• March

    18

    2019
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Scapular Winging

Scapular Winging

Scapular winging (also referred to as winged scapula) is a disease condition that affects the shoulder blades.   Scapula is the medical term for shoulder blade.  The shoulder blades usually rest flat against the back of the chest wall.  Scapular winging happens when the shoulder blade sticks out.  Though the condition is not very common, it is very debilitating and painful, making one’s day-to-day activities difficult, such as lifting shopping bags or brushing your teeth.

What is scapular winging?

Scapula is a fairly big important bone with a complex structure that helps make up the shoulder joint.  Many important muscles are attached to the scapula.  It is these muscles that stabilize the shoulder joint, apart from providing arm movement.  When these muscles are weak or paralyzed, it impacts adversely a person’s ability to stabilize the scapula and this may lead to winged scapula, which means instead of lying flat, scapula protrudes from the back in a wing-like appearance.  It can impair one’s ability to lift, pull, and push heavy objects, and consequently impacts the ability to carry out daily activities of living.  Scapular winging may cause intense pain and a feeling that shoulder is frail.  Moreover, it limits shoulder elevation, reduces range of shoulder movement and in some cases even cause deformity.  Cosmetically, people may find it embarrassing if their winging is very apparent.

Muscles around the scapula may get weak because of the injury to the muscles or the nerves that feed these muscles.  Injury to the serratus anterior muscle is a common cause of scapular winging.  Without the firm support of this muscle, arm cannot be raised above the shoulder level.  The serratus anterior is innervated by the long thoracic nerve.  The unique structure of the long thoracic nerve makes it prone to injury.

What are the symptoms of scapular winging?

Signs and symptoms of scapular winging are subjective, which means it varies from person to person depending on the underlying cause as well as the nerves and muscles involved.  However, shoulder blade sticking out is a common sign among people with scapular winging, making them sitting comfortably in a chair and wearing a backpack quite excruciating.  If the scapular winging occurred as a result of damage in the nerve, it can lead to weakness in the muscles fed by that nerve – muscles in the neck, shoulder and arm.  It may also be associated with other symptoms including:

  • pain or discomfort in your neck, shoulders, and back
  • fatigue
  • a drooping shoulder

What are the causes of scapular winging?

More often than not, scapular winging can occur due to 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

Both injuries and surgeries can cause damage to these nerves and muscles.

Injuries:

A number of injuries can cause damage to important nerves and muscles, leading to scapular winging.

Traumatic injuries:  Blunt trauma to the nerves that control the muscles of your neck, upper back, and shoulder can result in scapular winging. Examples of blunt trauma include dislocating your shoulder or twisting your neck in an unusual way.

Repetitive motion injuries:  Repetitive motion is another factor that can cause scapular winging.  This type of injury is commonly found among athletes, but activities of daily living can also cause this injury, such as:

  • washing the car
  • digging
  • trimming hedges
  • using your arms to prop your head up while lying down

Non-traumatic injuries:

Non-traumatic injuries are the ones caused without 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

Am I suffering from scapular winging?

Stand with a relaxed posture, keep your arms by your sides.  Get someone to take a photograph of your back.  Observe the scapular region. Does your shoulder blade protrude?  If you can see a definite protrusion of the medial border of the shoulder blade, then you have scapular winging.

Diagnosisof scapular winging:

In the clinic, your doctor may have a close look at your scapula for any signs of winging.  You may also be asked to perform certain shoulder and arm movements.  Inform your doctor if you have had any injuries, illnesses or surgeries that could affect your neck, arms, or back. 

Treatment:

Once diagnosis is made and if the condition is not severe, your doctor may recommend light physiotherapy or the use of brace to augment the recovery process.  If the disease condition is mild to moderate, the doctor may go in for a mix of physical therapy and drugs like muscle relaxants, anti-inflammatory drugs, analgesics or a combination of all three.  Supports such as braces and slings can also speed up the recovery process.

If non-surgical treatments are not yielding the required benefit, doctor may recommend surgery, especially in the case of winging caused by a traumatic injury.  Most common surgical routes are nerve and muscle transfers. 

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

For questions related to disorders of the scapula, send a message to www.BangaloreShoulderInstitute.com/contact

Q & As on Scapular Winging

1. What is the role of the scapula?

The scapula is the most significant shoulder bone with a complex set of muscles attached. It is also known as the shoulder blade. It is a large, flat triangular bone and forms the back of the shoulder girdle. The scapula and the surrounding muscles help in the stability of the arm. 

There are 6 types of motion that the scapula facilitates. It allows full upper extremity movement, retraction, elevation, depression, and both upward and downward rotation. The movement of the scapula is synchronized with the movement of the arm. 

2. What are the tips to prevent scapular winging?

Scapular winging risk can be reduced by following these tips listed below.

  • Maintain a correct posture, you can minimise the risk of scapular winging. 
  • Avoid moving your shoulders constantly without proper rotational technique..
  • You should avoid carrying a heavy weight on your shoulders.
  • You should use ergonomic furniture to support your posture.
  • You can practice stretching and muscle strengthening exercises in the neck, shoulders, and upper arm. 
  • Always try to use shoulder-friendly backpacks so that they are a support to your shoulders.

3.What is the surgical option for the treatment of winged scapula?

Surgical treatment is one of the methods of treatment for scapular winging. The nerve and muscle transfer process involves taking a part or whole of the muscles from nerves and moving it to another part of the body. The focus is mainly on the back, shoulder and chest. 

Static stabilisation is another process that involves using a sling to connect the scapula to the ribs. It controls the bony parts that stick out of your vertebral column.

Scapulothoracic fusion is the last resort doctors resort to when there are no alternatives available. Here, the scapula is directly attached to the ribs.

4. What are the non-surgical options available for scapular winging?

Certain cases heal on their own within a span of two years. This is the case of scapular winging due to damage to the serratus anterior nerve. You may be prescribed physical therapy along with wearing braces.

Muscle relaxants, analgesics and anti-inflammatory drugs may also be prescribed by the doctor. A mixture of physical and massage therapy may be prescribed by the doctor if the winging is due to injury to the dorsal scapular nerve.

5. What are the types of investigation that help identify scapular winging?

Doctors can analyse the presence of scapular winging through physical and clinical tests. Three kinds of winging can be identified, the serratus anterior palsy, trapezius palsy and rhomboids palsy. Deformation of the back and asymmetric neckline with drooping of the shoulder are indicators to identify winging. The patient is advised to push against the wall keeping the palm on the affected side which helps in identifying the protrusion.

With the help of electrodiagnostic testing, the basic neuromuscular pathology leading to winging can be easily recognized. Neuromuscular ultrasound is also another way used by doctors to identify the winging of the scapula. 

 

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