Scapular winging involves one or both shoulder blades sticking out from the back rather than lying flat. It is a rare condition that may happen as a result of injury or nerve damage.
The scapula, or shoulder blades, are flat bones that connect the upper arm to the collar bone. When they come out of place, it can cause scapular winging.
Scapular winging is a rare condition that can be painful.
This article will discuss the possible causes of scapular winging, as well as symptoms and treatment methods.
Image credit: Dwaipayanc, 2005.
A common cause of scapular winging is nerve damage. It may affect one of three major nerves in the shoulder:
- 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
Injuries to these nerves or surrounding muscles can result from:
- overuse of the shoulder, back, or neck
- allergic reactions
- illnesses, such as influenza
- use of some medications, such as those for muscle 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 scapular winging 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 some 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 some general questions about symptoms.
They will then conduct a physical examination and examine the shoulder blades for signs of winging. During this, they will ask the person to perform some basic shoulder movements to show the range of motion.
If the doctor suspects nerve damage, they may then use a technique — called electromyography — to record the electrical activity produced by the skeletal muscles. This helps them assess nerve function.
Different causes of scapular winging require different treatments. There are 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 may recommend physical therapy and a support device, such as a sling.
In the case of dorsal scapular nerve damage, the doctor will likely suggest physical therapy. They may also recommend muscle relaxants, anti-inflammatory drugs, and pain relief medication.
Traumatic injuries and spinal accessory nerve damage are more likely to require surgery.
A doctor may recommend a nerve and muscle transfer, in which a surgeon transplants healthy muscles and nerves from another part of the body to repair the damage.
Or, they may recommend scapulothoracic fusion, which involves attaching the shoulder blades to the backs of the ribs. This procedure involves more risks than a nerve and muscle transfer.
Exercises can often aid recovery and reduce pain. However, some can make scapular winging worse. Before starting any exercise or stretching routines, talk to a doctor.
The University of California, San Francisco Orthopaedic Institute recommend the following:
Scapular retraction
This involves pulling the shoulder blades back while in a standing position. Hold the retraction for 10 seconds, rest for another 10 seconds, and repeat the cycle ten times.
External rotation
From a standing position, attach an exercise band to a closed door or another secure object.
Hold the band with one hand crossed in front of the body. The elbow of this arm should be at a 90 degree angle.
Keeping the elbow still, pull the band in front of the body and to the side. Repeat this 12–15 times.
Horizontal row
While resting on the knees, secure two exercise bands in front of the body and within reach. Hold them at arm’s length.
Keeping the back straight, pull the bands toward the body. Repeat this motion 12–15 times.
Standard pushups
To begin, the back should be flat, the legs should be outstretched, and the hands should be flat against the floor, farther apart than the width of the shoulders.
Bend the elbows and lower the body to the floor. Then, push the body up, resuming the starting position. Start with a few reps. Over time, work up to 12–15.
Angel wings
Start in a standing position, touching the hands above the head. The elbows should be bent and point outward to each side.
Maintaining the bend in the elbows, bring the arms down, so that the elbows point toward the floor, while squeezing the shoulder blades together. Repeat this 12–15 times.
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
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. Talk to a doctor about symptoms of scapular winging as soon as possible.
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.