The shoulder blade itself scapula is the largest bone in your shoulder and has the greatest number of muscles attached to it.
Each muscle works together to enable you to move your arm in different directions. If any individual muscle fails to work correctly, it can lead to dysrhythmia, which is a break in the rhythmic motion of your shoulder blade. This can prevent the muscles from supporting your shoulder blade properly and lead to a 'winging' of your scapula. The classic cause of winging scapula is the dysfunction of a muscle called the serratus anterior muscle. This is an uncommon condition which arises out of damage to the long thoracic nerve which supplies the serratus anterior muscle.
An injury, or a lesion leading to inflammation, may cause damage to the nerve e. Parsonage Turner Syndrome also known as brachial neuritis. Damage to the spinal accessory nerve in the neck will result in paralysis of the trapezius muscle and will also result in a type of winging of the scapula.
Winging scapula can also be a symptom of another condition. For example, if you have dislocated your shoulder several times, the muscles that move and support your shoulder blade may become damaged or prone to dysfunction.
Sometimes, if you have pain in another part of your shoulder, you may find yourself compensating for it by moving or holding yourself in an unnatural posture. This could in turn lead to a weakening of the muscles that support your shoulder blade.
Winging scapula is actually very common, but because it often causes no pain or other symptoms, it can tend to get overlooked. In addition to the marked wing-like shape of the shoulder blade, symptoms that accompany a winging scapula vary according to the cause of the condition. Some people seem to have no symptoms at all. Others experience pain or weakness in their shoulder, arm, neck, or all three. There may be difficulty elevating the arm above shoulder height. Examples of specific muscle weakness include being unable to shrug your shoulders and being unable to lift your arm when lying on your front.
Cole will talk to you about your shoulder symptoms and your shoulder's history. He will examine your shoulder and assess your range of movement. Blunt trauma to the nerves that control the muscles of your neck, upper back, and shoulder can lead to scapular winging.
Examples of blunt trauma include dislocating your shoulder or twisting your neck in an unusual way. Repetitive movements can also cause injuries. This type of injury is common among athletes, but it can also be caused by everyday tasks, such as:. Rib resections, mastectomies, and procedures that require general anesthesia may cause nerve damage.
A study in Supportive Care for Cancer followed people who had undergone axillary dissection, a surgical breast cancer treatment. Among the surveyed, 8 percent exhibited scapular winging 15 days after surgery. Your doctor will first look at your shoulder blade for any obvious signs of winging. They may also ask you to perform certain arm or shoulder movements.
Tell your doctor about any recent injuries, illnesses, or surgeries that could affect your neck, arms, or back. Depending on which nerve and muscle is causing it, scapular winging has both nonsurgical and surgical treatment options.
Cases of scapular winging caused by damage to the serratus anterior nerve sometimes heal on their own within two years. Your doctor may also recommend light physical therapy or using a brace for several months early in your recovery. For scapular winging caused by damage to the dorsal scapular nerve, your doctor will likely recommend a mix of physical and massage therapy.
They may also prescribe muscle relaxants, anti-inflammatory drugs, analgesics, or a combination of all three. Supports such as braces and slings can also be helpful during recovery.
In addition, scapular winging caused by a traumatic injury is more likely to need surgery. Scapular winging due to damage to the spinal accessory nerve also usually requires surgery. The most common surgical treatments for scapular winging are nerve and muscle transfers. These surgeries involve taking all or part of a nerve or muscle and moving it to another part of the body. Nerve and muscle transfers for scapular winging usually focus on the shoulder, back, or chest.
Another option is called static stabilization. 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. There is a risk that the sling will stretch out over time, causing the winged scapula to return. This involves attaching the scapula directly to the ribs.
What causes this problem and what can be done about it? Causes of scapular winging are broken down into two groups: primary and secondary.
Primary scapular winging occurs when one of the main muscles that hold the scapula steady stops working as it should. Injury to the nerve controlling scapular muscles is one cause of primary scapular winging. Athletes are at greatest risk for nerve paralysis causing primary scapular winging. Whether an athlete, homemaker, industrial worker or other individual who suffers a fall, collision, or repetitive motion, you could develop this problem.
Secondary scapular winging is the result of a problem somewhere else in the shoulder complex. That other problem could be a rotator cuff tear, shoulder bursitis, shoulder dislocation, or a frozen shoulder. Any injury or condition that can alter the way the muscles fire or cause muscular fatigue can result in impairment of the scapular rhythm needed for normal arm movement.
Likewise, anything that changes the alignment of the scapula can have the same effects on scapular position and movement. Before defining the treatment, an accurate diagnosis and understanding of the cause is needed.
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