Winging of the Scapula | Treatment of Scapula Winging

Winging of the Scapula

Scapula Winging

• Anatomy
• Function
• Scapula Winging
• Treatment

Anatomy

The scapula - or most commonly referred to as the shoulder blade - is a flat triangular bone located posteriorly on the upper back against the rib cage. 

It spans the area between the second and seventh rib. 

The acromion, which is a bone that stems at the top of the scapula next to the superior border, is a joining force that connects the clavicle and the humerus.

Both superficial and deep muscles attach to the scapula. 

These are the trapezius, rhomboids, deltoids, supraspinatus, infraspinatus, levator scapulae, teres minor, teres major and  triceps brachii long head to mention a few. 

However, only three muscles are responsible for scapular movement (Trapezius, rhomboids and levator scapulae)

Function

The scapula performs a critical function of protraction and retraction; both of which are indispensible for shoulder and arm movement. 

Since the medial border of the scapula is not articulated with other bones, and it is rather kept in place (Against the vertebral column and thorax) only by muscles, it has the ability to rotate freely. 

This free rotation of the scapula provides a wider range of motion and a greater mobility for shoulder joint -therefore, the arm moves along with it - compared to others.

Upward and downward rotation of the scapula helps stabilize the shoulder capsule while the arm moves up or down simultaneously with a forward orientation. 

Although the motion seems easy, a lot of shoulder stabilization is needed, especially if the arm movement is excessive or weighted (As when training).

Scapula Winging

Due to the fact that a large number of muscles attach to the scapula, it is very rare that it fractures, or has any abnormalities. 

However, in some cases a scapulothoracic dysfunction, or most commonly known as scapular winging, might occur.

Denervation of the long thoracic nerve caused by disease or damage, for instance due to a severe trauma to the shoulder along with a sudden traction of the arm, directly affects the serratus anterior muscle. 

The serratus anterior is the primary muscle that holds the scapula tight to the rib cage through protraction. 

The loss of function of this muscle due to denervation makes the scapular protrude outward forming a wing. 

This is happens because the trapezius and rhomboids pull the scapula unopposed which retracts the medial scapular causing it to bulge out; this is known as medial winging.

Patients with scapular winging may experience severe to moderate pain that can keep them awake at night, but some patients experience no pain at all.

Treatment

Surgical solution is not really a good choice with scapula winging especially if the patient is aged or the condition is not severe. 

Physical therapy, however, is recommended to strengthen the serratus anterior and correct the imbalances that are making the condition worse. 

As a result, the scapular will gain its full function and performs its full range of motion. 

The damaged nerve will recover as the process of therapy goes on, so it just needs to be given some time of rehabilitation.  

There are a number of simple exercises and stretches that help the winged scapula recover; through addressing the root of the problem. 

Considering that the condition is caused by a weakness in the surratus anterior, strengthening it alone is not the best option out there.

You also have to address the other side of the problem which is the tight muscles at the back holding on the scapula (Rhomboids and trapezius).

Let’s start off by stretches. 

To stretch your rhomboids, stand with your back against the wall and put your arm fully extended out in front of you (With hands one above the other)

Start reaching forward as far as you can without bending your lower back. 

You should get in an upper back curved position that gives you a nice stretch up there.

Now, if you have an elevated shoulder on one side, it means your lavetor scapulae is tight. 

In this case, stand against the wall again and keep your whole back and head in contact with it. 

With your hand pull your head gently to the opposite side of the tight lavetor and raise the arm (of the tight side) to the direction of the head.

The stretches should be done a couple of times a day throughout the week. 

The length of each stretch should be about 15 to 20 seconds long.

As for strengthening the serratus anterior, you can first start by being on your four limbs on the ground - a cat pose.

Second, protract the scapula - push your upper back upward to create a curve - and then drive your torso backward (Push yourself back with your arms) creating an elevation of the arms above the body. Repeat this for reps.

Another good strengthening exercise can be done through pulling a resistance band apart. 

Again, protract the scapula first and reaching forward with your arms as far as possible before starting to pull the band apart. 

Once you open your arms as you would do in a reverse fly -except that you don’t pinch your shoulder blades and instead maintain the protraction - go back slowly to the starting position and repeat for reps.

You can also do the same protraction move on a dips bar, but with a slight modification. 

With your arms straight, and perpendicular to the dips bar, and your torso leaning forward a little bit, push through your shoulder blades protracting them and hold for 10 second before coming back down to the starting position. Perform a few reps of these.

Last but not least, you can do the straight arm push down, but… yes; you got it, with a protraction set up. 

Grab a rope on a cable machine, stand up tall and push your arms out in front of you (protracting the scapula)

From them push the rope down as you would do with the regular straight arm push down; then come back up, reset and repeat the same move for reps.