Winged Scapula: Symptoms, Causes, Diagnosis, Treatment, Prevention and Recovery

Also known as scapular flapping and / or winged shoulder blade, it is a condition that affects the shoulder blades.

The scapula is the anatomical term for the shoulder blade.

The shoulder blades generally rest flat against the back of the chest wall. Scapular flutter occurs when a shoulder blade sticks out.

While the condition is rare, it is usually painful and makes everyday activities difficult, such as lifting grocery bags or brushing your teeth.

What are the symptoms of scapular wing or winged scapula?

The symptoms of scapular flapping vary from person to person depending on the underlying cause, as well as the muscles and nerves involved.

Most people with a winged scapula have a protruding shoulder blade. This can make sitting in a chair or carrying a backpack uncomfortable.

If the winged scapula is the result of nerve damage, it can cause weakness in the muscles in your neck, shoulders, and arms.

That weakness can make it difficult to lift, pull, and push heavy objects.

The winged scapula often affects your ability to raise your arm above your shoulder. It can also be associated with other symptoms, including:

  • Pain or discomfort in your neck, shoulders, and back.
  • Fatigue.
  • A dropped shoulder.

What Causes Winged Scapula?

Scapular flapping is almost always caused by damage to one of the three nerves that control the muscles of the 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 nerve element, which controls the trapezius muscle.
  • Injuries and surgeries can damage these nerves and muscles.
  • Blunt trauma to the nerves that control the muscles of the neck, upper back, and shoulder can lead to the scapular wing. Some examples of blunt trauma include dislocation of the shoulder or twisting of the neck in an unusual way.
  • Repetitive motion injuries. This type of injury is common among athletes.

It can also be caused by everyday tasks, such as:

  • Washing the car.
  • Excavation.
  • Use your arms to support your head while lying down.
  • Non-traumatic injuries.

Non-traumatic injuries are not caused by 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.
  • Surgery.
  • Rib resections, mastectomies, and procedures that require general anesthesia can cause nerve damage.

A study in Supportive Care for Cancer followed people who had undergone axillary dissection, a surgical treatment for breast cancer. Among the 112 respondents, 8 percent exhibited winged scapula 15 days after surgery.

Diagnosis of winged scapula

Your doctor will first look at your shoulder blade for any obvious signs of flapping. They may also ask you to perform certain arm or shoulder movements. Tell your doctor about any recent injuries, illnesses, or surgery that may affect your neck, arms, or back.

If your doctor decides that you have a winged scapula, he or she might use electromyography to see if it is related to the serratus anterior, trapezius, or rhomboid muscles.

How is the scapular wing treated?

Depending on which nerve and muscle is causing it, the scapular wing has both non-surgical and surgical treatment options.

Non-surgical treatment

Cases of scapular wings 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 wearing a brace for several months early in your recovery.

For scapular flutter caused by damage to the dorsal scapular nerve, your doctor will likely recommend a combination of physical therapy and massage.

They may also prescribe muscle relaxants, anti-inflammatory medications, pain relievers, or a combination of all three. Supports, such as brakes and slings, can also be helpful during recovery.

If nonsurgical treatment options do not provide any relief, your doctor may recommend surgery. Also, scapular flapping caused by traumatic injury is more likely to require surgery.

Scapular flutter due to spinal accessory nerve damage also generally requires surgery.

Surgical treatment

The most common surgical treatments for scapular flight 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 to the scapular wing usually focus on the shoulder, back, or chest.

Another option is called static stabilization. This procedure involves the use of a sling to attach the scapula to the ribs or vertebral spinous processes, which are bony parts that protrude from the vertebrae. There is a risk that the sling will stretch over time, causing the winged scapula to return.

Your doctor may recommend a procedure called a scapulothoracic fusion if other treatments don’t work.

This involves attaching the scapula directly to the ribs. You may not be able to lift your arms after this procedure. It can also cause permanent bone fractures and lung problems. Your doctor will likely suggest this procedure only if there are no alternatives.

Home exercises

Stretching at home can help you improve your strength and range of motion. In some cases, stretching and exercise can make the scapular wing worse, so always check with your doctor before doing any exercises at home.

Other winged scapula exercises

A winged scapula is generally as a result of weakened shoulder blade stabilizers, especially the Serratus Anterior. The serratus anterior is also known as the perforation muscle.

To directly target the serratus anterior, shoulder blade protraction exercises work best in conjunction with serratus pressing exercises. Any movement that extends the shoulder forward into the final range of motion will target the serratus anterior. Punching a punching bag will work this muscle too.

Scapula protraction

Start with the end of the band in one hand at shoulder height, elbow bend. Push your hand forward, straightening your elbow as you go, in a piercing motion.

Make sure to push through the entire shoulder, trying to get as far forward as possible. Slowly return your hand to the starting position under complete control.

Serratus Press

Begin in a lying position as shown, with a medicine ball in both hands, elbows straight. Keep your elbows straight throughout the exercise. Push the ball upward, using only your shoulder girdle to move it. Lower your shoulders and repeat.

How can I prevent scapular flapping?

Scapular flapping isn’t always preventable, but you may be able to reduce your risk by:

  • Avoiding repetitive shoulder or arm movements when possible.
  • Maintaining the correct posture.
  • Using an ergonomic chair or pillow.
  • Use of easy-to-use ergonomic shoulder bags and backpacks.
  • Avoiding carrying too much weight on the shoulders.
  • Stretching and strengthening the muscles in your neck, shoulders, and upper arms.

Scapular flutter recovery

Recovery from scapular flapping can take anywhere from a few months to several years, depending on the initial cause, the method of treatment, and the affected nerves and muscles.

Non-surgical treatment options can start working almost immediately, while surgical treatment will likely take a few months to produce results.