UMEM Educational Pearls

Category: Orthopedics

Title: Winged Scapula

Keywords: winged scapula, trapezius, serratus anterior, long thoracic nerve (PubMed Search)

Posted: 10/18/2009 by Dan Lemkin, MD (Emailed: 10/24/2009) (Updated: 10/18/2019)
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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/
 
http://en.wikipedia.org/wiki/Winged_scapula