The scapula, commonly known as the shoulder blade, plays an important role in the movement and stability of the arm and shoulder. Normally, this triangular bone lies flat against the back of the rib cage, allowing for a wide range of upper limb motion. Winged scapula, or scapula alata, is a condition where the shoulder blade protrudes abnormally from the back. This noticeable change can be uncomfortable and often affects daily activities.
Defining Winged Scapula
Winged scapula is characterized by the shoulder blade visibly sticking out from the back, resembling a bird’s wing. This occurs when the scapula loses its normal anchor against the rib cage. In a healthy shoulder, muscles like the serratus anterior, trapezius, and rhomboids work in coordination to keep the scapula securely positioned. The serratus anterior muscle, for example, helps hold it against the rib cage for movements like raising the arm overhead. Nerves, such as the long thoracic nerve, innervate these muscles, ensuring proper function and maintaining scapular stability.
Underlying Causes
Winged scapula often results from damage to nerves or weakness in muscles that stabilize the shoulder blade. Injury to the long thoracic nerve, controlling the serratus anterior muscle, is the most frequent cause, leading to medial winging. Damage to the spinal accessory nerve can affect the trapezius muscle, resulting in lateral winging. Less commonly, the dorsal scapular nerve, innervating the rhomboid muscles, can be impaired, also leading to winging. These nerve injuries can arise from trauma (e.g., direct blows, falls, repetitive strain) or non-traumatic causes (e.g., viral illnesses, surgical procedures).
Identifying the Symptoms
Individuals with a winged scapula experience a range of symptoms, most apparent being the visible protrusion of the shoulder blade. This can make simple actions uncomfortable, such as leaning against a chair or wearing a backpack. Pain in the shoulder, neck, or upper back is a common complaint, often described as a dull ache or sharp discomfort. Weakness in the affected arm, especially when lifting objects or performing overhead activities, is also reported. The condition can limit the shoulder’s range of motion, making daily tasks like brushing hair or reaching for items challenging.
Diagnosis and Treatment Paths
Diagnosing winged scapula begins with a physical examination, where a healthcare provider observes the scapula’s position and movement. Specific maneuvers can accentuate the winging, helping to identify affected muscles. Electrodiagnostic tests are often utilized to confirm nerve involvement and to assess muscle function. Imaging studies may also be performed to rule out other underlying issues or structural abnormalities.
Treatment approaches for winged scapula depend on the underlying cause and severity. Conservative management is often the initial step, particularly for nerve damage cases, as some nerve injuries can spontaneously recover over time. This involves physical therapy focused on strengthening the muscles around the scapula and improving its stability. Bracing may also be used to provide support to the shoulder blade.
When conservative treatments are unsuccessful or for severe cases, surgical intervention may be considered. Surgical options include nerve or muscle transfers to restore function, or scapulothoracic fusion for persistent instability.