What is A WINGED Scapula & HOW CAN PHYSIOTHERAPY TREATMENT HELP?
The scapula, or shoulder blade, is the triangular shaped bone that serves as the connection between the main body and the shoulder and upper limb.
It serves as the primary attachment point for 17 different muscles which function to move and stabilise the scapula, and contribute to movement of the shoulder and arm.
This coordinated and balanced movement allows the shoulder to move through a significant range of motion. However, dysfunction of the muscles that act on the shoulder blade can result to an interruption of the synchronised and coordinated movements of the shoulder blade.
Scapula winging refers to an altered position of the shoulder blade (scapula) relative to the thorax (rib cage). This is characterised by the protrusion of the medial border (inside border) and inferior angle (bottom corner) of the scapula, and a change in the normal movement pattern of the shoulder blade during shoulder range of motion.
Whilst everybody’s scapula movement is unique to them, and differences in scapula movement are not always indicative of an injury, significant scapula winging may point to an underlying issue and be a cause of shoulder pain and dysfunction.
Scapula Winging is caused by a disruption to the nerve supply of the muscles that function to stabilise the Scapula.
Medial Scapula Winging
Medial scapula winging results from disruption of the long thoracic nerve. The long thoracic nerve is a motor nerve that supplies the Serratus Anterior muscle.
Long Thoracic Nerve palsy can be caused by compression to the nerve, traumatic injuries or an underlying neurological cause.
Long Thoracic Nerve palsy results in a disruption of the nerve signal to the Serratus Anterior muscle, leading to paralysis of the Serratus Anterior muscle.
The Serratus anterior lives on the surface of the upper ribs on the side of the chest and attaches to the medial border of the shoulder blade. It functions to fix the scapular into the back of the rib cage during movements of the shoulder.
Paralysis of the Serratus Anterior muscles results in a protrusion of the medial border and inferior angle of the shoulder blade at rest and during movements of the shoulder.
Long thoracic nerve palsy is uncommon and is only reported to affect less than 1% of the population.
Lateral Scapula Winging
Lateral Scapula winging results from disruption of the Accessory Nerve. The Accessory nerve supplies the Trapezius muscles. Injuries to the Accessory nerve can be caused by compression of the nerve, traumatic injuries and underlying neurological conditions.
Accessory Nerve palsy results in a disruption of the nerve signal to the trapezius muscle.
The Trapezius muscle has three portions, which all perform different movements on the scapula. The upper portion rotates the scapula upwards, the middle portion retracts the scapula and the lower potion pulls the scapula downward.
Coordinated movement of the three portions of the trapezius muscle are important for the normal movement of the shoulder.
Paralysis of Trapezius muscle can result in a notable downward ‘droop’ of the shoulder blade at rest and a lateral protrusion of the inferior angle during movements of the shoulder.
Accessory nerve palsy is equally as uncommon, however, changes to the normal movement patterns of the shoulder blade can be a significant contributor to shoulder pain and dysfunction.
Secondary scapula winging may occur during other pathologies of the shoulder such as frozen shoulder, osteoarthritis or rotator cuff injuries.
Secondary scapula winging can result from weakness to muscles of the shoulder blade resulting in reduced activation and synchronisation of these muscles during movement.
Equally, changes in normal movement patterns due to pain or stiffness of the shoulder joint can result in increased movement demands placed on the shoulder blade causing scapula winging during movement.
What are the Symptoms of a Winged Scapula?
Scapula winging can be associated with:
Shoulder or Scapula Pain during movement or at rest
A loss or change in the normal function of your shoulder
Abnormal protrusion of the shoulder blade at rest and during movement
A loss of shoulder range through different planes of movement
What is involved with Winged Scapula Treatment and Physiotherapy management?
A thorough physiotherapy assessment can help you determine the underlying cause of your scapula winging or shoulder pain. A clear and accurate diagnosis is important to ensure your rehabilitation can be targeted towards your specific problem and goals.
Primary Scapula Winging and Pain Relief
Research on Long Thoracic Nerve Palsy and Accessory Nerve Palsy shows that these conditions are commonly self-resolving and can recover in time.
However, physiotherapy can play an important role in providing appropriate strength exercises to support the muscles around the shoulder and shoulder blade to maintain your shoulder function and prevent further loss of strength. Physiotherapy exercises that focus on control may also help to improve normal shoulder blade function during everyday movement of the shoulder.
Physiotherapy treatment may be an effective method to help manage your winging scapula related shoulder blade pain.
It may also be necessary to discuss with your Physio the involvement of a Sports Doctor or Shoulder Specialist when managing primary scapula winging but it is important to note that this decision should be guided by your shoulder function, your deficits and your rehab goals.
Secondary Scapula Winging and Pain Relief
Physiotherapists play a vital role in improving and managing secondary scapula winging.
A thorough physiotherapy assessment can help determine the cause of your scapula winging and accurately diagnose any related shoulder conditions that may be contributing to your scapula winging.
This information can be used to develop a tailored rehabilitation plan that aims to address your specific areas of weakness and dysfunction and can be targeted towards your goals and needs.
Specific physiotherapy strength exercises that address areas of weakness or poor control can help significantly improve winging of the scapula.
This can be implemented in a home exercise program or integrated into your normal exercise routine. Taping may also be used to help facilitate normal scapular movement whilst you work to develop your strength and control.
Your physiotherapist can also provide you with strategies to modify your normal daily activities or sport whilst you improve your shoulder strength and control to prevent you from further aggravating your symptoms.
If you are suffering from winged scapula or shoulder pain, please contact Melbourne Sports Physiotherapy to arrange an assessment from one of our experienced sports physiotherapists. We look forward to helping you soon!