In most cases Physiopedia articles are a secondary source and so should not be used as references. This is … Physical exercises for the scapula. Scapula winging or a winged scapula is  rare condition that causes the shoulder blade to stick out from the back. Scapula alata : facteurs musculaires et neurologiques. This nerve sends motor signals only and does not get involved with any sensory information. The head of the humerus rests on the Glenoid fossa of the scapula where it articulates when the muscles of the shoulder contract to move the arm. Type 1:The characteristics of type 1 are a separated scapula of the thorax, elevation of scapula and the margo medialis comes closer to the spinal line. There are two types of scapular motion deviation:[11]. Épaule neurologique et médecine de réeducation 2009, 68-71.fckLREvidence levels : E, Sandro Giannini, MD; Cesare Faldini, MD; Stavroula Pagkrati, MD; Gianluca Grandi, MD;Vitantonio Digennaro, MD; Deianira Luciani, MD; and Luciano Merlini, MD. The doctor may recommend physical therapy and a support device, such as a sling. ACE Physical Therapy and Sports Medicine Institute, ACTIVE EXTENSION: ONE CAUSE OF LOW BACK PAIN IN ATHLETES, RUNNING INJURY PREVENTION: THE BEST MEDICINE. The middle fibers are oriented in a way that enables them to facilitate protraction. The most pronounced symptom of an injured long thoracic nerve is referred to “winging” of the scapula. If you have a painful shoulder and suspect that it is “winging” seek the advice and treatment of a Physical Therapist. Your email address will not be published. Long Thoracic Nerve Injuries But some studies prefer a non-operative treatment especially in case of older patients who are sedentary and with minimal symptoms. Scapula alata or winging scapula. Read more, © Physiopedia 2020 | Physiopedia is a registered charity in the UK, no. The primary goal of treatment is to re-establish the normal health to the long thoracic nerve which requires eliminating the primary cause be it over-stretch or compression. Wang, J.M. Crielaard, J.L. Treatment of winged scapula by pectoralis major transfer. This process is slow and usually takes 6-9 months but conservative treatment is usually successful. The therapist offers an isometric resistance against a scapular elevation in midrange of motion. Required fields are marked *, © 2010-2018 ACE Physical Therapy and Sports Medicine Institute, Designed by Elegant Themes | Powered by WordPress. Damage to the long thoracic nerve will lead to “winging” of the scapula. It attaches onto the under surface of the shoulder blade and to the side of the rib cage. Unfortunately, the muscles can be injured which leads to an imbalance and abnormal motions. The capsular tension will bring the scapula to the front. Type 2:The characteristics of type 2 are a separated scapula of the thorax, lowering of the scapula and spreading of the margo medialis against the spinal line. Physical Therapists are well trained to evaluate the shoulder’s mechanics and movements. Winged scapula treatment. The serratus anterior muscle is not able to perform its role and the vertebral border of the scapula “lifts off” the rib cage. Causes of Winging Scapula Foo, M. Swann. There is one very large muscle, serratus anterior (SA), that is located along the side of the rib cage that attaches to the scapula and helps to control its movements. That is usually the journal article where the information was first stated. Treatment for Restoring Shoulder Health Winging of the scapula: an unusual complication of chest tube placement. With a type 1 the angulus inferior becomes visible. As a result, the medial border of the scapula protrudes, like wings. This bone is the anchoring point of every shoulder muscle and when it moves too much or too little the joint structures can be compromised and injured. In any of these situations, the patient will present with abnormal shoulder mechanics. The anatomic structures involved in the winged scapula are: Structures involving the musculoskeletal winged scapula:[5] M.trapezius, M.serratus anterior, M.rhomboideus major, Mm.rhomboideï, M.levator scapulae, M.pectoralis minor, M.latissimus dorsiStructures involving the neurological winged scapula:[1] M.trapezius (pars descendens), M.serratus anterior, M.rhomboidei, N.accessories, N.thoracicus longus, Plexus brachialis. But a winged scapula is not always painful, this is often with a muscular scapula alata. Correction scapular position with tactile feedback on the level of the angulus inferior and ask the patient to move the scapula downwards and inwards. The patient put his fingers on the processus coracoideus, after this the patient moves his scapula backwards (medio-cranial) with his fingers on the processus coracoideus. http://en.wikipedia.org/wiki/Winged_scapula, http://www.maitrise-orthop.com/viewPage_us.do?id=1010, http://medischcontact.artsennet.nl/Nieuws-26/Tijdschriftartikel/87135/Afstaand-schouderblad-na-neurotrauma.htm, https://www.physio-pedia.com/index.php?title=Winged_scapula&oldid=244549. The shoulder blade has to remain in proper position during any motion or the head of the humerus cannot remain situated in the glenoid fossa in the correct place. The “winging” position places abnormal stress and strain on all of the soft tissues of the shoulder. The causes are damage to the N.accessorius and insufficiency of the M.trapezius pars descendens. If you do not have strength and/or control of this very important muscle, it can lead to scapular winging. This muscle has three distinct fiber orientations and each one helps to produce a specific movement of the scapula. Hassan, N.P. Winging can occur on one or both of your shoulders where the winged scapula protrudes outwards. The humerus is passively placed into endorotation behind the back. Diagnosis of damage to the long thoracic nerve has to be done with an EMG but a physical examination of shoulder movement is usually very reliable. The most important muscle to strengthen if you have a Winged scapular is the serratus anterior muscle. From their findings, they establish a treatment protocol that will address the symptoms and help to eliminate the problems. Received vovember 27, 2007; accepted November 27, 2007; published online January 8, 2008.fckLREvidence levels: A2, John Iceton, W.R. Harris. The shoulder blade appears to be disconnected from the ribs. Most of the painful scapula alata are caused by a neurological trauma. 2005, 104-135. 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