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Condition/Disorder Synonyms

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  • Winging scapula

  • Scapula alata

  • Facioscapulohumeral muscular dystrophy (FSH)

  • Serratus anterior palsy

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ICD-9-CM Code

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  • 736.89 Other acquired deformity of other parts of limb

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ICD-10-CM Code

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  • M21.80 Other specified acquired deformities of unspecified limb

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Preferred Practice Pattern1

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Key Features

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Description

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  • Inferior angle tilting of the scapula

  • Instability of the scapula to the thoracic wall

  • Scapula has the greatest number of muscles attached to it than any other bone

  • Scapula dysrhythmia

  • Result of serratus anterior muscle dysfunction

  • Injury to long thoracic nerve

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Essentials of Diagnosis

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  • Often asymptomatic

  • Winging can help identify a dysfunction possibly occurring in the shoulder

  • Symptoms of pain and weakness

  • Can be a result of a brachial plexus injury

  • Parsonage-Turner syndrome (brachial neuritis) underlying

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General Considerations

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  • Loss of serratus anterior muscle

  • Weakness of trapezius strength

  • Weakness of scapular stabilizers

  • Commonly associated with presence of other orthopedic pathologies: subacromial impingement syndrome, rotator cuff pathology, labral pathology.

  • Creates an abnormal scapulothoracic rhythm

  • Commonly associated with repeated overhead or overuse activities.

  • Full history of symptoms, medical history screening, and differential shoulder orthopedic examination will ensure appropriate diagnosis.

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Demographics

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  • Non-specific

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Clinical Findings

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Signs and Symptoms

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  • Pain

  • Weakness is commonly noted with functional reaching tasks

  • Scapula instability, moving away from rib cage

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Functional Limitations

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  • Inability to raise or lower the arms without the scapula's inferior angle tilting away from the rib cage

  • Pain/limitation with overhead activities

  • Pain/limitation with reaching

  • Pain/limitation with lifting

  • Pain/limitation dressing and grooming

  • Pain/limitation with sustained or repetitive shoulder activities

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Possible Contributing Causes

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  • Increased thoracic kyphosis and sub-optimal posture

  • Repetitive overhead activities

  • Posterior shoulder capsule tightness

  • Pectoralis minor tightness

  • Poor neuromuscular control

  • Non-traumatic injury to the long thoracic nerve

    • Influenza

    • Drug overdose

  • Traumatic injury to the long thoracic nerve

    • Impact injury

    • Stretch to cervical spine

    • Electrical shock

    • Mastectomy with axillary node dissection

  • Brachial neuritis (Parsonage-Turner syndrome)

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Differential Diagnosis

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  • Cervical radiculopathy, C7

  • Referred pain from lungs or diaphragm

  • Rotator cuff pathology (tendonitis, full- or partial-thickness tear)

  • Glenohumeral (GH) instability

  • Labral tear

  • Neuropathy

  • Internal impingement

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Means of Confirmation or Diagnosis

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  • Diagnosis based on orthopedic special tests, signs and symptoms, imaging studies, and exclusion of differential diagnosis

    • Push-ups test

    • Serratus wall test

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Treatment

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Medications

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  • NSAIDs

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Medical Procedures

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  • Surgery: intercostal nerve transfer

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Referrals/Admittance

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