Overview
Winged scapula is a condition in which the shoulder blade (scapula) protrudes abnormally from the back, giving it a “wing-like” appearance. It often results from muscle weakness or nerve injury, particularly involving the long thoracic nerve. This condition can affect shoulder movement and stability, making everyday tasks such as lifting or reaching difficult.
What is Winged Scapula?
Winged scapula occurs when the medial border of the scapula lifts away from the ribcage, instead of lying flat against it. This condition is typically caused by paralysis or weakness of the serratus anterior muscle, which is innervated by the long thoracic nerve. It can also result from injury to the trapezius or rhomboid muscles due to spinal accessory or dorsal scapular nerve damage. Winged scapula may occur following trauma, repetitive strain, surgery, or neurological disorders.
Symptoms
The key symptoms of a winged scapula include:
- Visible protrusion of the shoulder blade, especially when pushing against resistance (e.g., wall push-up)
- Shoulder weakness, especially during overhead movements
- Limited range of motion in the shoulder
- Pain or discomfort around the shoulder and upper back
- Muscle fatigue with repeated use
- Difficulty lifting objects or performing sports or work tasks requiring shoulder function
Causes
Winged scapula is most commonly caused by:
- Injury to the long thoracic nerve, leading to serratus anterior muscle paralysis
- Trauma or surgical complications, especially after procedures involving the chest, shoulder, or neck
- Repetitive shoulder movements or sports-related strain
- Neurological disorders such as muscular dystrophy, brachial plexus injury, or Guillain-Barré syndrome
- Less commonly, injury to the spinal accessory nerve or dorsal scapular nerve affecting other scapular stabilizers
Risk Factors
Certain factors increase the likelihood of developing winged scapula:
- Repetitive overhead or pushing movements (e.g., athletes, weightlifters, manual laborers)
- Shoulder or thoracic surgeries, especially involving lymph node dissection or trauma
- Neck and back trauma
- Neuromuscular disorders
- Poor posture and muscle imbalances
Complications
If not treated early, winged scapula can lead to:
- Chronic shoulder pain and dysfunction
- Severe limitations in shoulder mobility and strength
- Impairment of daily activities like dressing, grooming, or reaching
- Muscle atrophy and imbalance
- Postural deformities or compensatory strain in the neck and back
- In severe cases: permanent nerve damage or need for surgical correction
Prevention
While not all cases of winged scapula are preventable, some strategies may reduce risk:
- Proper warm-up and stretching before physical activity
- Strengthening of scapular stabilizer muscles (serratus anterior, trapezius, rhomboids)
- Avoiding repetitive strain or overuse in at-risk occupations or sports
- Ergonomic adjustments in work and activity
- Early intervention with physical therapy if shoulder weakness or instability appears
- Post-surgical rehabilitation to protect nerve function
Treatment Options in Korea
South Korea offers advanced orthopedic and neurologic care for conditions like winged scapula, with a focus on non-surgical and surgical management depending on severity:
- Physical therapy to strengthen shoulder muscles and improve posture
- Targeted rehabilitation programs including functional electrical stimulation (FES) and neuromuscular re-education
- Bracing or taping to stabilize the scapula during movement
- Nerve conduction studies and electromyography (EMG) for accurate diagnosis
- Surgical options for severe or non-responsive cases:
- Muscle transfer procedures (e.g., pectoralis major transfer)
- Nerve decompression or repair
- Minimally invasive surgical techniques performed at specialized centers
- Top hospitals like Samsung Medical Center, Seoul National University Hospital, and Severance Hospital offer multidisciplinary care, including orthopedics, neurology, and physical medicine
