Please help!

Dear all,
I’d like your help on this case of a 35 year old female who was referred for evaluation of the long thoracic nerve due to scapular winging (which she states had started after seeing a physiotherapist for shoulder pain!). There was no mention of any swelling!

What do you think it is? I was considering a myxoid tumor. But what about that spicule of subperiosteal bone arising from the scapula? Is it reactive? The lesion seems to be involving more than one muscle compartment. So it’s less likely to be a hematoma from pressure, as the patient stated. Correct?

Thank you in advance.

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