Scapular winging, sometimes called a winged scapula, is a condition that affects the shoulder blades. Scapula is the anatomical term for the shoulder blade.
The shoulder blades usually rest flat against the back of the chest wall. Scapular winging occurs when a shoulder blade sticks out.
While the condition is rare, it’s usually painful and makes day-to-day activities, such as lifting grocery bags or brushing your teeth, difficult.
What are the symptoms of scapular winging?
Scapular winging symptoms vary from person to person depending on the underlying cause as well as the muscles and nerves involved. Most people with scapular winging have a shoulder blade that sticks out. This can make sitting in a chair or wearing a backpack uncomfortable.
If the winged scapula is the result of nerve damage, it can cause weakness in the muscles of your neck, shoulders, and arms. That weakness can make lifting, pulling, and pushing heavy objects hard.
Scapular winging often affects your ability to raise your arm above your shoulder. It may also be associated with other symptoms, including:
- pain or discomfort in your neck, shoulders, and back
- a drooping shoulder
What causes scapular winging?
Scapular winging is almost always caused by damage to one of three nerves that control muscles in your arms, back, and neck:
- the long thoracic nerve, which controls the serratus anterior muscle
- the dorsal scapular nerve, which controls the rhomboid muscles
- the spinal accessory nerve, which controls the trapezius muscle
Injuries and surgeries can both cause damage to these nerves and muscles.
A variety of injuries can damage important nerves and muscles, leading to a winged scapula.
Blunt trauma to the nerves that control the muscles of your neck, upper back, and shoulder can lead to scapular winging. Examples of blunt trauma include dislocating your shoulder or twisting your neck in an unusual way.
Repetitive motion injuries
Repetitive movements can also cause injuries. This type of injury is common among athletes, but it can also be caused by everyday tasks, such as:
- washing the car
- trimming hedges
- using your arms to prop your head up while lying down
Nontraumatic injuries aren’t caused by physical force. Instead, they can be caused by:
- viral illnesses, such as influenza, polio, or tonsillitis
- allergic reactions to medication
- drug overdose
- exposure to toxins, such as herbicides
- certain medical conditions, such as congenital heart defects, cervical radiculopathy, and muscular dystrophy
Rib resections, mastectomies, and procedures that require general anesthesia may cause nerve damage.
A study in Supportive Care for Cancer followed people who had undergone axillary dissection, a surgical breast cancer treatment. Among the 112 surveyed, 8 percent exhibited scapular winging 15 days after surgery.
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 it’s related to the serratus anterior, trapezius, or rhomboid muscles.
How is scapular winging treated?
Depending on which nerve and muscle is causing it, scapular winging has both nonsurgical and surgical treatment options.
Cases of scapular winging caused by damage to the serratus anterior nerve sometimes heal on their own within two years. Your doctor may also recommend light physical therapy or using a brace for several months early in your recovery.
For scapular winging caused by damage to the dorsal scapular nerve, your doctor will likely recommend a mix of physical and massage therapy. They may also prescribe muscle relaxants, anti-inflammatory drugs, analgesics, or a combination of all three. Supports such as braces and slings can also be helpful during recovery.
If nonsurgical treatment options aren’t providing any relief, your doctor may recommend surgery. In addition, scapular winging caused by a traumatic injury is more likely to need surgery. Scapular winging due to damage to the spinal accessory nerve also usually requires surgery.
The most common surgical treatments for scapular winging are nerve and muscle transfers. These surgeries involve taking all or part of a nerve or muscle and moving it to another part of the body. Nerve and muscle transfers for scapular winging usually focus on the shoulder, back, or chest.
Another option is called static stabilization. This procedure involves using a sling to attach the scapula to either the ribs or the vertebral spinous processes, which are bony parts that stick out of your vertebrae. There is a risk that the sling will stretch out over time, causing the winged scapula to return.
Your doctor may recommend a procedure called scapulothoracic fusion if other treatments don’t work. This involves attaching the scapula directly to the ribs. You may not be able to lift your arms after this procedure. It can also cause permanent bone fractures and lung problems. Your doctor will likely suggest this procedure only if there are no alternatives.
Stretching at home may help you improve your strength and range of motion. In some cases, stretching and exercise can make scapular winging worse, so always check with your doctor before trying any home exercises.
Try scapular stabilization exercises to strengthen your shoulders. OptimumCareProviders offers great exercise videos, including one for strengthening the serratus anterior muscle under your shoulder. FreeFitGuy also demonstrates exercises specifically for scapular winging.
How can I prevent scapular winging?
Scapular winging isn’t always preventable, but you may be able to reduce your risk by:
- avoiding repetitive shoulder or arm movements when possible
- maintaining correct posture
- using an ergonomic chair or pillow
- using shoulder-friendly ergonomic bags and backpacks
- avoiding carrying too much weight on your shoulders
- stretching and strengthening the muscles in your neck, shoulders, and upper arms
Scapular winging recovery
Recovering from scapular winging can take anywhere from a few months to several years, depending on the initial cause, treatment method, and nerves and muscles affected. Nonsurgical treatment options can start working almost immediately, while surgical treatment will likely take a few months to produce results.
While scapular winging can usually be improved, you may experience a permanent decreased range of motion in rare cases. Make sure to talk to your doctor as soon as you start experiencing symptoms to improve your chances of making a full recovery.