Your shoulder blade jutting out shouldn’t give you pain, sloped shoulder, and worsened movement
Have you ever seen someone’s shoulder blade (or your own) stick out farther than it should? Especially when the arm moves?
Like the name suggests, “winged scapula” is a deformity where your shoulder blade protrudes like a wing, away from your ribs. It can show up on one side or both sides.
The winging comes from weakness or instability in your muscles. There are quite a few that can start it—there are over 20 muscles that attach to the scapula.
The serratus anterior muscle is the most common culprit. It’s the muscle you would use to lift something over your head or to throw a punch. When it’s working properly, it keeps your scapula sliding parallel to the ribs. When the serratus anterior is weak, the scapula pulls away from the ribs.
It’s not always obvious to the person with the winged scapula. Even people who recognize it may not notice it for many years. After all, it’s hard to notice something on your back.
Some only discover it when they’re uncomfortable laying against a hard surface, or when someone else points them winging out.
What causes winged scapula?
It’s usually due to nerve damage. Many times, it’s idiopathic—that is, the reason isn’t clear, even after your doctor runs tests.
Have you had any of these nerve-damaging injuries that can lead to winged scapula?
- Nerve damage that starts scapula winging can be from trauma.
- Some common injuries include breaking the collarbone, dislocating the shoulder, and strenuously lifting weights.
- Other injuries come from repetitive motions. Landscaping work is a prime offender, especially when it involves holding up a piece of equipment. Athletic injuries, like repeatedly landing on a shoulder, constantly stress the nerves and muscles all around the scapula.
- Poor posture can also stress the nerves, leading to weakened muscles. Do you find yourself frequently propping your head up with your hands? Or sleeping with your hands behind your head?
- Certain degenerative diseases, like Lyme’s disease and muscular dystrophy, can damage nerves throughout your body. The nerves controlling the muscles supporting your scapula are no exception.
- Did you notice a winged scapula after surgery? Damage can come from procedures like mastectomies or rib resections.
What movements is your winged scapula hindering?
A damaged nerve leading to scapula winging is caused by one of three nerves:
Long thoracic nerve1
- This nerve helps you move your arms muscles upwards and outwards, like when you hold up a piece of clothing in front of you to examine it. Do you have pain or struggle with this motion? If this nerve is causing the trouble, you may see it when you…Lift something over your head, like putting a box on a shelf.
- Repeatedly extend your arms, as with trimming hedges.
- Doing arm-extending exercises, such as lifting weights straight out.
Dorsal scapular nerve 2, 3
This nerve helps your muscles retract and elevate the scapula. You use this motion to raise your shoulders, raise your arms from your side, or pull your scapula closer together, like when you take a big chest stretch. If you have a winged scapula that’s affected by this nerve, you might see this when you experience…
- Trouble lifting your arms from your sides, like when you hold your arms out to balance yourself.
- Weakness and pain in your arm and shoulder.
- Struggle to lift your arm above your shoulder.
Spinal accessory nerve
This controls your trapezius muscle which supports and controls your scapula. This large muscle also supports your arm movement. The Winged scapula that involves this nerve is often from a specific injury. But these have recently had great surgical success.4 It can show up with:
- A neck surgery, like a lymph node removal or biopsy.
- Blunt force trauma, like getting hit in the neck.
- Penetrative injuries, such as shrapnel thrown into the neck from a car crash.
What’s available for winged scapula treatment?
Your doctor will start you out with muscle strengthening exercises. One of the best ways to get a bone back in place is to strengthen the muscles around it. These muscles keep your bones in place and moving on their right tracks.
If a movement or posture can be helped, muscle retraining and posture correction may help strengthen the muscles, reducing the winged scapula.
But if the muscle weakness is from a nerve injury, more exercise probably isn’t the answer. Conservative treatment often fails.
What happens if I don’t get my winged scapula treated?
If the winging is from nerve damage, your weakness could keep getting worse. It’s especially hard when you need to raise your arms over your head, push objects away from you, or move them closer to you. You may even begin to see your shoulder start to droop on the side of your winged scapula.5
If your winged scapula is keeping you from daily activities, or causing you chronic pain, your doctor may recommend surgery.
Winged scapula surgery
Surgery for winged scapula can be muscle or nerve transfers.6 This simply moves some of the muscle or nerve to a new location. The surgery will depend on what nerve is causing the muscle weakness around your scapula.
One muscle transfer surgery is a pectoralis major transfer or split pectoralis major transfer.7 This helps your chest muscles (your pecs) support your scapula from winging. It’s often picked for a paralyzed serratus anterior.
Another muscle transfer is the Eden-Lange procedure and modified Eden-Lange procedure.7 These reattach a neck and back muscle to your scapula to better support good scapula movement. It’s ideal for a trapezius that’s not working.
If a nerve is pinched, your doctor might choose a nerve transfer surgery for you.7 If the nerve is being compressed by a displaced tendon or muscle, moving the nerve to a new location may be the fix
Nevada Nerve Surgery for a winged scapula specialist
One or a pair of winged scapula stunts your movement. If your scapula sticks out in a way that makes certain movements painful, talk to your doctor about treatment options. Your shoulders and back shouldn’t have pain and restriction when you use them.
If nerve surgery is your next step, leave it in the hands of nerve professionals. We’ve got your back—scapula and all. The Tollestrup team is ready to answer you or your doctor at 702-505-8781.
[This article isn’t medical advice and shouldn’t replace an assessment or treatment plan from your physician. Please talk to your doctor about your health concerns.]
References:
- https://www.ncbi.nlm.nih.gov/books/NBK535396/#:~:text=
The%20long%20thoracic%20nerve%20is%20the%20motor%20nerve%20to%20the,the%20ribs%2C%20assisting%20in%20respiration - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6200514/
- https://www.youtube.com/watch?v=Zw1iD-2Vju8
- https://www.cancertherapyadvisor.com/home/decision-support-in-medicine/shoulder-and-elbow/evaluation-and-management-of-scapular-winging-due-to-spinal-accessory-nerve-palsy/#:~:text=Palsy%20of%20the%20eleventh%20cranial,disability%20about%20the%20upper%20extremity.
- https://www.healthline.com/health/scapular-winging#symptoms
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5802755/
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2505206/
