Winged scapula

  • Uncommon cause of MSK pain of shoulder and posterior chest wall
  • caused by paralysis of serratus anterior muscle
  • begins as painless weakness of the muscle, eventual finding is pathognomonic winged scapula
  • dysfunction secondary to paralysis of the muscle
  • usually occurs after heavy exertion i.e. carrying heavy backpacks
  • trauma to the long thoracic nerve of Bell is most often responsible for development of winged scapula syndrome
    • Arises from V, VI, VII cervical nerves
  • In most cases muscular dysfunction, rather than true nerve injury is usually the cause

Signs & Symptoms

  • paralysis of scapula resulting from weakness of serratus anterior muscle
  • pain develops after onset of acute muscle weakness, but often erroneously attributed to overuse during vigorous exercise
  • O/E last 30 degrees of overhead arm extension is lost and scapular rhythm is disrupted
  • having patient press outstretched arms against a wall and observe from behind, scapular winging can then be observed

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DDx

  • Lesions of cervical spinal cord, brachial plexus, and cervical nerve roots can produce clinical symptoms including winging of scapula

Treatment

  • no specific treatment for winged scapula other than earliest removal of any causes of nerve entrapment, i.e. heavy backpacks, tumours etc.
  • NSAIDs or COX-2 inhibitors and physical therapy to relieve pain
  • Local application of heat/cold may also be beneficial
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