Overview
Winging scapula is the description for a condition where the shoulder blade protrudes from your back, giving the impression of a wing. In most cases, only one shoulder blade is affected. However, although less common, it can affect both shoulder blades at the same time.
Why does winging scapula happen?
A variety of causes, ranging from injury to muscle dysfunction and nerve damage can lead to winging scapula. Because it is often symptomatic of another condition, evidence of a winging scapula should be investigated carefully and thoroughly.
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.g. 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.
How common is it?
Winging scapula is actually very common, but because it often causes no pain or other symptoms, it can tend to get overlooked.
Symptoms
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.
Investigating the problem
Physical examination
Mr. 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. Shrugging your shoulders or lifting your arms into certain positions may be difficult, for example. He may also ask you to push against a wall. This simple but effective test shows to what extent your shoulder blade protrudes.
X-ray
If Mr. Cole suspects a bony cause he may request an x-ray. X-rays are particularly good at showing pictures of your bones. They are not so good, however, at showing soft tissue problems. In most cases the X ray will be normal since the majority of cases are due to soft tissue problem.
MRI
MRI stands for Magnetic Resonance Imaging. A non-invasive and painless procedure, it uses a powerful magnet to obtain three dimensional pictures of body structures. It is good at showing soft tissue problems, such as a lesion which may be pressing on a nerve, for example
EMG Studies
An electromyogram (EMG) measures the electrical activity of muscles at rest and during contraction. Nerve conduction studies measure how well and how fast the nerves can send electrical signals. Nerves control the muscles in the body by electrical signals (impulses), and these impulses make the muscles react in specific ways.
Measuring the electrical activity in muscles and nerves can help diagnose conditions that affect muscle tissue (such as muscular dystrophy) or nerves. EMG and nerve conduction studies are often done together to give more complete information.
Treatment options
Non-surgical treatment
Physiotherapy
Most problems associated with a winging scapula can be solved with physiotherapy. This will involve the strengthening of weakened muscles and the retraining of dysfunctional muscles to work properly. Mr Cole will work closely with your team of physiotherapists to ensure a programme of exercises designed specifically for your shoulder and the individual causes unique to your situation.
Surgical treatment
In rare cases you may require an operation. This could be to remove a lesion, stablise your shoulder joint or tendon transfers to stabilize the scapula, for example. If you are offered surgery, Mr. Cole will discuss it in detail with you.
Exercises
Following your surgery, your team of physiotherapists will work with you to devise an exercise programme. This will be designed with advice from Mr. Cole to help you recover as quickly and efficiently as possible.