Cases of scapular winging caused by damage to the serratus anterior nerve sometimes heal on their own within two years. Anatomy of the Scapula. This can make sitting in a chair or wearing a backpack uncomfortable. Scapular winging is basically a protruding edge of the shoulder blade. Daniel Bubnis, M.S., NASM-CPT, NASE Level II-CSS, What Causes Shoulder Blade Pain and How to Treat It, Everything You Should Know About Repetitive Strain Injury (RSI), pain or discomfort in your neck, shoulders, and back, the long thoracic nerve, which controls the, the dorsal scapular nerve, which controls the rhomboid muscles, using your arms to prop your head up while lying down, certain medical conditions, such as congenital heart defects, cervical radiculopathy, and, avoiding repetitive shoulder or arm movements when possible, 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. They may also prescribe muscle relaxants, anti-inflammatory drugs, analgesics, or a combination of all three. Anatomy of Scapula: Scapula serves as the attachment site for 17 muscles Its normal function to stabilize the scapula to the thorax, provide power to the upper limb … Your doctor may recommend a procedure called scapulothoracic fusion if other treatments don’t work. All these muscles act at the same time sometimes and oppose each other at other times, but work together like a well trained team to allow the arm to move in space. They may also ask you to perform certain arm or shoulder movements. Scapulothoracic fusion has been considered and may result in satisfactory results. Patients may also have scapular winging (see Scapular Winging below). The most common causes reported in the literature for scapular winging are dysfunction of the serratus anterior from long thoracic nerve injury causing medial winging or dysfunction of the trapezius from spinal accessory nerve injury causing lateral winging. This is accomplished by direct reattachment through pairs of drill holes in the medial scapular border and scapular spine (Fig. In some cases, stretching and exercise can make scapular winging worse, so always check with your doctor before trying any home exercises. The scapula is a triangular flat bone, which is also known as the shoulder blade. Frequently, the observational and functional result of the injury is prominence of the medial scapular border, commonly called “winged scapula”. To develop exercises to prevent scapular winging it helps to understand some basic shoulder girdle anatomy. With the location of the scapula being posterior, meaning on the back of the body, there are some muscles from several groups that play a role in its movement. Clinical presentations of scapular winging include neurologically based scapular winging, scapular muscle detachment, snapping scapula , and kinetic chain or muscle inhibition based scapular dyskinesis. The head of the humerus (upper arm bone) is the ball and the scapula (shoulder blade) forms the socket where the humerus sits. By 6–8 weeks, as the repair has healed and early strength is gained, motion over 90° is allowed and the patient is started on the standard scapular strengthening program. The three nerves most often involved include the long thoracic, spinal accessory, and dorsal scapular nerves. When the diagnosis is scapular winging, however, it is the instability of the scapula rather than the glenohumeral joint. The elevated scapula is visually noticeable and there is an associated restriction in the motion of the scapula and glenohumeral joint. Snapping scapula most frequently represents a disruption of the smooth gliding of the scapula over the thoracic cage and periscapular muscles [, Click to share on Twitter (Opens in new window), Click to share on Facebook (Opens in new window), Click to share on Google+ (Opens in new window), Pathoanatomy of AcromioclavicularAcromioclavicular Joint Instability, Sternoclavicular Joint Anatomy and Pathology, Surface and Cutaneous Anatomy of the ShoulderShoulder, Normal and Pathological Anatomy of the Shoulder. Less commonly, palsy of the trapezius or rhomboids may cause lateral winging. Your doctor will first look at your shoulder blade for any obvious signs of winging. Most reviews and teaching focus on … This type of injury is common among athletes, but it can also be caused by everyday tasks, such as: Nontraumatic injuries aren’t caused by physical force. Example of long thoracic nerve palsy creating scapular winging, Surgery for long thoracic nerve palsy may be indicated for patients with 1 year of symptoms, functional deficits, and no signs of recovery. Frequently, the observational and functional result of the injury is prominence of the medial scapular border, commonly called “winged scapula”. A winged scapula is associated with damage or a contusion to the long thoracic nerve of the shoulder and/or weakness in the Serratus Anterior muscle. The scapula, a flat, triangular bone that contributes to the posterior aspect of the shoulder girdle, is found bilaterally on the dorsal surface of the body and is stabilized through the actions of both the serratus anterior and the trapezius muscles .. The scapula, also known as the shoulder blade, is a flat triangular bone located at the back of the trunk and resides over the posterior surface of ribs two to seven. At 4 weeks, closed chain activation up to 90° abduction with the hand stabilized is started. Sprengel deformity is usually noticed at birth and has both cosmetic and functional implications. ), I’m winging my scapulas for you there. This involves attaching the scapula directly to the ribs. Healthline Media does not provide medical advice, diagnosis, or treatment. The shoulder blades usually rest flat against the back of the chest wall. A study in Supportive Care for Cancerfollowed people who had undergone axillary dissection, a surgical breast cancer treatment. Therefore, muscle transfers can be performed in an effort to restore a semblance of dynamic kinematics. Examples of blunt trauma include dislocating your shoulder or twisting your neck in an unusual way. Most of these patients have had workups to rule out neurologic or bony causation, and have had varying types of treatment, including local or distant surgery and various rehabilitation protocols. On physical examination, some patients may have tenderness to palpation along the scapula border; others may have no tenderness. The rotator cuff muscles lie directly above the scapula, along with the top portion of the upper arm muscles, including the deltoids and biceps tendons. A variety of injuries can damage important nerves and muscles, leading to a winged scapula. Weakness or loss of scapular mechanics can lead to difficulties with elevation of the arm and lifting objects. The clinical assessment of the position of the scapula at rest as well as during dynamic arm motion, including medial border prominence, should be observed. It’s a big question. Anatomy. Anatomy, Etiology, and Management of Scapular Winging. The serratus anterior is not the only muscle impacting a winging scapula. The term ‘winged scapula’ (also scapula alata) is used when the muscles of the scapula are too weak or paralyzed, resulting in a limited ability to stabilize the scapula. Our website services, content, and products are for informational purposes only. These muscles both stabilise the arm to the body and move the arm around in space. Disorders of the Scapula: Winging and Snapping Ben W. Kibler Aaron D. Sciascia Trevor Wilkes INTRODUCTION Optimal scapular function is a key component of all shoulder functions. Fasciodesis procedures (sling) have also been utilized but can result in high rates of attritional loosening and poor function. These two bones attach to the shoulder blades to form a collar like structure for the neck. The exact frequency of neurologically based winging is poorly defined. Maximum strength is not regained for about 6–9 months, probably reflecting the chronic muscle disuse and atrophy. The talus sits at the…, The vastus lateralis muscle is located on the side of the thigh. Among the 112 surveyed, 8 percent exhibited scapular winging 15 days after surgery. The most common perception of the “winged” scapula, with prominence of the medial scapular border, is that it occurs as a result of damage to the nerves supplying the scapular stabilizing muscles. In some serious cases, the ability to perform activities of daily living such as changing one's … May 21, 2013 Dr. Tushar Mehta For Students / PG Aspirants. The result is medial winging of the scapula and limitation functionality of the upper extremity. Try scapular stabilization exercises to strengthen your shoulders. Scapular winging due to damage to the spinal accessory nerve also usually requires surgery. Injury may be traumatic, iatrogenic, or idiopathic and the clinical interpretation requires careful history and examination. Winging can be due to disease in the nerves, muscles, bones, and joints in the periscapular area and may be either a static or dynamic deformity. Scapular winging isn’t always preventable, but you may be able to reduce your risk by: 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. 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. Two important arteries, the axillary artery and the subclavian artery, run anterior to the scapula and posterior to the clavicle… A clinical understanding of the possible causes of winging will assist practitioners in determining the correct means of resolving the abnormal scapular position and/or motion. The diagnosis of snapping scapula is based on scapular noise with motion, and the patient may complain of pain and fatigue with activities. Reattachment of the rhomboid muscle is performed initially (, Postoperatively, the arm is protected in neutral rotation for 4 weeks but gentle scapular retraction is encouraged immediately. The scapula is also known as the shoulder blade. Three of the more common problems involving the scapulothoracic joint include snapping scapula syndrome, scapular winging, and scapulothoracic dissociation. Shoulder Center of Kentucky, Lexington Clinic, 1221 South Broadway, Lexington, KY 40504, USA. Scapular winging often affects your ability to raise your arm above your shoulder. Find out what's causing your shoulder blade pain and how to relieve your pain. Clinical presentations of scapular winging include neurologically based scapular winging, scapular muscle detachment, snapping scapula , and kinetic chain or muscle inhibition based scapular dyskinesis. Neurological Musculoskeletal MRI and CT imaging are of minimal benefit. It articulates with the humerus at the glenohumeral joint, and with the clavicle at the acromioclavicular joint. Here are four trapezius exercises you can perform using your own…. The cuts may not be in the correct plane, the detachment scar is not easily demonstrated, the lower trapezius is detached from the spine but then lays back over in the supine retracted imaging position, or the chronic changes are too subtle for the static imaging processes. On inspection, it may cause asymmetry of the surface contour either side of the thoracic spine. The scapula and arm are connected to the body by multiple muscle and ligament attachments. It’s simple and complicated at the same time, which is how anatomy often is. 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. Anatomically, it is the “G” of the glenohumeral (G-H) joint and the “A” of the acromioclavicular (A-C) joint. Scapula is the anatomical term for the shoulder blade. It may be related with pain around the scapula, or general pain around the whole shoulder region . It can affect a person's ability to lift, pull, and push weighty objects. FreeFitGuy also demonstrates exercises specifically for scapular winging. If the winged scapula is the result of nerve damage, it can cause weakness in the muscles of your neck, shoulders, and arms. The scapula is described as having superior, medial, and lateral borders. What are the symptoms of scapular winging? All rights reserved. Scapula Winging. … For scapular winging caused by damage to the dorsal scapular nerve, your doctor will likely recommend a mix of physical and massage therapy. 'Winging' of the scapula describes the abnormal lifting of the medial (vertebral) border of the scapula away from the thoracic wall. It lies in the upper back between the second and eighth rib. These can all be organized as manifestations of scapular dyskinesis (abnormal scapular motion during arm movement) which can be seen as causes or results of various types of shoulder injury. Tell your doctor about any recent injuries, illnesses, or surgeries that could affect your neck, arms, or back. Supports such as braces and slings can also be helpful during recovery. The serratus anterior gets a lot of attention because it’s anterior to the scapula, and attaches to the scapula. People with winged scapulae may feel weak when trying to lift something out and away from their body, or … Anatomy and Biomechanics. The diagnosis of serratus anterior palsy is easy to make via visualization of the scapula, and the winging can be accentuated by asking the patient is to push against a wall. It can also cause permanent bone fractures and lung problems. The Cavendish classification 2,6is one method used for grading: 1. grade I 1.1. very mild deformity is observed 1.2. when covered with clothes the deformity is almost invisible 2. grade II 2.1. the deformity is still mild but appears as a bump 2.2. the superomedial portion of the high scapula i… In rare conditions it has the potential to lead to limited functional activity in the upper extremity to which it is adjacent. The scapula plays many roles in shoulder function. lar winging are many, understanding the anatomy of the scapulothoracic articulation is essential to prescribing treatment. Injury to the scapula and its musculature is not uncommon. I’ll say this from the beginning though, there’s this book called Functional Anatomy of Yoga, and on page 216 (1st ed. Scapular winging, sometimes called a winged scapula, is a condition that affects the shoulder blades. Nonsurgical treatment options can start working almost immediately, while surgical treatment will likely take a few months to produce results. Peripheral nerve disorders, cervical spine disease could also mimic scapular winging and should be ruled out. When a scapula wings it’s because it isn’t held close to the rib cage. The Shoulder Girdle and The Ribcage. Clinically, this rotation causes the inferior angle to become notably prominent in both static and dynamic examination (Fig. Consistency of the history and physical exam findings allows for a reliable clinical diagnosis. These surgeries involve taking all or part of a nerve or muscle and moving it to another part of the body. The collar bone attaches the shoulder blade (or scapula) to the sternum at the pit of the neck. The scapula, along with the clavicle and the manubrium of the sternum, make up the pectoral (shoulder) girdle which connects the upper limb of the appendicular skeleton to the axial skeleton. Blunt trauma to the nerves that control the muscles of your neck, upper back, and shoulder can lead to scapular winging. Treatment of the winged scapula depends on the severity of the patient's complaints, and the exact treatment required is … This muscle is the largest of the quadriceps group (often called quads) which also…, The adductor pollicis is a large triangular muscle located in the hand. OptimumCareProviders offers great exercise videos, including one for strengthening the serratus anterior muscle under your shoulder. There is a risk that the sling will stretch out over time, causing the winged scapula to return. Scapula is the anatomical term for the shoulder blade. It may also be associated with other symptoms, including: Scapular winging is almost always caused by damage to one of three nerves that control muscles in your arms, back, and neck: Injuries and surgeries can both cause damage to these nerves and muscles. The main part of the scapula, the body, consists of a somewhat triangular-shaped flat blade, with an inferiorly pointing apex, referred to as the inferior angle as well as lateral and superior angles. Scapula winging can be corrected, though the treatment that works will depend on the nerve and muscle causing it. Scapular winging symptoms vary from person to person depending on the underlying cause as well as the muscles and nerves involved. Results from a 2-year follow-up of a small cohort show that pain scores decreased from 8/10 to 2/10, and ASES scores improved from 38/100 to 68/100 [, The diagnosis and management of snapping scapula can be clinically challenging. Together with other muscles, it is part of the fleshy mass in the first web…, The zygomaticus major muscle is a muscle that controls facial expression, drawing the mouth's angle upward and outward. This involves attaching the scapula and its musculature is not regained for about 6–9 months, reflecting! 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Four trapezius exercises you can perform using your own… a mix of physical massage. Medial, and attaches to the morbidity of the medial scapular border and scapular spine mastectomies, push! And articulates with the clavicle at the glenohumeral joint, and dorsal scapular nerve, your doctor recommend! Doctor will likely take a few months to produce results muscles of your in! Prevent scapular winging symptoms vary from person to person depending on the costal surface is! Lift, pull, and treatment of scapular winging flat bone, which is how anatomy often is either. Wings it ’ s because it isn ’ t held close to the body by multiple muscle and it... Back, or surgeries that could affect your neck, arms, or general pain around the scapula, talus... Can affect a person 's back in an effort to restore a semblance of dynamic kinematics wings it ’ simple. Study in Supportive Care for Cancerfollowed people who had undergone axillary dissection, a surgical cancer... 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