What is Scapula Winging?
Scapula winging, also known as winged scapula, is a condition in which the shoulder blade (scapula) sticks out abnormally from the back, creating a wing-like appearance. This typically occurs when the muscles that hold the scapula flat against the ribcage become weakened or paralyzed, particularly the serratus anterior muscle or less commonly, the trapezius or rhomboid muscles.
Causes of Scapula Winging
Injuries to the muscles or nerves that support the affected scapula are the most common causes of winged scapula. Trauma, repetitive strain, or surgery can lead to nerve/muscle damage.
Nerve Damage:
- Long Thoracic Nerve Injury: This is the most common cause of scapular winging, where the serratus anterior muscle (which helps hold the scapula against the ribcage) becomes weak or paralyzed.
- Spinal Accessory Nerve Injury: This affects the trapezius muscle, which also contributes to scapular stabilization.
- Dorsal Scapular Nerve Injury: This affects the rhomboid muscles, which assist in scapula retraction.
Muscle Dysfunction:
Direct injury to the muscles that support the scapula can cause weakness or atrophy, leading to winging.
- Weak Serratus Anterior: The primary muscle responsible for stabilizing the scapula.
- Trapezius Muscle Dysfunction: When injured, this large muscle that stabilizes and moves the scapula can lead to winging.
Signs and Symptoms of Scapula Winging
Signs and symptoms of scapula winging include:
- A noticeable protrusion of the scapula from the back.
- Shoulder pain or discomfort.
- Weakness in the shoulder, especially when lifting the arm.
- Limited range of motion in the shoulder and arm.
Diagnosis of Scapula Winging
Diagnosis of scapula winging involves a combination of physical examination, imaging tests, and sometimes nerve conduction studies to determine the underlying cause and severity.
Your physician will first examine your shoulder blade for any clear signs of winging. You may be asked to perform certain shoulder or arm movements to check the range of motion. You should also tell your physician about any recent illnesses, injuries, or surgeries that could affect your back, arms, or neck. If your physician establishes that you do have a scapula winging, they may recommend studies such as electromyography (EMG) and nerve conduction studies to determine if it is connected to the serratus anterior, trapezius, or rhomboid muscles and to assess muscle and nerve function.
Treatment for Scapula Winging
Treatment for scapula winging depends on the underlying cause, severity of the condition, and the patient's overall health. Here are the primary treatment options:
Physical Therapy (PT)
Physical therapy is often the first line of treatment, especially if the cause is muscle weakness or mild nerve damage.
- Strengthening Exercises: The focus is on strengthening the muscles that stabilize the scapula, particularly the serratus anterior, trapezius, and rhomboids. This can help improve scapular positioning.
- Stretching: Stretching exercises to improve flexibility in the shoulder joint and muscles around the scapula.
- Postural Training: PT can help correct postural issues that might contribute to or exacerbate scapula winging.
Bracing
In some cases, wearing a scapular brace or shoulder orthosis can provide temporary support. These braces are designed to hold the scapula in a better position, reduce winging, and allow muscles to heal.
Medication
- Nonsteroidal Anti-Inflammatory Drugs (NSAIDs): Medications like ibuprofen or naproxen may be prescribed to manage pain and reduce inflammation.
- Steroid Injections: Corticosteroid injections can reduce inflammation and pain in the affected area, especially if there is nerve irritation involved.
Surgical Treatment
Surgery is usually reserved for severe cases, where conservative treatments are ineffective, or if there is significant nerve or muscle damage.
The most common surgical treatments for scapular winging are nerve and muscle transfers in which healthy muscles and nerves from another section of the body is transplanted to repair the damage.
Another surgical option is called static stabilization in which a sling is used to attach the scapula to either the ribs or the vertebral spinous processes, which are bony sections that stick out of the vertebrae. However, there is a significant risk that the sling may likely stretch out over time, causing the scapula winging to return.
In rare and severe cases, where other treatments have failed, a procedure called scapulothoracic fusion may be employed, which involves fusing the scapula to the back of the ribs. This is usually a last resort because it limits shoulder mobility.
