II. Epidemiology
- Uncommon to rare
III. Pathophysiology
- Scapular Winging results from innervation loss
- Long Thoracic Nerve (most common, C5-7 origin)
- Spinal Accessory nerve (Cranial Nerve 11)
- Innervates levator Scapulae and rhomboid Muscles
- Iatrogenic causes are most common (e.g. Lymph Node or Neck Mass excision)
- Dorsal Scapular Nerve (C4-5 origin)
- Innervates trapezius Muscle
- Injury occurs with strenuous activity or lifting
- Results in paralysis of the trapezius Muscle, rhomboid Muscles, or serratus anterior Muscle
IV. Signs
- Serratus anterior weakness (Long Thoracic Nerve Palsy)
- Medial Scapula Winging increased when arms forward flexed and pushing against the wall
- Overhead abduction reduced (last 30 degrees lost)
- Levator Scapulae and rhomboid Muscle Weakness (Cranial Nerve 11 palsy)
- Lateral Scapula Winging increased when arms abducted
- Trapezius Muscle Weakness (Dorsal Scapular Nerve Palsy)
- Lateral Scapula Winging increased when arms abducted (similar to Cranial Nerve 11 palsy)
- Shoulder Abduction above 90 degrees is difficult
- Affected Shoulder droops
V. Imaging
- Evaluate for alternative causes
VI. Diagnostics
- Consider Electromyogram
VII. Differential Diagnosis
- See Cervical Spine Injury
- See Shoulder Injury
VIII. Management
- Oral Analgesics as needed (e.g. NSAIDS)
- Relative rest of affected Shoulder
- Physical Therapy
IX. Prognosis
- Most patients recover within 2 years with physical therapy and without surgery
X. References
- Kuczynski (2023) Crit Dec Emerg Med 37(10): 12-3
- Didesch (2019) J Hand Surg Am 44(4):321-30 +PMID: 30292717 [PubMed]
- Gooding (2014) Shoulder Elbow 6(1):4-11 +PMID: 27582902 [PubMed]
Images: Related links to external sites (from Bing)
Related Studies
Concepts | Finding (T033) |
SnomedCT | 17211005 |
English | 'Winged' scapulae, Winged scapulae, Winging of the scapulae, winged scapula (physical finding), winged scapula, wing scapula, winging scapula, scapula alata, winging of scapula, scapulas winged, scapula winging, Winged scapula, Scapula alata, Winging of scapula, Winged scapula (finding) |
Spanish | Escápula en ala, Escápula alada, omóplato alado (hallazgo), omóplato alado, escápula alada (hallazgo), escápula alada, escápula alata |
French | Scapula alata, Décollement de l'omoplate |
Dutch | gevleugeld schouderblad, scapula alata |
Portuguese | Escápula alada, Escápula em forma de asa |
German | Scapula alata, fluegelartiges Abstehen des Schulterblattes |
Italian | Scapola alata |
Japanese | 翼状肩甲骨, ヨクジョウケンコウコツ |
Czech | Okřídlená lopatka, Scapula alata |
Hungarian | Scapula alata, Scapulae alatae |