Winged scapula is caused by muscular injury or damage to corresponding muscular innervation. Mechanism can be due to blunt or penetating thoracic trauma.
Trapezius muscle
Long thoracic nerve
Serratus Anterior muscle
Spinal Accessory Nerve
Clinical findings include
Protruding medial edge of the scapula
Exacerbation by pushing against resistance
Difficulty lifting arm over head
Treatments
Initial splinting and orthopedic referral
Depending on mechanism - trial of physical therapy
Surgical treatments include fascial grafts or adjacent muscle attachment
References
Gregory J. Galano, MD, Louis U. Bigliani, MD, Christopher S. Ahmad, MD, and William N. Levine, MD. Surgical Treatment of Winged Scapula. Clin Orthop Relat Res. 2008 March; 466(3): 652–660. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2505206/
