How Is Scapular Winging Diagnosed
Your doctor will first look at your shoulder blade for any obvious signs of winging. They may also ask you to perform certain arm or shoulder movements. Tell your doctor about any recent injuries, illnesses, or surgeries that could affect your neck, arms, or back.
If you doctor decides you do have a winged scapula, they might use electromyography to see if its related to the serratus anterior, trapezius, or rhomboid muscles.
Depending on which nerve and muscle is causing it, scapular winging has both nonsurgical and surgical treatment options.
Dorsal Scapular Nerve/rhomboid Muscle Dysfunction
The dorsal scapular nerve innervates the rhomboid major and minor muscles . Dorsal scapular nerve entrapment is an uncommon and frequently under-recognized cause of neck and shoulder pain. The scapular winging may be subtle, and the symptoms are easily mistaken for other problems. Causes may include repetitive overhead activity and trauma such as anterior shoulder dislocation or whiplash neck injury.
A Winged Scapula Is It Serious What Are The Causes
A winged scapula can be serious, but it depends on the causes. There can be two main types of injuries that could cause you to have a winged scapula. Both of the injuries have to do with your serratus anterior. A muscle which its job is to glue your shoulder blade towards the midline so it doesnt wing-out during shoulder movement:
What are the causes?
It could be NEUROLOGICAL, a nerve issue.The most serious and rare reason is an injury to the nerve that activates the serratus anterior muscle. If you are suffering from nerve damage your muscle will lose its ability to contract. Therefore, there will be a winging on the shoulder blade as the muscle is unable to keep it glued to your back.
There are 17 different muscles that attach to your shoulder blade. At times it is not just an injury to the long thoracic nerve but an injury to other nerves that come from your neck that will lead to it. A big sign is if your winged scapula is very noticeable on overhead movement.
The most common cause is weaknessWeakness in the muscles that stabilize the shoulder blade will cause your scapula to move where it should not move. It will give you the appearance of a winged scapula.
Common therapy procedures are targeted towards strengthening the serratus anterior. However, sometimes the exercises that are prescribed are not efficient at solving the issue because the problem is usually more complicated than just a weakness of one muscle.
A common complaint is heard:
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What Percentage Of Rotator Cuff Surgeries Fail
Failure rates after arthroscopic repair of large and/or massive rotator cuff repairs have been reported to range from 34%-94% in various series. Despite poor healing rates in patients with large and/or massive rotator cuff tears, functional outcomes have generally been reported to be good following repair.
Be Persistent & Fix It For Good
If you have scapular winging to any degree, be sure to make correct posture and muscle balance a priority to prevent or improve your shoulder blade alignment.
Recovery can take anywhere from a few weeks to a few years, depending on the cause, the nerves and muscles involved in the injury or misalignment, and the treatment method used.
However, its always ideal to check with a professional who can diagnose scapular winging and get you on track with the best treatment for you. This can help speed up your recovery and ensure youre not at risk of worsening your injury.
Once youve corrected scapular winging, you want to continue using the same home exercises that helped you fix it, in order to prevent it from recurring in the future.
Regularly stretching, strengthening and massaging the muscles in your shoulders, back, arms and neck will help you maintain correct posture and prevent injuries that could cause scapular winging.
Diagnosis Of Scapular Dyskinesis
Scapular dyskinesis may not be obvious at first. You may feel pain or discomfort without obvious physical symptoms. Alternately, your shoulder blades may stick out with no accompanying pain or discomfort.â
If you think something is wrong, talk to your doctor immediately. Allowing the condition to go on without treatment may leave you at greater risk for additional damage, including:
- Nerve damageâ
- Damage to your rotator cuff or surrounding cartilage
Usually, an x-ray or MRI isnât necessary for diagnosis. Instead, your doctor may look for physical signs of other related injuries leading to your shoulder dysfunction. Occasionally a specialized nerve test is used to evaluate the extent of your damage to help determine what treatment is best.
âIf you notice that specific movement makes your pain or discomfort worse, be sure to share that. Include details about what happened when you first experienced a loss of motion or noticed a change in your shoulder blades.
What Is Winged Scapula Or Scapular Winging
Shoulder blade is also known as scapula. The scapula or the shoulder blade is the largest bone present in the shoulder. Several muscles are attached to scapula or the shoulder blade. Scapula or the shoulder blade slides along the rib cage and allows smooth movement of arm in all directions. The muscles attached to the scapula or the shoulder blade prevent dislocation and over sliding of the scapula and assist movements of the arm at the shoulder joint. These muscles act at all times together as a single unit for smooth movement of the arms. The injuries or paralysis of any of the muscles attached to scapula results in uncoordinated movements of the scapula. The scapula when angulates or turns away from chest wall is known as winged scapula or scapular winging. The bones of scapula become prominent and lie in angulation to back of the chest wall surface. The degree and direction of angulation depends on weak group of muscles, which is paralyzed.
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Physical Therapy Guide To Snapping Scapula Syndrome
Snapping scapula syndrome is a condition that involves the popping, grating, grinding, or “snapping” of bones and tissue in the shoulder blade area when lifting and moving the arm. The snapping symptoms may be painful and can sometimes make a sound. Snapping scapula syndrome is most common in young, active people who perform repeated overhead movements. Activities such as stocking shelves, or sports like weightlifting, swimming, or baseball, can cause the syndrome. Other causes can include shoulder blade or rib cage bone conditions, such as fractures, muscle weakness, or tumors.
Snapping scapula syndrome is usually the result of overuse of the arm, poor posture during sports activities, or incorrect joint motion. But it also can be caused by a single episode of trauma to the shoulder blade area. Physical therapists treat the pain, muscle weakness, loss of motion, and soft tissue swelling that can occur with snapping scapula syndrome.
Physical therapists are movement experts who improve quality of life through hands-on care, patient education, and prescribed movement. You can contact a physical therapist directly for an evaluation. To find a physical therapist in your area, visit Find a PT.
Treatment For Winged Scapula Or Scapular Winging
- Conservative Treatment for Winged Scapula or Scapular Winging- Application of ice may be helpful to reduce pain associated with Winged Scapula or Scapular Winging, although it is a very difficult endeavor as it is a very tough place to apply ice. Cold application works better than warm or heat treatment for Winged Scapula or Scapular Winging.
- Physical Therapy and Rehabilitation for Winged Scapula or Scapular Winging- Strengthening of weak muscle and retraining of normal predominant muscle can reduce the deformity and pain.
- Surgical Treatment- The long thoracic nerve is repositioned surgically if entrapped in scar tissue or pinched following injury or trauma.1
- Strengthening is definitely required for the Serratus Anterior Muscle.
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What Is Scapula Winging
The scapula is the anatomical term for the shoulder blade. Scapula winging describes the position of the shoulder blade sticking outwards as opposed to being flat against the ribcage. An untreated winging scapula can lead to more debilitating shoulder injuries like a rotator cuff tear. Doing scapula push ups will exercise the muscles that prevent scapula winging.
A rested shoulder blade flat against the ribcage is the normal biomechanical position of the shoulder blade. This is regardless of the position of the arm. The shoulder blade slides upwards, downwards, forwards, backwards as well as rotating clockwise or anti-clockwise as the arm moves. However, it should not come away from the ribcage as seen in the right shoulder blade in the picture below.
The following video shows how a winging scapula looks like when the shoulder is moving. Look at how much the bottom tip of the left scapula sticks out compared to the right scapula.
Winging Of The Scapula Secondary To Instability
This is one of the commonest causes of scapula dysrythmia . Recurrent dislocations of the shoulder leads to dysfunction of the muscles that move and support the shoulder complex and scapula. The more frequent the dislocations and the less trauma involved in causing the dislocations, the worse the scapula dysryrhmia . An essential part of treating shoulder instability is treating the scapula dysrythmia. This is done by an experienced physiotherapist in association with a shoulder surgeon.
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What Causes A Winged Scapula
A winged scapula is a symptom of another condition, rather than an injury itself. It is where the shoulder blade protrudes out on the back, rather than laying flat against the back of the chest wall.
It is quite a common dysfunction of the shoulder as it is also associated with poor posture. It is known as winged scapula as the medial border of the scapula can appear to be wing-like on the back.
A winged scapula is associated with damage or a contusion to the long thoracic nerve of the shoulder and/or weakness in the Serratus Anterior muscle. If the long thoracic nerve is damaged or bruised it can cause paralysis of the serratus anterior muscle. As a result, winging of the scapular or shoulder blade occurs. Damage to the nerve can be caused by a contusion or blunt trauma of the shoulder, traction of the neck and can also sometimes follow a viral illness.
Push Up Plus On Knees
- Get down on all fours and get into a neutral curve with the spine, with shoulder blades sinking in.
- Now, use your hands to push off the floor and spread your shoulder blades apart.
- Hold for 1-2 seconds at top position and feel the serratus muscle working.
- Come out of that position, and let your shoulder blades sink in
- Strive for 15 reps, 2 sets.
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How Can You Tell If You Have Winged Scapula
As discussed, when someone has a winged scapula youll notice that their shoulder blade seems to stick out more than it should.
In some cases, you may even see the shoulder blade stick out of a persons shirt.
A normal shoulder blade should be pushed up right against the back of the ribcage, however, with a winged scapula, it has become loosened from the rib cage.
You can typically tell if you have scapular winging because of the physical protruding of the scapula from your back while in your natural resting posture.
Other symptoms include pain in the shoulder blade and surrounding area, weakness, reduced range of motion and difficulty raising your arm above your shoulder.
Symptoms vary from person to person depending on the cause and which muscles and nerves are affected.
However, there are some signs you can test for.
Symptoms Associated With A Winged Scapula
The presence of some amount of scapula winging is often considered normal in young children and is frequently not a cause for concern. In children this will usually rectify itself given time, as they build and develop trunk and shoulder strength over their formative years. However winged scapula are not considered normal shoulder blade postures in older children and adults. With scapular winging, symptoms may vary from person to person depending on the cause of the winging in the first place. Pain is not always a symptom in shoulder blade winging, however fatigue is a relatively common characteristic, as well are limitations in activities of daily living. Restrictions and fatigue associated with daily tasks can come about due to the potential for a loss of active range of movement when using arms above shoulder/head height as well as weakness in these and other shoulder postures.
Some of the possible symptoms associated with winged scapula may include:
- A winged scapula may affect both sides, or be just a unilateral issue.
- Pain or discomfort experienced in your neck, shoulders, and upper back.
- Weakness, fatigue or difficulty with pushing, pulling or lifting activities.
- A reduced capacity to raise and/or sustain holding your arm above shoulder height.
- Cosmetic appearance of a drooping shoulder
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What Are The Risks Of Having A Long Thoracic Nerve Decompression
All operations involve an element of risk, these are very small but you need to be aware of them and can discuss them with your doctor at any time.
The risks are
- Complications relating to the anaesthetic
- Stiffness and or pain around the shoulder
- Damage to nerves or blood vessels around the shoulder
When The Patient Does Have Symptoms From A Winged Scapula They Can Be As Follows:
Pain or discomfort in the scapular region when this area of the back is against a chair when the patient is seated.
Pain in the shoulder blade area.
Restriction with shoulder elevation.
Though scapular winging can be debilitating, it can alsoas Dr. Rue has saidpresent with no symptoms.
If the symptoms reach a debilitating level, the patient will have difficulty lifting, pushing and pulling heavy objects and even performing the movements of daily living like brushing hair.
If you seem to have a winged scapula but are not experiencing any symptoms, its still important to see an orthopedic physician.
Though there are no symptoms in some cases, a winged scapula can start producing symptoms down the road.
There are many causes of this condition, and treatments vary.
Dr. Rue specializes in prevention and treatment of sports and exercise injuries. His primary focuses are knee, shoulder and elbow injuries including ACL and cartilage injuries, rotator cuff injuries and overuse tendonitis.
Lorra Garrick is a former personal trainer certified through the American Council on Exercise. At Bally Total Fitness she trained women and men of all ages for fat loss, muscle building, fitness and improved health.
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Serratus Anterior Weakness: One Of Many Reasons For Shoulder Blade Winging
We are all familiar with the shape of our shoulder blade. It lies flat on our chest, and moves along with the arm as we position our hand in space. But in some shoulder conditions, the shoulder blade does not lie flat on the chest any more it protrudes like the wing of a bird. The shoulder blade is also known as scapula, and the term scapular winging is used to describe this abnormal positioning of the shoulder blade, with various degrees of visible prominence. Apparently, the first surgeon who wrote about scapular winging was Dr. Velpeau, from France, in 1825 .
Individuals who suffer from scapular winging oftentimes complain of deep-seated pain around the shoulder blade, shoulder region, and neck. In addition, raising the arm oftentimes becomes increasingly difficult. There are many reasons for scapular winging, and identifying the culprit for each particular individual can be tricky. Weakness of one particular muscle, the serratus anterior, is one of the leading causes for scapular winging. Interestingly, many health care providers will miss this condition all the time
Serratus Anterior, Long Thoracic Nerve, All These Names!
Why Would People Develop Serratus Anterior Weakness?
Making The Diagnosis
Split pectoralis major transfer for serratus anterior palsy
The pectoralis major muscle arises partly from the collarbone and partly from the anterior chest wall . It attach into the humerus bone in the arm.
How Do You Test For Winged Scapula
Specific testing of the serratus anterior is performed by having the patient push-up off of the wall from a standing position and observing asymmetric winging of the scapula. Alternatively, resisted flexion with the arm below the horizontal will place the serratus under maximum resistance and will demonstrate winging.
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Winging Scapula: A Cause For Shoulder Pain
Hi, Im Parnashree from Miami Physio and I am going to explain why shoulder blades wing out and why it causes problems.
Movements of the scapula or the shoulder blades are essential for normal shoulder and arm use. Scapular winging is a term used when the inner border of the shoulder blades becomes prominent. The border sticks out because of weakness of the shoulder blade muscles. This can happen either because of damage to the muscles of the scapula, their nerve supply, the scapular bones and the surrounding joints.
Firstly lets talk about the nerve and muscles that can cause your shoulder blades to stick out. Injury to the scapular muscles themselves can lead to weakness. Strenuous exercises , repetitive small injuries, or upper arm and upper back surgery can cause the nerves to become irritated leading to weakness or paralysis of the scapular muscles they supply.
Secondly, scapular bony injuries such as fractures to the shoulder blade or collar bone can also lead to compensations in the way you move, resulting in the muscles becoming weak.
Finally, having a painful shoulder will change the way you move your shoulder and use the shoulder muscles, resulting in an imbalance of muscles forces in the scapular muscles and weakness in these muscles.
If you have shoulder pain already and would like to get started on a program to correct your shoulder blade position and get on top of your pain, book an appointment with one of our physios today.