Scapular Winging - An Overview

Introduction -

Scapular winging is a condition where shoulder blades stick out from the back. This is a sign of a problem with the muscles and tendons that control the shoulder blades. Scapular winging can occur for a number of reasons, including injury, muscle weakness, and nerve issues. The most common treatment is strengthening and stretching the affected muscles. This can be done with exercises or physical therapy. It is important to get treatment for scapular winging as soon as possible; the sooner treatment is started, the better the chances of a successful outcome.

What Is Scapular Winging?

When the shoulder blade (scapula) rides up too high on the back, it is known as scapular winging; the shoulder becomes unstable and weak. Several factors, including muscle weakness, poor posture, and nerve damage, can cause this condition. It may also indicate an underlying medical condition, such as shoulder arthritis or a tear in the rotator cuff.

What Are the Causes of Scapular Winging?

Bad posture for a long period causes weak muscles and ligaments, leading to winging. Several factors can lead to scapular winging.

• One of the most common causes is winging due to a weakness or paralysis of the muscles that can control the scapula.

• Scapular winging can be caused by several medical conditions, such as muscular dystrophy, polio, or Guillain-Barre syndrome.

• Winging can also be caused by damage to the nerves that supply the scapula muscles.

• Trauma or surgery can also cause scapular winging.

• Winging can also occur as a result of poor posture.

• Nerve Injuries - Three nerves are responsible for scapular winging. These are:

  • Long Thoracic Nerve.

  • Dorsal Scapular Nerve.

  • Spinal Accessory Nerve.

• If they get damaged by injury or surgery, they will result in scapular winging.

• Repetitive Work Injury - Athletes are commonly injured with this kind of injury. However, it can also happen during routine work. For example, repetitive swinging arms, such as while balling in cricket, can result in scapular winging.

• Nontraumatic Injury - Medicine overdose reaction, exposure to the toxin, and allergic reaction can also result in scapular winging.

What Are the Symptoms of Scapular Winging?

When experiencing scapular winging symptoms, it is important to consult with a doctor for diagnosis and treatment. Symptoms of scapular winging are listed below:

• Pain or discomfort in the shoulder area.

• A feeling of weakness or instability in the shoulder.

• Difficulty lifting the arm overhead.

• The shoulder blade protrudes outwards from the back.

• Fatigue.

How to Diagnose Scapular Winging?

For diagnosis of scapular winging,

• The doctor will ask for any previous or recent injuries, diseases, medicine overdose, or surgery.

• The doctor will ask to move the arms in different directions. The doctor will also check if the shoulder blades are symmetrical while moving the arms up and down.

• A doctor may suggest an X-ray or MRI (magnetic resonance imaging) if they suspect scapular winging and want to find out what is causing the problem.

• Electromyography can be done to check the related muscles of the serratus anterior, trapezius, or rhomboid muscles.

How Is Scapular Winging Treated?

The root cause of scapular winging determines the course of treatment. Treatment involves physical therapy and surgical treatment.

Physical Therapy -

• If the problem is due to weak muscles, the patient may be referred to a physical therapist for strengthening exercises.

• If the muscles are too tight, the therapist may refer the patient to a massage therapist or chiropractor for loosening.

• A combination of painkillers and analgesic ointment is also helpful.

• If the damage is caused by serratus anterior nerve, it can self-heal in one to two years.

Surgical Treatment -

• Surgery may be required if the problem is due to a structural defect such as a scapular dislocation.

• Sometimes, a brace may be prescribed to keep the shoulder in place.

Surgical treatments include -

• Nerve and muscle transfer procedure.

• Static stabilization (attaching scapula to the ribs with the help of a sling) and if these procedures are insufficient, then a procedure called scapulothoracic (direct attachment of scapula to the ribs) is advisable.

• Home-based exercises such as stretching and flexibility-improving exercises (yoga) are also helpful in treating scapular winging, but without supervision or doctors' prescription, these can result in adverse effects.

What Are the Complications of Scapular Winging?

Scapular winging can develop some serious complications. Complications of scapular winging include the following:

• Shoulder pain.

• Reduced range of motion.

• Trouble lifting arm.

• Numbness or tingling in arm or hand.

How to Prevent Scapular Winging?

• Avoid repetitive shoulder or arm movement, take breaks, and rest during intervals.

• Correct posture is important.

• Ergonomic chairs, cushions, and pillows are helpful in the prevention of scapular winging.

• Shoulder-friendly ergonomic bags are helpful in prevention.

• The person should take care not to put too much weight on the arms, back, or shoulders.

• Stretching and strengthening exercises of the muscles of the neck, shoulders, and upper arms with the help of exercises are helpful in the prevention of scapular winging.

What Structures Are Involved in Scapular Winging?

In the case of scapular winging, the muscles and structures around the shoulder blade are not working properly; This can cause the scapula to move out of its normal position and cause pain and discomfort. Several muscles and structures can be involved in scapular winging, including:

• Pectoralis minor muscle.

• Coracobrachialis muscle.

• Subscapularis muscle.

• Serratus anterior muscle.

• Trapezius muscle.

Conclusion -

The scapular winging condition causes shoulder blades to stick out from the back. It occurs due to injury to the scapular region's nerves, muscles, and tendons. It causes discomfort in moving shoulders and arms. Young athletes are commonly affected by scapular winging because they have tight muscles. However, it is also seen in people doing their routine work. There are many causes of scapular winging, and getting it diagnosed and treated as soon as possible is important. Some common treatment includes surgery, physical therapy, and braces. On experiencing any symptoms of scapular winging, it is important to see a doctor as soon as possible. With the right diagnosis and treatment, scapular winging can be fully treated, and getting back to normal life is easier.