Scapular winging occurs when the shoulder blade protrudes abnormally from your back, affecting shoulder stability and causing discomfort. Often caused by nerve injury or muscle weakness, it can significantly impact daily activities and athletic performance. Understanding this condition can help you seek timely treatment and regain function.
What is Scapular Winging?
Scapular winging is a condition characterised by the unusual protrusion or sticking out of the shoulder blade (scapula). Normally, the scapula sits flat against your back, supported by several muscles. When these muscles become weak or paralysed—usually due to nerve damage—the shoulder blade can lift away from the rib cage, causing winging.
Types of Scapular Winging
There are two main types of scapular winging, classified by the direction the shoulder blade protrudes:
- Medial Winging (most common):
- Involves the inner edge of the scapula protruding towards the spine.
- Usually due to weakness of the serratus anterior muscle, caused by damage to the long thoracic nerve.
- Lateral Winging:
- The outer edge of the scapula sticks outwards and upwards.
- Often due to weakness of the trapezius muscle, caused by damage to the spinal accessory nerve.
What Causes Scapular Winging?
Common causes include:
- Trauma or injury, such as direct blows, falls, or repetitive strain from overhead sports or heavy lifting.
- Surgical procedures involving the neck, chest, or shoulder, where nerves might be accidentally damaged.
- Infections and illnesses, including viral infections like influenza.
- Neurological conditions, such as Guillain-Barré syndrome or muscular dystrophy.
- Unknown causes (idiopathic), where no clear reason can be found.
Clinical Pearls / Key Points
- The serratus anterior muscle (long thoracic nerve) is most commonly affected.
- Early diagnosis and treatment improve the chance of full recovery.
- Scapular winging may resolve spontaneously within 6 to 24 months if nerve damage is minor.
- Severe or persistent winging often requires surgical intervention.
Symptoms of Scapular Winging
Common signs and symptoms include:
- Shoulder blade visibly sticking out from the back.
- Difficulty lifting or pushing objects.
- Weakness or pain around the shoulder, especially during overhead movements.
- Fatigue and discomfort when sitting against hard surfaces or wearing backpacks.
- Restricted shoulder movement, making daily tasks difficult.
Diagnosing Scapular Winging
Your specialist will typically diagnose scapular winging through:
- Physical examination: Observing shoulder blade movements and posture.
- Special tests: Such as the wall push-up test to accentuate winging.
- Electromyography (EMG): To confirm nerve injuries.
- Imaging: Occasionally, X-rays or MRI scans to exclude other shoulder problems.
Treatment for Scapular Winging
Treatment depends on the severity and underlying cause. Initial conservative management includes:
- Physiotherapy: Exercises to strengthen shoulder muscles, especially the serratus anterior.
- Activity modification: Avoiding activities that worsen symptoms.
- Pain relief: Anti-inflammatory medication or targeted injections.
- Bracing: Occasionally used to stabilise the shoulder blade.
Surgical Treatment Options
If conservative treatment fails, surgical options may be considered:
- Nerve decompression: Releasing compressed nerves.
- Muscle transfer surgery: Using healthy muscles to restore shoulder function.
- Split Pectoralis Major Transfer for medial winging.
- Eden-Lange Transfer for lateral winging.
- Scapulothoracic fusion: Rarely performed; used only when other treatments fail.
Patient FAQs
Can scapular winging heal by itself?
Yes, mild cases often resolve spontaneously within 6 months to 2 years. However, if symptoms persist or worsen, medical intervention is usually necessary.
Is surgery always needed?
No. Surgery is only recommended if conservative treatments fail or nerve damage is severe.
How long is recovery after surgery?
Most patients recover significant function within 6–12 months after surgery, depending on the procedure.
Call-to-Action
If you’re experiencing shoulder blade protrusion, weakness, or pain, early specialist assessment can significantly improve your outcome.
For professional advice and treatment, visit www.TheArmDoc.co.uk or book an appointment by phoning 020 3384 5588or emailing Info@TheArmDoc.co.uk.
Disclaimer
This information is intended for educational purposes only and does not substitute for professional medical advice. Always consult your doctor or healthcare professional regarding your condition and treatment options.