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635 - Conservative treatment for scapular winging due to elastofibroma dorsi: a case report

Thursday, February 27, 2025

5:00 PM - 6:30 PM MST

Presenting Author(s)

AV

Andrew Y. Vassantachart, MD

Resident Physician
Loma Linda University Health Department of Physical Medicine and Rehabilitation
Loma Linda, California, United States

Co-Author(s)

BC

Brian Chau, MD

Assistant Professor
Loma Linda University Health Department of Physical Medicine and Rehabilitation and VA Loma Linda Healthcare System Department of Physical Medicine and Rehabilitation
Redlands, California, United States

Case Diagnosis: Elastofibroma dorsi

Case Description: An 87-year-old man presented with seven years of painless crepitus of his right scapula and limited range of motion (ROM). Exam noted shoulder flexion limited by 20 degrees, crepitus as a soft, mobile mass partially slid into the scapulothoracic space, and non-reducible medial scapular winging worsened by resisted protraction. Point of care ultrasound revealed an encapsulated mass with hypochoic and hyperechoic regions and later magnetic resonance imaging (MRI) confirmed a 9.0 x 2.0 cm mass consistent with an elastofibroma. Serial MRIs over two years did not show growth of the mass, so no biopsy or surgical intervention was pursued. He completed eight sessions of physical therapy with improvement to full shoulder range of motion and no functional impairments.

Discussions: Elastofibromas are a benign connective tissue lesion typically arising beneath the rhomboid major and latissimus dorsi muscles near the inferior angle of the scapula. Etiology remains unclear but may be related to hyperproliferation of fibroelastic tissue from repetitive microtrauma. Presentation is variable but commonly presents as mild shoulder discomfort or scapular crepitus. Diagnosis is often made with imaging modalities such as MRI whereas biopsy or excisional surgery is typically reserved for enlarging or more symptomatic lesions. We present the case of a patient with an elastofibroma dorsi who had improvement in scapular crepitus and shoulder ROM after physical therapy.

Conclusions: Patients with elastofibroma dorsi often do not receive surgical resection due to the benign nature of the lesion and low symptomatology. This case highlights a patient with medial scapular winging and diminished shoulder flexion who underwent conservative treatment and had improvement in both scapular crepitus and shoulder ROM. Clinicians must remain educated on uncommon causes of shoulder and scapular symptoms to understand the diagnostic and treatment options available to patients.