The term ‘winged scapula’ (also scapula alata) is used when the muscles of the scapula are too weak or paralyzed, resulting in a limited ability to stabilize the scapula. This leads to the protruding of the borders of the scapula from back, like wings and hence the name. They are Broadly classified as musculoskeletal- and neurological
Classification based on the etiology
· Serratus Anterior Palsy
· Trapezius Palsy
· Rhomboid Palsy
Causes
Traumatic (athletic injuries, car accidents)
Post infection (Influenza, Poliomyelitis, etc)
Iatrogenic (Post-surgical complications)
Congenital (Muscular Dystrophy)
Spontaneous (Idiopathic as in the case of Parsonage-Turner Syndrome.)
Symptoms
Winging of scapula disturbs scapulohumeral rhythm
Loss of muscle power
Limited movement of the upper extremity
Pain.
Fatigue
Difficulty to lift, pull, and push heavy objects
Difficulty to perform daily activities of living
1. Serratus anterior palsy is the most common type and it shows deformation of the back due to a protrusion of the medial portion of the scapula.
2. Trapezius palsy manifests asymmetrical neckline with drooping of the effected shoulder. This may be accompanied with lateral displacement and winging of the scapula.
3. Rhomboids palsy shows a very subtle winging of the scapula, with the scapula laterally translated and the inferior angle rotated laterally
Management
First line of management is pain control and physical therapy.
Surgical
Physical Therapy management
PT management is based on the etiology of the winging of scapula
Trapezius palsy benefits from Special shoulder orthosis and surgical approach.
Rhomboids palsy is treated conservatively with cervical spine stabilization (collar or cervical traction), muscle relaxants, anti-inflammatories, and physical therapy.
Serratus anterior palsy patients should be advised to avoid overhead use of the effected extremity and to avoid activities that cause pain and avoid stretching the serratus anterior muscle. Treatment must include Range of motion (ROM) exercises in the supine position. Scapular brace has been effective in compliant patients.
Your physiotherapist will help you with:
a) conscious muscles activation of the scapula
b) automate exercises for the scapula muscles and finally,
c) dynamic exercises for the muscles of the scapula and get your scapular muscles fit to keep your scapula in place and thereby, improve your pain and muscle function.
We, at Valley Healing Hands, Brownsville, Texas Provide the best Physical therapy for patients with winged scapula and our therapists will be more than pleased to assist you.