The scapula is a triangular flat bone, which is also known as the shoulder blade. Injury to the scapula and its musculature is not uncommon. Reattachment of the rhomboid muscle is performed initially (, Postoperatively, the arm is protected in neutral rotation for 4 weeks but gentle scapular retraction is encouraged immediately. ), I’m winging my scapulas for you there. The scapula is a triangular bone overlying the second to seventh ribs on the posterior thorax. Scapular winging due to damage to the spinal accessory nerve also usually requires surgery. The most common surgical treatments for scapular winging are nerve and muscle transfers. Scapulothoracic fusion has been considered and may result in satisfactory results. The composite scapular motion of rotation, abduction, and tilting is necessary for proper shoulder function. At 4 weeks, closed chain activation up to 90° abduction with the hand stabilized is started. They may also prescribe muscle relaxants, anti-inflammatory drugs, analgesics, or a combination of all three. Consistency of the history and physical exam findings allows for a reliable clinical diagnosis. The scapula, along with the clavicle and the manubrium of the sternum, make up the pectoral (shoulder) girdle which connects the upper limb of the appendicular skeleton to the axial skeleton. Anatomy. Peripheral nerve disorders, cervical spine disease could also mimic scapular winging and should be ruled out. Your doctor will likely suggest this procedure only if there are no alternatives. If they have failed an appropriate scapular rehabilitation program and do not demonstrate other anatomic defects, surgical reattachment is indicated. Your doctor may also recommend light physical therapy or using a brace for several months early in your recovery. The physical exam also exhibits a consistent cluster of findings including the localized tenderness, often a noticeable and palpable soft tissue defect, either due to the detachment or the muscle atrophy, altered scapular resting position as well as dynamic dyskinesis including snapping scapula , shoulder impingement and weakness in forward flexion, and clinical decrease or relief of symptoms with scapular corrective maneuvers. If the long thoracic nerve is damaged or bruised it can cause paralysis of the serratus anterior muscle. Depending on which nerve and muscle is causing it, scapular winging has both nonsurgical and surgical treatment options. In more serious cases, surgery may be required. Scapula winging can be corrected, though the treatment that works will depend on the nerve and muscle causing it. The scapula, also known as the shoulder blade, is a flat triangular bone located at the back of the trunk and resides over the posterior surface of ribs two to seven. Supports such as braces and slings can also be helpful during recovery. Less commonly, palsy of the trapezius or rhomboids may cause lateral winging. Anatomy, Etiology, and Management of Scapular Winging. … A variety of injuries can damage important nerves and muscles, leading to a winged scapula. They may also ask you to perform certain arm or shoulder movements. Posteriorly, the scapula is divided into a supraspinous fossa and infraspinous fossa by the scapular spine. However, acute traumatic tears of the serratus anterior, trapezius, and rhomboids off of the scapula are important and under-recognized causes of scapular winging and dysfunction. Healthline Media does not provide medical advice, diagnosis, or treatment. Clinical presentations of scapular winging include neurologically based scapular winging, scapular muscle detachment, snapping scapula , and kinetic chain or muscle inhibition based scapular dyskinesis. Clinical presentations of scapular winging include neurologically based scapular winging, scapular muscle detachment, snapping scapula , and kinetic chain or muscle inhibition based scapular dyskinesis. I’ll say this from the beginning though, there’s this book called Functional Anatomy of Yoga, and on page 216 (1st ed. Anatomy of Scapula: Scapula serves as the attachment site for 17 muscles Its normal function to stabilize the scapula to the thorax, provide power to the upper limb … Shoulder Center of Kentucky, Lexington Clinic, 1221 South Broadway, Lexington, KY 40504, USA. Anatomy of the Scapula. The Cavendish classification 2,6is one method used for grading: 1. grade I 1.1. very mild deformity is observed 1.2. when covered with clothes the deformity is almost invisible 2. grade II 2.1. the deformity is still mild but appears as a bump 2.2. the superomedial portion of the high scapula i… This article will review the relevant anatomy, etiology, clinical evaluation, diagnostic testing, and treatment of scapular winging. Daniel Bubnis, M.S., NASM-CPT, NASE Level II-CSS, What Causes Shoulder Blade Pain and How to Treat It, Everything You Should Know About Repetitive Strain Injury (RSI), pain or discomfort in your neck, shoulders, and back, the long thoracic nerve, which controls the, the dorsal scapular nerve, which controls the rhomboid muscles, using your arms to prop your head up while lying down, certain medical conditions, such as congenital heart defects, cervical radiculopathy, and, avoiding repetitive shoulder or arm movements when possible, using shoulder-friendly ergonomic bags and backpacks, avoiding carrying too much weight on your shoulders, stretching and strengthening the muscles in your neck, shoulders, and upper arms. The head of the humerus (upper arm bone) is the ball and the scapula (shoulder blade) forms the socket where the humerus sits. Results: Scapula winging was severe in 10 of 16 patients (63%), moderate in 2 patients (12%), and mild in 4 patients (25%) in our present study. You may not be able to lift your arms after this procedure. Weakness or loss of scapular mechanics can lead to difficulties with elevation of the arm and lifting objects. The zygomaticus major muscleâ¦. Most of these patients have had workups to rule out neurologic or bony causation, and have had varying types of treatment, including local or distant surgery and various rehabilitation protocols. The most common perception of the “winged” scapula, with prominence of the medial scapular border, is that it occurs as a result of damage to the nerves supplying the scapular stabilizing muscles. Anteriorly, on the costal surface, is the shallow subscapula… The rotator cuff muscles lie directly above the scapula, along with the top portion of the upper arm muscles, including the deltoids and biceps tendons. Â© 2005-2020 Healthline Media a Red Ventures Company. Scapular winging occurs when a shoulder blade sticks out. This is accomplished by direct reattachment through pairs of drill holes in the medial scapular border and scapular spine (Fig. As a result, winging of … The shoulder blades usually rest flat against the back of the chest wall. The cuts may not be in the correct plane, the detachment scar is not easily demonstrated, the lower trapezius is detached from the spine but then lays back over in the supine retracted imaging position, or the chronic changes are too subtle for the static imaging processes. The serratus anterior gets a lot of attention because it’s anterior to the scapula, and attaches to the scapula. That weakness can make lifting, pulling, and pushing heavy objects hard. Cases of scapular winging caused by damage to the serratus anterior nerve sometimes heal on their own within two years. Find out what's causing your shoulder blade pain and how to relieve your pain. These can all be organized as manifestations of scapular dyskinesis (abnormal scapular motion during arm movement) which can be seen as causes or results of various types of shoulder injury. It can also cause permanent bone fractures and lung problems. All these muscles act at the same time sometimes and oppose each other at other times, but work together like a well trained team to allow the arm to move in space. The most common causes reported in the literature for scapular winging are dysfunction of the serratus anterior from long thoracic nerve injury causing medial winging or dysfunction of the trapezius from spinal accessory nerve injury causing lateral winging. These two bones attach to the shoulder blades to form a collar like structure for the neck. The result is medial winging of the scapula and limitation functionality of the upper extremity. Injury may be traumatic, iatrogenic, or idiopathic and the clinical interpretation requires careful history and examination. The shoulder blades usually rest flat against the back of the chest wall. Treatment of the winged scapula depends on the severity of the patient's complaints, and the exact treatment required is … Scapular winging often affects your ability to raise your arm above your shoulder. If the winged scapula is the result of nerve damage, it can cause weakness in the muscles of your neck, shoulders, and arms. The articulation takes place at … FreeFitGuy also demonstrates exercises specifically for scapular winging. Another option is called static stabilization. Here are four trapezius exercises you can perform using your ownâ¦. It’s a big question. Example of long thoracic nerve palsy creating scapular winging, Surgery for long thoracic nerve palsy may be indicated for patients with 1 year of symptoms, functional deficits, and no signs of recovery. If nonsurgical treatment options arenât providing any relief, your doctor may recommend surgery. To develop exercises to prevent scapular winging it helps to understand some basic shoulder girdle anatomy. Results from a 2-year follow-up of a small cohort show that pain scores decreased from 8/10 to 2/10, and ASES scores improved from 38/100 to 68/100 [, The diagnosis and management of snapping scapula can be clinically challenging. Most people with scapular winging have a shoulder blade that sticks out. The term ‘winged scapula’ (also scapula alata) is used when the muscles of the scapula are too weak or paralyzed, resulting in a limited ability to stabilize the scapula. Three of the more common problems involving the scapulothoracic joint include snapping scapula syndrome, scapular winging, and scapulothoracic dissociation. lar winging are many, understanding the anatomy of the scapulothoracic articulation is essential to prescribing treatment. The diagnosis of snapping scapula is based on scapular noise with motion, and the patient may complain of pain and fatigue with activities. Anatomy and Biomechanics. These muscles both stabilise the arm to the body and move the arm around in space. The main reasons for this condition are musculoskeletal- and neurological-related. In doing so, the scapula … Winging of Scapula. In rare conditions it has the potential to lead to limited functional activity in the upper extremity to which it is adjacent. OptimumCareProviders offers great exercise videos, including one for strengthening the serratus anterior muscle under your shoulder. head, neck, and body. On physical examination, some patients may have tenderness to palpation along the scapula border; others may have no tenderness. Clinically, this rotation causes the inferior angle to become notably prominent in both static and dynamic examination (Fig. Together with other muscles, it is part of the fleshy mass in the first webâ¦, The zygomaticus major muscle is a muscle that controls facial expression, drawing the mouth's angle upward and outward. Scapular winging is basically a protruding edge of the shoulder blade. Scapula is the anatomical term for the shoulder blade. Try scapular stabilization exercises to strengthen your shoulders. In most cases, scapular winging can be fixed through physical therapy, massage, stretching and strength exercises. Most reviews and teaching focus on … Maximum strength is not regained for about 6–9 months, probably reflecting the chronic muscle disuse and atrophy. The talus sits at theâ¦, The vastus lateralis muscle is located on the side of the thigh. Nerve and muscle transfers for scapular winging usually focus on the shoulder, back, or chest. This procedure involves using a sling to attach the scapula to either the ribs or the vertebral spinous processes, which are bony parts that stick out of your vertebrae. The clinical assessment of the position of the scapula at rest as well as during dynamic arm motion, including medial border prominence, should be observed. Scapular winging symptoms vary from person to person depending on the underlying cause as well as the muscles and nerves involved. For scapular winging caused by damage to the dorsal scapular nerve, your doctor will likely recommend a mix of physical and massage therapy. All rights reserved. It’s simple and complicated at the same time, which is how anatomy often is. While the condition is rare, itâs usually painful and makes day-to-day activities, such as lifting grocery bags or brushing your teeth, difficult. There is a risk that the sling will stretch out over time, causing the winged scapula to return. The scapula plays many roles in shoulder function. 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