A winged scapula, also known as scapular winging, is a condition where the shoulder blade protrudes abnormally from the back instead of lying flat against the ribcage. This creates a noticeable, wing-like appearance, indicating an underlying issue with shoulder blade stability and positioning. While it may seem like a minor cosmetic concern, it can impact shoulder function and lead to various physical challenges.
Understanding Winged Scapula
The scapula plays a significant role in shoulder stability and movement, relying on a balanced interplay of surrounding muscles and nerves. Winged scapula commonly occurs due to weakness or paralysis in specific stabilizing muscles, primarily the serratus anterior, trapezius, or rhomboids. Damage to the nerves controlling these muscles, such as the long thoracic nerve, is a frequent cause.
Injuries to these nerves or muscles can disrupt the natural balance needed to keep the shoulder blade flush against the ribcage. Common causes include traumatic injuries, repetitive strain, sports injuries, or surgical complications. Beyond the visible protrusion, individuals with a winged scapula often experience symptoms such as shoulder pain, stiffness, weakness, and movement limitations, particularly when lifting the arm overhead. A grinding or snapping sensation is also common.
Non-Surgical Correction Strategies
Addressing a winged scapula often begins with non-surgical approaches focused on strengthening affected muscles and improving shoulder mechanics. Physical therapy is a primary method, guiding individuals through targeted exercises and stretches. The goal is to enhance muscle strength, coordination, and endurance in key scapular stabilizers like the serratus anterior, trapezius, and rhomboids.
Exercises commonly recommended include the “push-up plus,” which engages the serratus anterior by pushing the body beyond a standard push-up. Wall slides, performed by sliding arms up a wall, promote proper scapular upward rotation and control. Scapular retractions, such as squeezing shoulder blades together, strengthen the middle and lower trapezius muscles. These exercises aim to improve the scapula’s ability to stay close to the ribcage and move smoothly.
Physical therapists incorporate specific stretches to address muscle imbalances and tightness, such as those for the pectoralis minor and upper trapezius, to improve posture and allow the shoulder blade to move freely. Manual therapy techniques mobilize soft tissues and joints, supporting muscle re-education and improving range of motion. Occupational therapists may also assist by adapting daily activities.
In some cases, especially when nerve damage is the underlying cause, the condition might resolve spontaneously within several months to two years. During this period, physical therapy helps manage symptoms and prevent secondary complications. The emphasis remains on restoring muscle function through progressive strengthening and stability exercises.
Medical Interventions and Professional Care
When conservative measures are not sufficient, medical interventions become necessary. A healthcare provider diagnoses winged scapula through a physical examination, observing the shoulder blade’s movement and protrusion. They may ask the individual to perform specific movements, such as a wall push-up test, where the winging becomes more evident. Diagnostic imaging may be employed to understand the underlying cause.
Imaging tests like X-rays can rule out bone abnormalities, and an MRI can provide detailed images of muscles and soft tissues. Electromyography (EMG) and nerve conduction studies assess nerve function and identify specific nerve damage, such as to the long thoracic, spinal accessory, or dorsal scapular nerves. These tests help pinpoint which nerve and muscle are affected, guiding the most appropriate treatment plan.
Bracing may be considered to help position the scapula correctly and provide support. Scapular-protecting braces aim to keep the shoulder retracted and the scapula flat against the thoracic cavity. While bracing can provide some improvement, it may not completely resolve symptoms for all patients, with many still experiencing pain or residual winging.
Surgical intervention is typically a last resort for severe, persistent cases unresponsive to extensive non-surgical treatment, especially those caused by significant nerve damage or trauma. Options include nerve decompression or nerve transfers to re-innervate damaged muscles. Muscle transfer procedures, such as using the pectoralis major for a paralyzed serratus anterior, restore dynamic scapular control. In rare cases, static stabilization procedures like scapulothoracic arthrodesis, which fuses the scapula to the ribcage, may be considered, though this limits shoulder mobility. Recovery involves immobilization followed by physical therapy.