Winged Scapula

What is a winged scapula?

A winged scapula happens when your shoulder blade (scapula) noticeably sticks out instead of lying flat on your back. Healthcare providers also call it scapular winging.

Winged scapulae (the plural form of scapula) get their name from the way they make your shoulder blades protrude. It can make your shoulder blade flare out away from your back, like a bird’s wing.

Having a winged scapula can make it hard or painful to move and use your affected shoulder blade. Lifting and moving your arm and shoulder on that side might hurt or feel weak.

Visit a healthcare provider if you notice that one of your shoulder blades looks visibly different from the other, or if you have symptoms like pain and stiffness that last for more than a week.

Scapular dyskinesis

Scapular winging is rare, and most cases that do happen are usually mild. Healthcare providers call this scapular dyskinesis (scapular misalignment).

If you have scapular dyskinesis, your shoulder blade might only look slightly different than usual. It won’t fully lift off your back when you move your arm or shoulder. It causes many of the same symptoms and “true” scapular winging, but they’re usually less severe.

What are scapula winging symptoms?

The most obvious winged scapula symptom is one shoulder blade looking noticeably out of place compared to the other.

You might feel symptoms in your affected scapula or shoulder, including:

• Shoulder pain.
• Stiffness.
• A reduced range of motion (how far or smoothly you can move your shoulder), especially when you try to lift your arm over your head.
• Weakness.
• Hearing or feeling grinding or snapping when you move your shoulder.
• Straining on one side of your neck when you raise your arm.

What causes a winged scapula?

Injuries to the nerves or muscles that support your affected shoulder blade are the most common causes of scapular winging.

The parts in your shoulder work together as a unit. They move best when there’s balanced tension in your shoulder muscles that push and pull each other when you move your shoulder and arm. Injuries that damage the nerves that control your muscles (or the muscles themselves) disrupt that natural balance. This prevents your muscles from holding your shoulder blade flat against your ribcage.

Picture trying to close a cardboard box by tucking all four flaps into and under each other. If one side of the box is bent or damaged, one of the four flaps will slip out and pop up when you try to tuck it in place.

The muscles and nerves that can cause a winged scapula when they’re damaged include:

• Serratus anterior muscle (controlled by the long thoracic nerve).
• Any of the three trapezius muscles (controlled by the spinal accessory nerve).
• Either of the rhomboid muscles (controlled by the dorsal scapular nerve).

Some of the most common injuries that lead to scapular winging include:

• Sports injuries.
• Repetitive strain injuries.
• Dislocated shoulders.
• Traumas like car accidents or falls.
• Surgical side effects, either from direct damage or as a reaction to anesthesia.

What are the risk factors?

True scapular winging usually only happens when an injury causes nerve or muscle damage. People who have surgeries on their chest — especially mastectomies (breast removal) — also have a higher risk.

You might have an increased risk of developing a mild winged scapula (scapular dyskinesis) if you:

• Play a sport that puts a lot of stress on your shoulders.
• Do physically demanding work.
• Wear a very heavy backpack often.
• Have a slumped posture.
• Have one shoulder that’s much weaker than the other.

How do healthcare providers diagnose a winged scapula?

A healthcare provider will diagnose a winged scapula with a physical exam and tests. Your provider will ask you to stand naturally while they look at your back. They’ll usually be able to see a winged scapula, especially comparing it to your other, unaffected shoulder blade.

Winged scapula tests

Your provider might have you perform a series of physical movement or posture changes to check your range of motion and shoulder strength. The most common test to diagnose a winged scapula is the wall pushup test.

Your provider will have you face a wall and press your palms flat against it. Next, they’ll have you press off the wall with both hands at the same time — like you’re doing a pushup exercise away from the wall instead of on the floor. A winged scapula will noticeably stick out (tip up) during this motion.

Your provider may also have you do tests to check for scapular dyskinesis:

• The scapular assistance test (SAT): Your provider will ask you to lift your arm straight up over your head to check your range of motion. They’ll gently press up on your shoulder blade to see if that small assistance relieves the pain or noticeably improves your range of motion.
• The scapular retraction test (SRT): Your provider will press down on your shoulder with their hand and press your scapula in toward your back with their forearm. This will gently force your shoulder blade into a correct, neutral position. Then, your provider will ask you to extend your arm out at your side. They’ll press down lightly on your shoulder and arm. You might have scapular dyskinesis if your shoulder and arm hurt less or feel stronger after having your scapula retracted (pushed back into place).

Providers don’t always need imaging tests to diagnose a winged scapula, but your provider may also want to use them to take pictures of your scapula and shoulder. They might use:

• Shoulder X-ray.
• MRI.
• EMG.
• Nerve conduction study.

How do you fix scapular winging?

Your healthcare provider will suggest winged scapula treatments based on what’s causing it. The most common treatments include:

• Pain management: Your provider will suggest medications to reduce pain and swelling. Most people can take over-the-counter NSAIDs. Some people need prescription muscle relaxers, too.
• Physical therapy: Physical therapy (PT) helps you improve how your body performs physical movements. A physical therapist will give you exercises and stretches to strengthen your shoulder muscles and increase your flexibility. PT can’t repair nerve damage, but it can help improve your range of motion and manage other symptoms.
• Surgery: Most people don’t need surgery to treat a winged scapula. But you might if other nonsurgical treatments haven’t worked and you’re experiencing severe pain or loss of shoulder mobility. People with winged scapulas caused by injuries and traumas are more likely to need surgery. You might need a muscle or nerve graft (inserting new, healthy tissue into a damaged area) or a scapular arthrodesis (joint fusion). Your surgeon will tell you which type of surgery is best for you and what you can expect.

What happens if scapular winging is left untreated?

A winged scapula can put extra pressure on your shoulder and its supporting tissues. People with untreated scapular winging have an increased risk of developing a frozen shoulder (adhesive capsulitis).

If nerve damage causes a winged scapula, there’s a chance you’ll lose feeling and movement in your affected muscles. This risk increases the longer it takes to get the issue diagnosed and treated.

Can you prevent scapular winging?

You might not be able to prevent a winged scapula because it’s usually caused by unexpected injuries.

Follow these general safety tips to reduce your risk of an injury:

• Always wear your seat belt.
• Wear the right protective equipment for all activities and sports.
• Make sure your home and workspace are free from clutter that could trip you or others.
• Always use the proper tools or equipment at home to reach things. Never stand on chairs, tables or countertops.
• Use a cane or walker if you have difficulty walking or have an increased risk of falls.

What can I expect if I have a winged scapula?

Most people don’t need surgery to manage a winged scapula. Your provider and physical therapist will help you find treatments that manage the symptoms you’re experiencing. They’ll also suggest ways to tweak how you do certain jobs or activities to prevent injuries and reduce strain on your shoulders.

How long scapular winging lasts

How long a winged scapula lasts depends on what caused it and if you have any nerve or muscle damage. It can take a few months of physical therapy to restore your shoulder’s natural alignment and range of motion.

Some people have symptoms for a few years, especially if the scapular winging happens after an injury. One-quarter of people with a winged scapula feel some pain, even after they recover.

When should I see my healthcare provider?

Visit a healthcare provider if you’re experiencing pain, stiffness or other symptoms in your shoulder for more than a week.

Go to the emergency room if you can’t move or use your shoulder at all. Never try to force your shoulder back into place if you think it’s dislocated. Keep your arm and shoulder as still and supported as possible and go to the ER right away.

Which questions should I ask my doctor?

• What caused the winged scapula?
• Do I have any nerve or muscle damage?
• Which treatments do you suggest?
• How often will I need physical therapy?
• Can you suggest stretches or exercises I can do at home?