Scapular winging

• Winging scapula
• Scapula alata
• Facioscapulohumeral muscular dystrophy (FSH)
• Serratus anterior palsy

• 736.89 Other acquired deformity of other parts of limb

• M21.80 Other specified acquired deformities of unspecified limb

• 4E: Impaired Joint Mobility, Motor Function, Muscle Performance, and Range of Motion Associated With Localized Inflammation

Description

• 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

Essentials of Diagnosis

• 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

General Considerations

• 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.

Demographics

• Non-specific

Signs and Symptoms

• Pain
• Weakness is commonly noted with functional reaching tasks
• Scapula 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 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

Possible Contributing Causes

• 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)

Differential Diagnosis

• 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

• Diagnosis based on orthopedic special tests, signs and symptoms, imaging studies, and exclusion of differential diagnosis
  • Push-ups test
  • Serratus wall test

Medications

• NSAIDs

Medical Procedures

• Surgery: intercostal nerve transfer

• Radiologist for imaging: x-ray, MRI for differential diagnosis
• Nerve conduction test

• Weakness and pain limiting overhead activities or activities involving arm out to side or across body including, dressing or grooming daily activities.
• Impaired (sub-optimal) posture
• Muscle imbalances
  • Periscapular muscle ...