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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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