Scapular winging involves one or both shoulder blades sticking out from the back rather than lying flat. It is a rare condition that may result from injury or nerve damage.
This article will discuss the possible causes, symptoms, and treatments of scapular winging.
The scapula, or shoulder blades, are flat bones that connect the upper arm to the collar bone. They typically lie almost flat across the back. In scapular winging, a portion of the scapula rotates atypically and appears to protrude out of the back under the skin.
Scapular winging can cause pain, a loss of mobility, and decreased strength. It typically occurs due to nerve damage but may also result from impact injury.
The
- the dorsal scapular nerve, which controls the rhomboid muscles
- the spinal accessory nerve, which controls the trapezius muscle
- the long thoracic nerve, which controls the serratus anterior muscle
Less commonly, physical damage to or separation from the muscles, bones, and joint tissues around the scapula may also lead to winging. This may occur due to:
- overuse of the shoulder, back, or neck
- viral-induced neuropathy (nerve damage), such as post-influenza
- post-viral autoimmune conditions, such as Guillain-Barré syndrome
- illnesses, such as influenza
- muscular dystrophy
- surgery near the shoulders or ribs, such as a mastectomy or rib resection
- blunt force trauma to the nerves of the shoulder, neck, or back
The symptoms of scapular winging can depend on the location of the nerve or muscle damage. The main indication of this health issue is one shoulder blade sticking out from the back.
The projection of the shoulder blade can make it difficult to sit on chairs with hard backs, wear certain clothing, and carry bags with shoulder straps.
Scapular winging can also affect the person’s ability to lift their arms over their head or carry heavy items. If there is nerve damage, it can also cause weakness in the arms, shoulders, and neck.
Some other symptoms include:
- sagging of one or both shoulders
- pain or discomfort in the shoulders, neck, and back
- tiredness
A doctor will begin the diagnostic process by asking general questions about symptoms.
They will then conduct a physical examination, checking the shoulder blades for signs of winging. They will also ask the person to perform basic shoulder movements to demonstrate their range of motion.
If the doctor suspects nerve damage, they may then use a technique known as electromyography to record the electrical activity from the skeletal muscles. This helps them assess nerve function.
Different causes of scapular winging require different treatments, which can involve surgical and nonsurgical options. The variety and suitability of nonsurgical options depend on the type of nerve damage.
If the person has sustained damage to the long thoracic nerve, recovery may require little or no treatment. The doctor
Physical therapy
The doctor will likely suggest physical therapy in the case of dorsal scapular nerve damage. They may also recommend anti-inflammatory drugs and pain relief medication.
Surgery
Traumatic injuries and spinal accessory nerve damage are more likely to require surgery.
A doctor may recommend a nerve and muscle transfer. In this technique, a surgeon transplants healthy muscles and nerves from another part of the body to repair the damage.
Alternatively, they may recommend scapulothoracic fusion, which involves attaching the shoulder blades to the backs of the ribs. However, this procedure involves more risks than a nerve and muscle transfer.
Recovery times vary among people with scapular winging. It may take several months or years, depending on:
- the severity of the damage
- whether the person undergoes surgery
- which nerves or muscles are damaged
Early treatment can make a difference, so a person needs to consult a doctor about symptoms of scapular winging as soon as possible.
It is not always possible to prevent scapular winging, but the following can help reduce the risk:
- having good posture
- avoiding tasks that involve repetitive arm or shoulder motions
- strengthening the shoulder, neck, and back muscles
- avoiding carrying heavy objects on the shoulders
- using ergonomic chairs, pillows, and backpacks
Scapular winging is a rare condition. It involves one or both shoulder blades sticking out from the back and commonly results from nerve damage around the shoulders.
Various exercises and treatments can help ease symptoms and promote recovery.
