16/08/2025
🔥 Winged Scapula – “The Floating Shoulder Blade”
💥 A striking sign where the shoulder blade juts out like a wing — often unnoticed until weakness or injury affects your movement!
📜 Name Origin & History
The term “Winged Scapula” comes from the visual resemblance of the scapula (shoulder blade) sticking out from the back like a bird’s wing.
First described in medical literature in the 19th century, commonly linked to injury of the long thoracic nerve affecting the serratus anterior muscle.
⚠️ Causes
💧 Long thoracic nerve injury (most common)
💧 Serratus anterior muscle weakness or paralysis
💧 Brachial plexus injury
💧 Direct trauma to shoulder/back
💧 Neurological conditions (e.g., poliomyelitis, muscular dystrophy)
💧 Post-surgical complication (e.g., mastectomy, lymph node removal)
🗂️ Signs & Symptoms
🩸 Visible protrusion of the scapula from the thoracic wall
🩸 Shoulder instability
🩸 Weakness when pushing against resistance
🩸 Limited shoulder flexion and abduction
🩸 Pain or discomfort in shoulder/back area
🩺 Physical Assessment & Examination⤵️
1️⃣ Wall Push-Up Test – Increased winging when pushing against a wall
2️⃣ Scapular Observation – Compare both sides during shoulder movement
3️⃣ Manual Muscle Testing – Assess serratus anterior strength
4️⃣ Neurological Exam – To check nerve involvement
🩻 Radiologic Findings⤵️
📌 X-ray – Usually normal (used to rule out fractures or deformities)
📌 MRI – May reveal muscle atrophy or nerve injury
📌 EMG/Nerve Conduction Study – Confirms long thoracic nerve damage
⭕ Conservative Treatment ⤵️
✅ Pain management (NSAIDs if needed)
✅ Activity modification to avoid aggravating movements
✅ Orthotic bracing (scapular stabilizing braces)
🧘♀️ Physiotherapy Management⤵️
🏅 Strengthening of serratus anterior (e.g., wall slides, dynamic hugs)
🏅 Scapular stabilization drills
🏅 Postural correction exercises
🏅 Stretching of tight pectoralis minor & levator scapulae
🏅 Neuromuscular re-education
🏅 Taping for scapular positioning support
🏠 Home Advice⤵️
✅ Continue prescribed exercises daily
✅ Avoid heavy lifting overhead until strength returns
✅ Maintain good posture at desk/work
✅ Use a mirror to monitor scapular movement
✅ Apply warm compress for tightness relief
✅ Physio Masud
