{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2022,3,30]],"date-time":"2022-03-30T01:39:31Z","timestamp":1648604371069},"reference-count":37,"publisher":"Oxford University Press (OUP)","issue":"1","license":[{"start":{"date-parts":[[2021,9,1]],"date-time":"2021-09-01T00:00:00Z","timestamp":1630454400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2021,12,16]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>Winged scapula (WS) is a critical complication of axillary surgery in patients treated for breast cancer, and is associated with pain, impairment of the upper extremity\u2019s function and poor performance in daily activities.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Sources of data<\/jats:title>\n                  <jats:p>A systematic review and meta-analysis were performed following the PRISMA guidelines. Two independent reviewers searched PubMed, Embase and Virtual Health Library databases from January 1, 2000 to December 1, 2020. Clinical studies evaluating the diagnosis and epidemiology of WS among breast cancer surgery (BCS) patients were included.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Areas of agreement<\/jats:title>\n                  <jats:p>The diagnosis of WS relies almost entirely on physical assessment. Studies have suggested a high variability in the report of the incidence of WS given the subjectivity of its diagnosis, and the different criteria used during clinical assessment.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Areas of controversy<\/jats:title>\n                  <jats:p>The diagnosis of WS in BCS patients remains a challenge given the lack of standardized diagnostic protocols. Physical examination cannot rely on one manoeuvre only, as it may overlook patients with subtle injuries or overweight and contributing to the underreporting of its incidence.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Growing points<\/jats:title>\n                  <jats:p>BCS patients undergoing axillary lymph node dissection experience a significantly higher incidence of WS than those undergoing sentinel lymph node dissection. The global incidence of WS after BCS is 16.79%. Additionally, the anterior flexion test and the push-up test are the most commonly performed diagnostic manoeuvers.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Areas timely for developing research<\/jats:title>\n                  <jats:p>Further studies should aim for objective diagnostic tests, especially when the condition is not evident.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/bmb\/ldab021","type":"journal-article","created":{"date-parts":[[2021,8,9]],"date-time":"2021-08-09T11:14:30Z","timestamp":1628507670000},"page":"23-35","source":"Crossref","is-referenced-by-count":0,"title":["Diagnosis and epidemiology of winged scapula in breast cancer patients: A systematic review and meta-analysis"],"prefix":"10.1093","volume":"140","author":[{"given":"Milger P","family":"Plaza Meza","sequence":"first","affiliation":[{"name":"Department of General Surgery, Hospital Universitario Perif\u00e9rico de Coche, Av. Intercomunal de El Valle con Calle Zea, 1090 Caracas, Venezuela"},{"name":"Cl\u00ednica de Prevenci\u00f3n del Cancer, Sociedad Anticancerosa de Venezuela, Av. Norte 3, Can\u00f3nigos a Esperanza, N\u00b0 43, Parroquia Altagracia, 1010 Caracas, Venezuela"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Theodorakys","family":"Mar\u00edn Ferm\u00edn","sequence":"additional","affiliation":[{"name":"Department of Traumatology, Hospital Universitario Perif\u00e9rico de Coche, Av. Intercomunal de El Valle con Calle Zea, 1090 Caracas, Venezuela"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nicola","family":"Maffulli","sequence":"additional","affiliation":[{"name":"Department of Trauma and Orthopaedic Surgery, AOU San Giovanni di Dio e Ruggi D\u2019Aragona, Via San Leonardo 1, 84131 Salerno, Italy"},{"name":"Department of Medicine, Surgery and Dentistry, University of Salerno, Via S. Allende, 84081 Baronissi, Italy"},{"name":"Queen Mary University of London, Barts and the London School of Medicine and Dentistry, Centre for Sports and Exercise Medicine, Mile End Hospital, 275 Bancroft Road, London E1 4DG, UK"},{"name":"School of Pharmacy and Bioengineering, Keele University School of Medicine, Thornburrow Drive, Stoke on Trent, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2021,9,1]]},"reference":[{"key":"2021121701073151500_ref1","doi-asserted-by":"crossref","first-page":"364","DOI":"10.5435\/JAAOS-20-06-364","article-title":"Scapular dyskinesis and its relation to shoulder injury","volume":"20","author":"Kibler","year":"2012","journal-title":"J Am Acad Orthop Surg"},{"key":"2021121701073151500_ref2","doi-asserted-by":"crossref","first-page":"352","DOI":"10.1111\/j.1600-0838.2010.01274.x","article-title":"Scapular positioning and movement in unimpaired shoulders, shoulder impingement syndrome, and glenohumeral instability","volume":"20","author":"Struyf","year":"2011","journal-title":"Scand J Med Sci Sports"},{"key":"2021121701073151500_ref3","doi-asserted-by":"crossref","first-page":"600","DOI":"10.1016\/j.clinbiomech.2005.03.002","article-title":"Scapular kinematics during humeral elevation in adults and children","volume":"20","author":"Dayanidhi","year":"2005","journal-title":"Clin Biomech (Bristol, Avon)"},{"key":"2021121701073151500_ref4","doi-asserted-by":"crossref","first-page":"790","DOI":"10.1016\/j.jse.2008.02.009","article-title":"A cadaveric study of the serratus anterior muscle and the long thoracic nerve","volume":"17","author":"Hamada","year":"2008","journal-title":"J Shoulder Elbow Surg"},{"key":"2021121701073151500_ref5","doi-asserted-by":"crossref","first-page":"453","DOI":"10.5435\/00124635-201108000-00001","article-title":"Scapular winging: an update","volume":"19","author":"Meininger","year":"2011","journal-title":"J Am Acad Orthop Surg"},{"key":"2021121701073151500_ref6","doi-asserted-by":"crossref","first-page":"941","DOI":"10.1016\/j.clinbiomech.2013.09.003","article-title":"Specific scapular kinematic patterns to differentiate two forms of dynamic scapular winging","volume":"28","author":"Roren","year":"2013","journal-title":"Clin Biomech (Bristol, Avon)"},{"key":"2021121701073151500_ref7","first-page":"e1923","article-title":"Winged scapula: a comprehensive review of surgical treatment","volume":"9","author":"Vetter","year":"2017","journal-title":"Cureus"},{"key":"2021121701073151500_ref8","doi-asserted-by":"crossref","first-page":"4","DOI":"10.1111\/sae.12033","article-title":"Scapular winging","volume":"6","author":"Gooding","year":"2014","journal-title":"Shoulder Elbow"},{"key":"2021121701073151500_ref9","doi-asserted-by":"crossref","first-page":"397","DOI":"10.32635\/2176-9745.RBC.2009v55n4.1600","article-title":"Esc\u00e1pula Alada P\u00f3s-Linfadenectomia no Tratamento do C\u00e2ncer de Mama","volume":"55","author":"Mastrella","year":"2009","journal-title":"Revista Brasileira de Cancerologia"},{"key":"2021121701073151500_ref10","doi-asserted-by":"crossref","first-page":"1045","DOI":"10.3109\/0284186X.2012.695087","article-title":"Shoulder morbidity after treatment for breast cancer is bilateral and greater after mastectomy","volume":"51","author":"Shamley","year":"2012","journal-title":"Acta Oncol"},{"key":"2021121701073151500_ref11","doi-asserted-by":"crossref","first-page":"21","DOI":"10.1007\/s10549-014-2846-5","article-title":"Shoulder and arm morbidity in sentinel node-negative breast cancer patients: a systematic review","volume":"144","author":"Verbelen","year":"2014","journal-title":"Breast Cancer Res Treat"},{"key":"2021121701073151500_ref12","doi-asserted-by":"crossref","first-page":"972","DOI":"10.1111\/j.1742-1241.2006.01152.x","article-title":"Candido dos reis FJ. 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