What is Scapular Winging

Scapular winging is a condition that causes part of the shoulder blade (scapula) to stick out from the back and look similar to a wing. This causes pain and weakness in the shoulder and upper arm.

Scapular winging happens when the muscle groups that hold the scapula in place against the back (scapular stabilizers) stop functioning normally.

This condition usually goes away with treatment. Scapular winging most commonly affects one shoulder blade, but it can affect both shoulder blades.

What are the causes?

This condition may be caused by nerve damage, weakness (fatigue), or loss of motor control in the scapular stabilizers, which can result from:

• A sudden (acute) injury.
• Injury from overuse.
• Infection.
• A reaction to a medicine.
• Exposure to poisons (toxins).
• Surgery on the neck or chest.

What increases the risk?

This condition is more likely to develop in athletes, especially athletes who participate in sports that involve a lot of arm and shoulder movement.

What are the signs or symptoms?

The main symptoms of this condition are aching or burning shoulder pain and a shoulder that has an abnormal shape (deformity). The scapula may wing out from the back all the time, or only with upper arm and shoulder movement. The scapula may wing out near the shoulder or near the spine.

Other signs and symptoms may include:

• Pain that gets worse with overhead arm movement.
• Pain that moves to the arm or neck.
• Decreased range of motion.
• Weakness.

How is this diagnosed?

This condition is diagnosed based on:

• Your symptoms.
• Your medical history, including your history of recent injuries.
• A physical exam.
• Tests, such as:
  • Electromyogram (EMG). This is an electrical nerve study that is used to find out which nerves and muscles are affected.
  • X-rays to check for a break (fracture) in a bone.
  • CT scan.
  • MRI.

How is this treated?

Treatment for this condition may include:

• Wearing a brace around your chest to hold your scapula against your back.
• Avoiding all activities that cause pain.
• Physical therapy.
• Medicines to help relieve pain.
• Surgery. This may be needed if your condition has not improved in 6–12 months. After surgery, you will need to wear a brace and start physical therapy exercises.

Follow these instructions at home:

If you have a brace:

• Wear it as told by your health care provider. Remove it only as told by your health care provider.
• Loosen the brace if it is too tight around your chest, or if your arm tingles or becomes numb.
• Do not let your brace get wet if it is not waterproof. Ask your health care provider if you may remove the brace before bathing or showering.
• Keep the brace clean.

General instructions

• Ask your health care provider when it is safe for you to drive.
  • Do not drive or operate heavy machinery while taking prescription pain medicine.
• Return to your normal activities as told by your health care provider. Ask your health care provider what activities are safe for you.
• Do exercises as told by your health care provider.
• Do not use any tobacco products, such as cigarettes, chewing tobacco, or e-cigarettes. Tobacco can delay bone healing. If you need help quitting, ask your health care provider.
• Take over-the-counter and prescription medicines only as told by your health care provider.
• Keep all follow-up visits as told by your health care provider. This is important.

Contact a health care provider if:

• You have pain that gets worse or does not get better with medicine.
• Your symptoms get worse or do not go away after 6 months of treatment.

Scapular Winging Rehabilitation

Ask your health care provider which exercises are safe for you. Do exercises exactly as told by your health care provider and adjust them as directed. It is normal to feel mild stretching, pulling, tightness, or discomfort as you do these exercises, but you should stop right away if you feel sudden pain or your pain gets worse. Do not begin these exercises until told by your health care provider.

Stretching and range of motion exercises

These exercises warm up your muscles and joints and improve the movement and flexibility of your shoulder. These exercises also help to relieve pain, numbness, and tingling.

Exercise A: Pendulum

1. Stand near a wall or a surface that you can hold onto for balance.
2. Bend at the waist and let your left / right arm hang straight down. Use your other arm to support you.
3. Relax your arm and shoulder muscles, and move your hips and your trunk so your left / right arm swings freely. Your arm should swing because of the motion of your body, not because you are using your arm or shoulder muscles.
4. Keep moving so your arm swings in the following directions, as told by your health care provider:
   1. Side to side.
   1. Forward and backward.
   1. In clockwise and counterclockwise circles.
5. Slowly return to the starting position.

Repeat __________ times. Complete this exercise __________ times a day.

Exercise B: Flexion, seated

1. Sit in a stable chair so your left / right forearm can rest on a flat surface. Your elbow should rest at a height that keeps your upper arm next to your body.
2. Keeping your shoulder relaxed, lean forward at the waist and let your hand slide forward. Stop when you feel a stretch in your shoulder, or when you reach the angle that is recommended by your health care provider.
3. Hold for __________ seconds.
4. Slowly return to the starting position.

Repeat __________ times. Complete this exercise __________ times a day.

Exercise C: Flexion, standing

1. Stand and hold a broomstick, a cane, or a similar object with your hands a little more than shoulder-width apart on the object. Your left / right hand should be palm-up, and your other hand should be palm-down.
2. Use both hands to raise the stick in front of your body and then over your head. Stop when you feel a stretch in your shoulder, or when you reach the angle that is recommended by your health care provider.
   1. Keep your left / right elbow straight and keep your shoulder muscles relaxed.
   1. Avoid shrugging your shoulder while you raise your arm. Keep your shoulder blade tucked down toward the middle of your spine.
3. Hold for __________ seconds.
4. Slowly return to the starting position.

Repeat __________ times. Complete this exercise __________ times a day.

Exercise D: Abduction, supine

1. Lie on your back and hold a broomstick, a cane, or a similar object. Place your hands a little more than shoulder-width apart on the object. Your left / right hand should be palm-up, and your other hand should be palm-down.
2. Push the stick to raise your left / right arm out to your side and then over your head. Use your other hand to help move the stick. Stop when you feel a stretch in your shoulder, or when you reach the angle that is recommended by your health care provider.
   1. Avoid shrugging your shoulder while you raise your arm. Keep your shoulder blade tucked down toward the middle of your spine.
3. Hold for __________ seconds.
4. Slowly return to the starting position.

Repeat __________ times. Complete this exercise __________ times a day.

Exercise E: Flexion, active-assisted

1. Lie on your back. You may bend your knees for comfort.
2. Hold a broomstick, a cane, or a similar object with your hands about shoulder-width apart on the object. Your palms should face toward your feet.
3. Use both hands to raise the stick toward the ceiling. Continue by moving your arms in front of your face, then behind your head, toward the floor. Use your uninjured arm to help your left / right arm move farther. Stop when you feel a gentle stretch in your shoulder, or when you reach the angle where your health care provider tells you to stop.
4. Hold for __________ seconds.
5. Slowly return to the starting position.

Repeat __________ times. Complete this exercise __________ times a day.

Strengthening exercises

These exercises build strength and endurance in your shoulder. Endurance is the ability to use your muscles for a long time, even after they get tired.

Exercise F: Scapular depression and adduction

1. Sit on a stable chair. Support your arms in front of you with pillows, armrests, or a tabletop. Keep your elbows near the sides of your body.
2. Gently move your shoulder blades down and back toward your spine. Relax the muscles on the tops of your shoulders and in the back of your neck.
3. Hold for __________ seconds.
4. Slowly release the tension, and relax your muscles completely before you repeat the exercise.

Repeat __________ times. Complete this exercise __________ times a day. After you have practiced this exercise, try doing it without the arm support. Then, try doing it while standing instead of sitting.

Exercise G: Scapular protraction, standing

1. Stand so you are facing a wall, about one arm-length away from the wall.
2. Place your hands on the wall and straighten your elbows.
3. Move your shoulder blades down, toward the middle of your spine.
4. Keep your shoulder blades down and move them forward, toward the wall. You should feel your shoulder blades sliding forward, around your ribcage.
   1. If you are not sure that you are doing this exercise correctly, ask your health care provider for more instructions.
5. Hold for __________ seconds.
6. Slowly return to the starting position. Let your muscles relax completely before you repeat this exercise.

Repeat __________ times. Complete this exercise __________ times a day.

Exercise H: Scapular protraction, supine

1. Lie on your back on a firm surface. Hold a __________ weight in your left / right hand.
2. Raise your left / right arm straight into the air so your hand is directly above your shoulder joint.
3. Push the weight into the air so your shoulder blade lifts off of the surface that you are lying on. Do not move your head, neck, or back.
4. Hold for __________ seconds.
5. Slowly return to the starting position. Let your muscles relax completely before you repeat this exercise.

Repeat __________ times. Complete this exercise __________ times a day.

Exercise I: Scapular protraction, quadruped

1. Get on your hands and knees. Your hands should be directly below your shoulder blades.
2. Straighten your arms until your elbows are locked.
3. Round your back as much as you can. Think about lifting your rib cage up into your shoulder blades. Keep your neck muscles relaxed.
4. Hold for __________ seconds.
5. Slowly return to the starting position. Let your muscles relax completely before you repeat this exercise.

Repeat __________ times. Complete this exercise __________ times a day.

Exercise J: Scapular depression

1. Sit in a stable chair that has armrests. Sit upright, with your feet flat on the floor.
2. Put your hands on the armrests with your elbows bent and your fingers pointing forward. Your hands should be about even with the sides of your body.
3. Push down on the armrests to lift yourself off of the chair. Straighten your elbows and lift yourself up as much as you comfortably can.
   1. Move your shoulder blades down and back.
   1. Do not let your shoulders move up toward your ears.
   1. Keep your feet on the ground. As you get stronger, your feet should support less of your body weight as you do this exercise.
4. Hold for __________ seconds.
5. Slowly lower yourself back into the chair.

Repeat __________ times. Complete this exercise __________ times a day.

Exercise K: Shoulder extension, prone

1. Lie on your abdomen on a firm surface so your left / right arm hangs over the edge.
2. Hold a __________ weight in your left / right hand so your palm faces in toward your body. Your arm should be straight.
3. Squeeze your shoulder blade down toward the middle of your back.
4. Slowly raise your arm behind you and toward the ceiling, up to the height of the surface that you are lying on. Keep your arm straight.
5. Hold for __________ seconds.
6. Slowly return to the starting position and relax your muscles.

Repeat __________ times. Complete this exercise __________ times a day.

Exercise L: Horizontal abduction, prone

1. Lie on your abdomen on a firm surface so your left / right arm hangs over the edge.
2. Hold a __________ weight in your hand so your palm faces toward your feet. Your arm should be straight.
3. Squeeze your shoulder blade down toward the middle of your back.
4. Bend your elbow so your hand moves up, until your elbow is bent to an “L” shape (90 degree angle). With your elbow bent, slowly move your forearm forward and up. Raise your hand up to the height of the surface that you are lying on.
   1. Your upper arm should not move, and your elbow should stay bent.
   1. At the top of the movement, your palm should face the floor.
5. Hold for __________ seconds.
6. Slowly return to the starting position and relax your muscles.

Repeat __________ times. Complete this exercise __________ times a day.

Exercise M: Scapular retraction

1. Sit in a stable chair without armrests, or stand.
2. Secure an exercise band to a stable object in front of you so it is at shoulder height.
3. Hold one end of the exercise band in each hand. Your palms should face down.
4. Straighten your elbows and lift your arms up to shoulder height.
5. Step back, away from the secured end of the exercise band, until the band stretches.
6. Squeeze your shoulder blades together and move your elbows back behind you. Do not shrug your shoulders while you do this.
   1. Your elbows should stay at about chest or shoulder height.
   1. Keep your upper arms lifted, away from your sides.
7. Hold for __________ seconds.
8. Slowly return to the starting position.

Repeat __________ times. Complete this exercise __________ times a day.

Exercise N: Shoulder extension

1. Sit in a stable chair without armrests, or stand.
2. Secure an exercise band to a stable object in front of you so it is at shoulder height.
3. Hold one end of the exercise band in each hand. Your palms should face each other.
4. Straighten your elbows and lift your hands up to shoulder height.
5. Step back, away from the secured end of the exercise band, until the band stretches.
6. Squeeze your shoulder blades together and pull your hands down to the sides of your thighs. Stop when your hands are straight down by your sides. Do not let your hands go behind your body.
7. Hold for __________ seconds.
8. Slowly return to the starting position.

Repeat __________ times. Complete this exercise __________ times a day.

Exercise O: Scapular retraction and external rotation

1. Sit in a stable chair without armrests, or stand.
2. Secure an exercise band to a stable object in front of you so it is at shoulder height.
3. Hold one end of the exercise band in each hand. Your palms should face down.
4. Straighten your elbows and lift your hands up to shoulder height.
5. Step back, away from the secured end of the exercise band, until the band stretches.
6. Bend your elbows and raise your hands up to the height of your head.
   1. Your palms should face out, in front of you, at the top of the movement.
   1. Squeeze your shoulder blades together during this movement.
7. Hold for __________ seconds.
8. Slowly straighten your arms to return to the starting position.

Repeat __________ times. Complete this exercise __________ times a day.