Dancing Scapula: The Missed Movement

A 12-year-old male child, at the age of 7 years, was misdiagnosed as mitral valve stenosis based on abnormal rhythmic clicking sounds during chest auscultation. He was extensively evaluated by primary care physician. His echocardiography and antistreptolysin-O titer were within normal limits. Subsequently, he was found to have clicks associated with left shoulder movements, and he was referred to a neurologist. There was no prior trauma. These movements remitted spontaneously after 2 years of onset. Then, around 1？ years later, it appeared again. This time, he was evaluated at our center. His scapular movements were rhythmic elevation with a clicking sound consistent with focal contractions of his left levator scapulae, left rhomboids major and minor [Video 1]. There was no distractability or variability in the movements. Needle electromyography (EMG) revealed dystonic contraction of left levator scapulae. He was given 30 units of botulinum neurotoxin in the left levator scapulae under EMG guidance. These movements completely resolved [Video 2] and had not recurred at 3 years of follow-up. His magnetic resonance imaging brain and cervical spine was normal. There were no stigmata of Wilson's disease