Scapular winging is where the scapula (Shoulder blade) juts out and appears to “wing” out of the back. This winging can cause limited range of motion, pain, and unattractive appearance.[1][3][5]
There are several types of scapular winging and in this article we’re going to focus on Medial scapular winging which is the most common,[1][2] pictured below:
Winged scapula usually occurs when there is damage or impaired innervation to the serratus anterior muscle from the long thoracic nerve – resulting in weakness of the Serratus anterior muscle, as well as other muscles around the shoulder blade.[1][2] Due to the weakness or paralysis of the muscles around the scapula, the inner edge of the scapula bulges out and becomes more prominent, meaning it is not in its correct position flush against the rib cage.[2]
What Can Cause Long Thoracic Nerve Damage:
- Trauma or Injury[2][5]
- Impingement of the nerve[1][2]
- Repetitive Movements[5]
- Idiopathic (Unknown reasons)[5]
Underactive muscles:
- Serratus Anterior weakness/paralysis
- Lower trapezius weakness
- Middle Trap weakness
Overactive muscles:
- Upper Trapezius
- Levator Scapulae
- Rhomboids
Symptoms:
- Inability to raise arm overhead[1]
- Difficult to perform regular daily activities like brushing teeth/hair or carrying grocery bags.[2][5]
- Loss of shoulder flexion and abduction[2][3][5]
- Winging may be more noticeable when arms are straight out in front of you at shoulder height because the scapula lifts further away from rib cage.[5]
- Pain[3][5]
- Pain could radiate down into the arm/scapula[5]
- Patients may compensate for serratus anterior weakness by using Upper trapezius muscle [4][5]
- Shoulder Weakness[5]
Prognosis/Treatment:
Medial winged scapula typically responds well to conservative treatment within 1-24 months.[5] A study by Martin et al suggests conservative treatment for 6-24 months after initial onset of symptoms and considering surgery if conservative treatment fails.[5]
6 Winged Scapula Exercises:
#1: Self Massage (Using Massage Ball)
Apply a gentle pressure using a massage ball or tennis ball to the Rhomboid area, as well as the Upper Trapezius area.
#2: Seated Levator Scapulae Stretch
- Begin in a seated position and grasp the bottom of your chair with your right hand.
- Bring your chin in towards your chest and rotate your head towards the left shoulder.
- Then using your left arm gently push your head down looking towards your left armpit until you feel a slight stretch along with right side of your neck.
- Hold this position for 15 to 20 seconds.
- Repeat on the opposite side
- Aim for 3 repetitions of this stretch on each side.
#3: Upper Trapezius Stretch
This will stretch out the neck and upper back muscles (Scalene & Upper Trapezius) which can get very tight on individuals with this forward neck syndrome.
- Start either in a standing or seated position.
- Place one of your hands on the opposite side of your head and tuck the other hand behind your back.
- Now bring the head down towards your shoulder.
- Use the hand on top to press your head down – to get a deeper stretch (Not too hard).
- Hold for 20-30 seconds and do both sides
#4: Push up plus on knees
- Get down on all fours and get into a neutral curve with the spine, with shoulder blades sinking in.
- Now, use your hands to push off the floor and spread your shoulder blades apart.
- Hold for 1-2 seconds at top position and feel the serratus muscle working.
- Come out of that position, and let your shoulder blades sink in (starting pose)
- Strive for 15 reps, 2 sets.
#5: Wall Slides, Front Facing
- Position your forearms on the wall with elbows at 90 degrees, one foot in front of the other.
- Now, glide your forearms up the wall (without arching the low back)
- Then glide the forearms down the wall
- Strive for 15 reps, 2 sets.
#6: Prone Ys
This exercise is done for scapular stabilization and strengthening your back.
- Can be done off the side of a bed or while lying on your stomach on a large exercise ball with arms hanging straight down.
- Raise your arms up to a 45-degree angle (with thumbs up), making a Y between your arms and body. Only raise arms up to shoulder height.
- Now lower arms to starting position
- Build up to 2x 10
** Careful not to arch your low back as you lift your arms.
** Do not shrug your shoulders
Related:
3 Self Tests For Shoulder Impingement (Easy To Do)
Easy Sternocleidomastoid Stretch (SCM) – Posture Correction
Tight Neck? Try The Levator Scapulae Stretch (Video)
Fix Pain Between Shoulder Blades In Upper Back
Cervical Spinal Stenosis Exercises
[1] Park SB and Ramage JL. Winging of the scapula. StatPearls Publishing 2021.[2] Gooding BWT, Geoghegan JM, Wallace, WA et al. Scapular winging. Shoulder Elbow. 2014 ; 6 (1): 4-11. doi: 10.1111/sae.12033[3] Shin AR, Lee JH, kim DE, et al. Thera-band application changes muscle activity and kyphosis and scapular winging during knee push-up plus in subjects with scapular winging. Medicine (Baltimore). 2018;97(14). doi: 10.1097/MD.0000000000010348
Corrective Exercise Specialist (NASM-CES), Certified Personal Trainer (NASM-CPT), Professional Dancer
As a long time back sufferer Leon found unique methods to alleviate his pain using natural methods including self massage, exercise/stretching and postural habits. He founded Backintelligence.com to empower others to fix their postures and ease their back pain from home.
Co Authors :
Doctor of Physical Therapy and currently works full time as a pediatric physical therapist. Rachel has worked in Sports, Inpatient Rehab and Outpatient Ortho settings under the guidance of incredible mentors focusing on low back pain. Rachel believes in holistic and patient centered care and enjoys developing their course of treatment.