Sections View Full Chapter Figures Tables Videos Annotate Full Chapter Figures Tables Videos Supplementary Content +++ Condition/Disorder Synonyms ++ Winging scapulaScapula alataFacioscapulohumeral muscular dystrophy (FSH)Serratus anterior palsy +++ ICD-9-CM Code ++ 736.89 Other acquired deformity of other parts of limb +++ ICD-10-CM Code ++ M21.80 Other specified acquired deformities of unspecified limb +++ Preferred Practice Pattern1 ++ 4E: Impaired Joint Mobility, Motor Function, Muscle Performance, and Range of Motion Associated With Localized Inflammation +++ Key Features +++ Description ++ Inferior angle tilting of the scapulaInstability of the scapula to the thoracic wallScapula has the greatest number of muscles attached to it than any other boneScapula dysrhythmia Result of serratus anterior muscle dysfunctionInjury to long thoracic nerve +++ Essentials of Diagnosis ++ Often asymptomaticWinging can help identify a dysfunction possibly occurring in the shoulderSymptoms of pain and weaknessCan be a result of a brachial plexus injuryParsonage-Turner syndrome (brachial neuritis) underlying +++ General Considerations ++ Loss of serratus anterior muscleWeakness of trapezius strengthWeakness of scapular stabilizersCommonly associated with presence of other orthopedic pathologies: subacromial impingement syndrome, rotator cuff pathology, labral pathology.Creates an abnormal scapulothoracic rhythmCommonly associated with repeated overhead or overuse activities. Full history of symptoms, medical history screening, and differential shoulder orthopedic examination will ensure appropriate diagnosis. +++ Demographics ++ Non-specific +++ Clinical Findings +++ Signs and Symptoms ++ PainWeakness is commonly noted with functional reaching tasksScapula instability, moving away from rib cage +++ Functional Limitations ++ Inability to raise or lower the arms without the scapula’s inferior angle tilting away from the rib cagePain/limitation with overhead activitiesPain/limitation with reachingPain/limitation with liftingPain/limitation dressing and groomingPain/limitation with sustained or repetitive shoulder activities +++ Possible Contributing Causes ++ Increased thoracic kyphosis and sub-optimal postureRepetitive overhead activitiesPosterior shoulder capsule tightnessPectoralis minor tightnessPoor neuromuscular controlNon-traumatic injury to the long thoracic nerveInfluenzaDrug overdoseTraumatic injury to the long thoracic nerveImpact injuryStretch to cervical spineElectrical shockMastectomy with axillary node dissectionBrachial neuritis (Parsonage-Turner syndrome) +++ Differential Diagnosis ++ Cervical radiculopathy, C7Referred pain from lungs or diaphragmRotator cuff pathology (tendonitis, full- or partial-thickness tear)Glenohumeral (GH) instabilityLabral tearNeuropathyInternal impingement +++ Means of Confirmation or Diagnosis ++ Diagnosis based on orthopedic special tests, signs and symptoms, imaging studies, and exclusion of differential diagnosisPush-ups testSerratus wall test +++ Treatment +++ Medications ++ NSAIDs... Your Access profile is currently affiliated with [InstitutionA] and is in the process of switching affiliations to [InstitutionB]. Please select how you would like to proceed. Keep the current affiliation with [InstitutionA] and continue with the Access profile sign in process Switch affiliation to [InstitutionB] and continue with the Access profile sign in process Get Free Access Through Your Institution Learn how to see if your library subscribes to McGraw Hill Medical products. Subscribe: Institutional or Individual Sign In Error: Incorrect UserName or Password Username Error: Please enter User Name Password Error: Please enter Password Sign in Forgot Password? Forgot Username? Download the Access App: iOS | Android Sign in via OpenAthens Sign in via Shibboleth You already have access! Please proceed to your institution's subscription. Create a free profile for additional features.