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 … Anatomy, Etiology, and Management of Scapular Winging. In doing so, the scapula … In more serious cases, surgery may be required. The scapula, a flat, triangular bone that contributes to the posterior aspect of the shoulder girdle, is found bilaterally on the dorsal surface of the body and is stabilized through the actions of both the serratus anterior and the trapezius muscles .. It’s simple and complicated at the same time, which is how anatomy often is. You may not be able to lift your arms after this procedure. The diagnosis of snapping scapula is based on scapular noise with motion, and the patient may complain of pain and fatigue with activities. Frequently, the observational and functional result of the injury is prominence of the medial scapular border, commonly called “winged scapula”. Our website services, content, and products are for informational purposes only. 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. While the condition is rare, it’s usually painful and makes day-to-day activities, such as lifting grocery bags or brushing your teeth, difficult. 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… Scapular winging often affects your ability to raise your arm above your shoulder. The articulation takes place at … When the diagnosis is scapular winging, however, it is the instability of the scapula rather than the glenohumeral joint. Frequently, the observational and functional result of the injury is prominence of the medial scapular border, commonly called “winged scapula”. It may be related with pain around the scapula, or general pain around the whole shoulder region . Three of the more common problems involving the scapulothoracic joint include snapping scapula syndrome, scapular winging, and scapulothoracic dissociation. Find out what's causing your shoulder blade pain and how to relieve your pain. A clinical understanding of the possible causes of winging will assist practitioners in determining the correct means of resolving the abnormal scapular position and/or motion. 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. Here are four trapezius exercises you can perform using your own…. 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 shoulder blades usually rest flat against the back of the chest wall. Scapular winging symptoms vary from person to person depending on the underlying cause as well as the muscles and nerves involved. Scapular winging isn’t always preventable, but you may be able to reduce your risk by: Recovering from scapular winging can take anywhere from a few months to several years, depending on the initial cause, treatment method, and nerves and muscles affected. Anatomy. Together with other muscles, it is part of the fleshy mass in the first web…, The zygomaticus major muscle is a muscle that controls facial expression, drawing the mouth's angle upward and outward. The scapula is described as having superior, medial, and lateral borders. Transfer of the sternocostal head of the pectoralis major has found the greatest measure of success [, Scapular winging can also be the product of injury to the, Less commonly, weakness of the major and minor rhomboid muscles is encountered in deficits of the, This problem is not well known or well categorized with limited results reported [. Supports such as braces and slings can also be helpful during recovery. Another option is called static stabilization. Anteriorly, on the costal surface, is the shallow subscapula… It may also be associated with other symptoms, including: Scapular winging is almost always caused by damage to one of three nerves that control muscles in your arms, back, and neck: Injuries and surgeries can both cause damage to these nerves and muscles. The head of the humerus (upper arm bone) is the ball and the scapula (shoulder blade) forms the socket where the humerus sits. Snapping scapula most frequently represents a disruption of the smooth gliding of the scapula over the thoracic cage and periscapular muscles [, Click to share on Twitter (Opens in new window), Click to share on Facebook (Opens in new window), Click to share on Google+ (Opens in new window), Pathoanatomy of AcromioclavicularAcromioclavicular Joint Instability, Sternoclavicular Joint Anatomy and Pathology, Surface and Cutaneous Anatomy of the ShoulderShoulder, Normal and Pathological Anatomy of the Shoulder. Injury to the scapula and its musculature is not uncommon. This can make sitting in a chair or wearing a backpack uncomfortable. The main reasons for this condition are musculoskeletal- and neurological-related. Neurological Musculoskeletal They may also ask you to perform certain arm or shoulder movements. Scapular winging occurs when a shoulder blade sticks out. If the winged scapula is the result of nerve damage, it can cause weakness in the muscles of your neck, shoulders, and arms. Clinical presentations of scapular winging include neurologically based scapular winging, scapular muscle detachment, snapping scapula , and kinetic chain or muscle inhibition based scapular dyskinesis. Healthline Media does not provide medical advice, diagnosis, or treatment. Consistency of the history and physical exam findings allows for a reliable clinical diagnosis. At 4 weeks, closed chain activation up to 90° abduction with the hand stabilized is started. The main part of the scapula, the body, consists of a somewhat triangular-shaped flat blade, with an inferiorly pointing apex, referred to as the inferior angle as well as lateral and superior angles. Scapula Winging. Scapular winging is basically a protruding edge of the shoulder blade. Depending on which nerve and muscle is causing it, scapular winging has both nonsurgical and surgical treatment options. If the long thoracic nerve is damaged or bruised it can cause paralysis of the serratus anterior muscle. 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. Repetitive movements can also cause injuries. Two important arteries, the axillary artery and the subclavian artery, run anterior to the scapula and posterior to the clavicle… These surgeries involve taking all or part of a nerve or muscle and moving it to another part of the body. The scapula (shoulder blade) is the largest bone of the shoulder complex and has the greatest number of muscles attached to it. The composite scapular motion of rotation, abduction, and tilting is necessary for proper shoulder function. Winging of Scapula. The elevated scapula is visually noticeable and there is an associated restriction in the motion of the scapula and glenohumeral joint. lar winging are many, understanding the anatomy of the scapulothoracic articulation is essential to prescribing treatment. Blunt trauma to the nerves that control the muscles of your neck, upper back, and shoulder can lead to scapular winging. 'Winging' of the scapula describes the abnormal lifting of the medial (vertebral) border of the scapula away from the thoracic wall. Fasciodesis procedures (sling) have also been utilized but can result in high rates of attritional loosening and poor function. The scapula is a triangular bone overlying the second to seventh ribs on the posterior thorax. These muscles both stabilise the arm to the body and move the arm around in space. Anatomically, it is the “G” of the glenohumeral (G-H) joint and the “A” of the acromioclavicular (A-C) joint. In anatomy, the scapula (plural scapulae or scapulas), also known as the shoulder bone, shoulder blade, wing bone or blade bone, is the bone that connects the humerus (upper arm bone) with the clavicle (collar bone). Your doctor will first look at your shoulder blade for any obvious signs of winging. … FreeFitGuy also demonstrates exercises specifically for scapular winging. The adductor hallucis is a two-headed muscle that is responsible for flexing and contracting the big toe, and reinforcing the arch of the foot. Scapula is the anatomical term for the shoulder blade. 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. When a scapula wings it’s because it isn’t held close to the rib cage. Most people with scapular winging have a shoulder blade that sticks out. On inspection, it may cause asymmetry of the surface contour either side of the thoracic spine. Among the 112 surveyed, 8 percent exhibited scapular winging 15 days after surgery. The serratus anterior gets a lot of attention because it’s anterior to the scapula, and attaches to the scapula. This muscle is the largest of the quadriceps group (often called quads) which also…, The adductor pollicis is a large triangular muscle located in the hand. The three nerves most often involved include the long thoracic, spinal accessory, and dorsal scapular nerves. It’s a big question. Scapular winging due to damage to the spinal accessory nerve also usually requires surgery. Less commonly, palsy of the trapezius or rhomboids may cause lateral winging. 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. © 2005-2020 Healthline Media a Red Ventures Company. A winged scapula is a skeletal medical condition in which the shoulder blade protrudes from a person's back in an abnormal position. In addition, scapular winging caused by a traumatic injury is more likely to need surgery. Scapula is the anatomical term for the shoulder blade. Mobilization of the infraspinatus away from the medial border of the scapula (, Illustration of the reattachment of the rhomboid and lower trapezius muscles. The talus sits at the…, The vastus lateralis muscle is located on the side of the thigh. A variety of injuries can damage important nerves and muscles, leading to a winged scapula. Peripheral nerve disorders, cervical spine disease could also mimic scapular winging and should be ruled out. Anatomy of the Scapula. In some serious cases, the ability to perform activities of daily living such as changing one's … Posteriorly, the scapula is divided into a supraspinous fossa and infraspinous fossa by the scapular spine. Scapular winging is a painful and debilitating condition. Examples of blunt trauma include dislocating your shoulder or twisting your neck in an unusual way. This article will review the relevant anatomy, etiology, clinical evaluation, diagnostic testing, and treatment of scapular winging. Patients may also have scapular winging (see Scapular Winging below). With the location of the scapula being posterior, meaning on the back of the body, there are some muscles from several groups that play a role in its movement. The most common surgical treatments for scapular winging are nerve and muscle transfers. 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. May 21, 2013 Dr. Tushar Mehta For Students / PG Aspirants. Scapular winging occurs when a shoulder blade sticks out. This type of injury is common among athletes, but it can also be caused by everyday tasks, such as: Nontraumatic injuries aren’t caused by physical force. The scapula is also known as the shoulder blade. ), I’m winging my scapulas for you there. What are the symptoms of scapular winging? Although the sources of scapular winging are many, understanding the anatomy of the scapulothoracic articulation is essential to prescribing treatment. In most cases, scapular winging can be fixed through physical therapy, massage, stretching and strength exercises. Maximum strength is not regained for about 6–9 months, probably reflecting the chronic muscle disuse and atrophy. 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. All rights reserved. They may also prescribe muscle relaxants, anti-inflammatory drugs, analgesics, or a combination of all three. Like their connected bones, the scapulae are paired, with each scapula on either side of the body being roughly a mirror image of the other. The result is medial winging of the scapula and limitation functionality of the upper extremity. Treatment of the winged scapula depends on the severity of the patient's complaints, and the exact treatment required is … Disorders of the Scapula: Winging and Snapping Ben W. Kibler Aaron D. Sciascia Trevor Wilkes INTRODUCTION Optimal scapular function is a key component of all shoulder functions. Long thoracic nerve injury creates loss of the serratus anterior muscle function which results in translation of the scapula superiorly and medially and disruption of normal scapulohumeral kinematics. I’ll say this from the beginning though, there’s this book called Functional Anatomy of Yoga, and on page 216 (1st ed. Nonsurgical treatment options can start working almost immediately, while surgical treatment will likely take a few months to produce results. If they have failed an appropriate scapular rehabilitation program and do not demonstrate other anatomic defects, surgical reattachment is indicated. It connects the upper limb to the trunk and articulates with the humerus or upper arm bone. While scapular winging can usually be improved, you may experience a permanent decreased range of motion in rare cases. 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. As a result, winging of … Shoulder Center of Kentucky, Lexington Clinic, 1221 South Broadway, Lexington, KY 40504, USA. Therefore, muscle transfers can be performed in an effort to restore a semblance of dynamic kinematics. Weakness or loss of scapular mechanics can lead to difficulties with elevation of the arm and lifting objects. If you doctor decides you do have a winged scapula, they might use electromyography to see if it’s related to the serratus anterior, trapezius, or rhomboid muscles. However, due to the morbidity of the procedure it is generally reserved for high demand laborers and salvage situations. It can affect a person's ability to lift, pull, and push weighty objects. Your doctor will likely suggest this procedure only if there are no alternatives. People with winged scapulae may feel weak when trying to lift something out and away from their body, or … Instead, they can be caused by: Rib resections, mastectomies, and procedures that require general anesthesia may cause nerve damage. It articulates with the humerus at the glenohumeral joint, and with the clavicle at the acromioclavicular joint. 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. Clinical presentations of scapular winging include neurologically based scapular winging, scapular muscle detachment, snapping scapula , and kinetic chain or muscle inhibition based scapular dyskinesis. 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. Scapulothoracic fusion has been considered and may result in satisfactory results. This is accomplished by direct reattachment through pairs of drill holes in the medial scapular border and scapular spine (Fig. A study in Supportive Care for Cancerfollowed people who had undergone axillary dissection, a surgical breast cancer treatment. By 6–8 weeks, as the repair has healed and early strength is gained, motion over 90° is allowed and the patient is started on the standard scapular strengthening program. Clinically, this rotation causes the inferior angle to become notably prominent in both static and dynamic examination (Fig. 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. 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. The condition has been estimated to be present in up to 30 % of asymptomatic individuals yet can cause crippling pain. The exact frequency of neurologically based winging is poorly defined. The front of the scapula (acromion) is also connected to the clavicle (collarbone) through the acromioclavicular joint. MRI and CT imaging are of minimal benefit. The serratus anterior is not the only muscle impacting a winging scapula. Winging can be due to disease in the nerves, muscles, bones, and joints in the periscapular area and may be either a static or dynamic deformity. It lies in the upper back between the second and eighth rib. Your doctor may recommend a procedure called scapulothoracic fusion if other treatments don’t work. The Shoulder Girdle and The Ribcage. Your doctor may also recommend light physical therapy or using a brace for several months early in your recovery. Sprengel deformity is usually noticed at birth and has both cosmetic and functional implications. 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. Last medically reviewed on September 25, 2017, If you want to work your trap muscles, you don't need a ton of fancy gym equipment. 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. On physical examination, some patients may have tenderness to palpation along the scapula border; others may have no tenderness. That weakness can make lifting, pulling, and pushing heavy objects hard. 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. The shoulder blades usually rest flat against the back of the chest wall. Stretching at home may help you improve your strength and range of motion. There is a risk that the sling will stretch out over time, causing the winged scapula to return. Cases of scapular winging caused by damage to the serratus anterior nerve sometimes heal on their own within two years. Try scapular stabilization exercises to strengthen your shoulders. The collar bone attaches the shoulder blade (or scapula) to the sternum at the pit of the neck. 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. The zygomaticus major muscle…. As a result, the medial border of the scapula protrudes, like wings. 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. Make sure to talk to your doctor as soon as you start experiencing symptoms to improve your chances of making a full recovery. It can also cause permanent bone fractures and lung problems. OptimumCareProviders offers great exercise videos, including one for strengthening the serratus anterior muscle under your shoulder. Most reviews and teaching focus on … The…, The ankle bones include the calcaneus, cuboid, external cuneiform, internal cuneiform, middle cuneiform, navicular, and talus. For scapular winging caused by damage to the dorsal scapular nerve, your doctor will likely recommend a mix of physical and massage therapy. A winged scapula is associated with damage or a contusion to the long thoracic nerve of the shoulder and/or weakness in the Serratus Anterior muscle. The scapula and arm are connected to the body by multiple muscle and ligament attachments. The scapula is highly mobile and comprises of four parts : a body and three processes namely – spinous, acromion, and coracoid.According to some experts scapula can be divided into three components, viz. The scapula plays many roles in shoulder function. Anatomy and Biomechanics. Injury may be traumatic, iatrogenic, or idiopathic and the clinical interpretation requires careful history and examination. These two bones attach to the shoulder blades to form a collar like structure for the neck. Nerve and muscle transfers for scapular winging usually focus on the shoulder, back, or chest. head, neck, and body. In rare conditions it has the potential to lead to limited functional activity in the upper extremity to which it is adjacent. … Tell your doctor about any recent injuries, illnesses, or surgeries that could affect your neck, arms, or back. All right Matt. Illustration of drill hole placement when performing the scapular muscle reattachment procedure. If nonsurgical treatment options aren’t providing any relief, your doctor may recommend surgery. This involves attaching the scapula directly to the ribs. To develop exercises to prevent scapular winging it helps to understand some basic shoulder girdle anatomy. 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. Scapula winging can be corrected, though the treatment that works will depend on the nerve and muscle causing it. Anatomy and Biomechanics The scapula is a triangular bone overlying the second to seventh ribs on the posterior thorax. The diagnosis of serratus anterior palsy is easy to make via visualization of the scapula, and the winging can be accentuated by asking the patient is to push against a wall.

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