PT Corner with Kristin Williams

Scapular Winging

By Kristin Williams

May 3, 2022

Scapular winging…it’s one of those mysterious musculoskeletal diagnoses that you might never hear of until you get it…and then it seems like literally everyone you come across has it or knows someone who has it! As a physical therapist, if I had a dollar for every person who asked me to “fix” their winged scapula, I’d be rich. Ok, maybe not rich, but I think you get the picture. 🙂 So what is scapular winging and what can you do about it?

 

Scapula is the anatomical term for the shoulder blade. Under normal conditions, the scapula should rest flush upon the thorax and move along the rib cage in conjunction with the upper extremity. Scapular winging is when the medial border, closest to the spine, pops off the ribs and “wings out”. So what causes it? In most cases, scapular winging is caused by damage to one of three nerves:

 

  • Long Thoracic Nerve – innervates the serratus anterior, which attaches to the medial border of the scapula from ribs underneath
  • Spinal Accessory Nerve – innervates the trapezius muscle, which attaches to the spine of the scapula
  • Dorsal Scapular Nerve – innervates the rhomboid muscles, which attach to the medial border of the scapula from the spine

 

Various sports or blunt traumatic related injuries can cause injuries to the nerves and yield scapular winging. Surgeries can also damage the nerves, specifically those surgeries related to breast cancer. In many instances, people develop scapular winging as a result of repetitive upper extremity motion. Greater than 50% of medial scapular winging is caused by a traction nerve injury to the long thoracic nerve. So think of repetitive throwing, overhead volleyball serves, wearing a heavy backpack, or overhead weightlifting. Many cases of injuries to the long thoracic nerve which temporarily paralyze the serratus anterior will resolve on their own within 2 years, as long as the repetitive stretching stops.

 

Rehabilitation following atrophy of the scapular stabilizers can be long and arduous. Depending on the severity of the scapular winging, a visit to your local physical therapist may be warranted. However, so much of what we do in LYT yoga addresses scapular stability and the serratus anterior in particular. Use of manual and visual cues to encourage forced use of the serratus on the side of the dysfunction can help to speed up recovery once the neural trauma is resolved. Maintaining optimal posture both on your mat and off also help to facilitate a neutral scapula and cervical spine, which facilitate healing and strengthening as well. So if your scapula wings, it’s not the end of the world. No need to “fly” off the handle! (Bad pun, but I couldn’t resist!) Take a hard look at what might have caused or be causing the issue and go from there. See a physical therapist for specific treatment. And as always, get on your mat and keep those scapulae neutral! Fly high friends!

 

Xoxo,

Kristin

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