Scapula Winging: Causes, Symptoms, and Management

Have you ever noticed a shoulder blade sticking out like a wing when lifting your arm or pushing against a wall? This condition is called scapula winging, and it can affect posture, movement, and overall shoulder health.

What Is Scapula Winging?

The scapula, or shoulder blade, normally rests flat against the rib cage, moving smoothly as you raise, rotate, or push with your arm. In scapula winging, one or both shoulder blades protrude abnormally away from the back. This makes the shoulder look uneven and can lead to pain, weakness, and functional limitations.

Types of Scapula Winging

There are two main types, depending on which muscle is affected:

1. Medial winging

   • The inner (medial) border of the scapula sticks out.

   • Usually due to weakness or paralysis of the serratus anterior muscle, caused by injury to the long thoracic nerve.

2. Lateral winging

   • The outer (lateral) border of the scapula protrudes.

   • Often linked to weakness of the trapezius muscle (spinal accessory nerve injury) or rhomboid muscles (dorsal scapular nerve injury).

Common Causes

• Nerve injury (trauma, surgery, repetitive strain).

• Muscle weakness (serratus anterior, trapezius, or rhomboids).

• Shoulder or neck injury.

• Postural problems from prolonged sitting, slouching, or poor ergonomics.

• Neurological conditions (rare, but possible in stroke or muscular dystrophy).

Symptoms of Scapula Winging

• Visible protrusion of the shoulder blade, especially when pushing against a wall.

• Shoulder or upper back pain.

• Limited ability to lift or carry objects.

• Weakness when raising the arm overhead.

• Difficulty with daily activities like combing hair or reaching for items.

Diagnosis

A physiotherapist or doctor may:

• Perform a wall push-up test (scapula winging becomes obvious).

• Assess shoulder strength and range of motion.

• Conduct nerve tests or EMG to evaluate nerve damage.

• Use imaging if associated injuries are suspected.

Treatment and Management

1. Physiotherapy (First-line Treatment)

• Strengthening exercises for the serratus anterior, trapezius, and rhomboids.

• Scapular stability training (wall slides, scapular punches, theraband work).

• Postural correction to improve alignment and reduce strain.

• Manual therapy & modalities to relieve pain and improve movement.

2. Medications

• Anti-inflammatory drugs if pain is significant.

3. Surgical Options

• Considered only if nerve damage is severe and doesn’t improve after 12–24 months.

• Options include nerve repair, tendon transfer, or muscle grafts.

Prevention Tips

• Maintain good posture at work and during daily activities.

• Strengthen upper back and core muscles regularly.

• Avoid carrying heavy loads on one shoulder.

• Be cautious with repetitive overhead movements.

Key Takeaway

Scapula winging can limit movement and affect quality of life if left untreated. The good news is that most cases improve significantly with physiotherapy and strengthening exercises. If you notice your shoulder blade sticking out, seek early assessment to get a tailored rehabilitation plan.