5 easy Physical Therapy scapular exercises to improve shoulder strength and prevent injuries and pain in elbows, wrists, and hands. Winging or tipping of the scapula; Instability of the shoulder; CAUSES OF SCAPULAR DYSKINESIA. As a result, the medial border of the scapula protrudes, like wings. Foo, M. Swann. Causes of Winging Scapula Surgical treatment of winged scapula. Physiopedia articles are best used to find the original sources of information (see the references list at the bottom of the article). Scapula alata. Wang, J.M. Many individuals have pain in the shoulder joint due to the abnormal movement one or more bones. 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. But some studies prefer a non-operative treatment especially in case of older patients who are sedentary and with minimal symptoms. I give my consent to Physiopedia to be in touch with me via email using the information I have provided in this form for the purpose of news, updates and marketing. It attaches onto the under surface of the shoulder blade and to the side of the rib cage. In most cases Physiopedia articles are a secondary source and so should not be used as references. There are “back” muscles that attach to the scapula border closest to the spine that help to control and stabilize the scapula as it moves. Your email address will not be published. Scapula alata or winging scapula. The muscles in the neck region can compress it, the over-hand throwing motion can stretch it, contact sports can move the head one way and the shoulder another which stretches it too far, acute trauma and various other structures can compress it causing damage. Physical Therapists are well trained to evaluate the shoulder’s mechanics and movements. This can cause pain in completing normal activities like slipping on a shirt or brushing teeth. The causes of both species of winged scapula are:[2][6][7] • Acute traumas, for example a direct shock on the shoulder during a car accident with a sudden traction on the arm.• Micro traumas, repeated stretching of the neck in later flexion as in tennis (N. Thoracicus longus) or by wearing a heavy backpack (N. Accessories)• Post-infection, for example an influenza infection• Injections• From birth• The result of post-surgical complications, like a chest tube placement[8] • Idiopathic as in the case of Parsonage-Turner Syndrome, Most of these patients describe a sever or excruciating pain, often keeping them awake. Type 3:A visible angulus inferior and a downward rotation of scapula can be notified.The causes are: shortening of the M.levator scapulae and muscular unbalance of the M.trapezius pars descendens and ascendens. First conscious muscles activation of the scapula, then automate exercises for the scapula muscles and at last dynamic exercises for the muscles of the scapula. This nerve sends motor signals only and does not get involved with any sensory information. The humerus is passively placed into endorotation behind the back. If you have a painful shoulder and suspect that it is “winging” seek the advice and treatment of a Physical Therapist 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 thorough approach enables them to restore the normal function and movement of the shoulder. Fixation of winged scapula in facioscapulahumeral muscular dystrophy. 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 term ‘winged scapula’ (also scapula alata) is used when the muscles of the scapula are too weak or paralyzed, resulting in a limited ability to stabilize the scapula. 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. by ACE Physical Therapy and Sports Medicine Institute. La revue de la Médecine Générale 2010 (269), 32-33.fckLREvidence levels : A1, Grethe Aalkjӕr, Lisbeth Rejsenhus. The journal of bone and joint surgery 1987 (69-B), 108-110.fckLREvidence levels: A2. The long thoracic nerve is only a motor nerve and it innervates the Serratus Anterior muscle. There are two types of scapular motion deviation:[11]. 1173185, Clinical presentation for the musculoskeletal winged scapula, Clinical presentation for the neurological winged scapula, Dr Jacques Vanderstraeten, médecin généraliste et du sport. The middle fibers are oriented in a way that enables them to facilitate protraction. In a throwing athlete, their performance will be greatly effected in a negative way where they will suffer from pain, loss of strength and accuracy. The journal of bone and joint surgery 1983 (65-B), 552-556.fckLREvidence levels: 3, B. Forthomme, F.C. But a winged scapula is not always painful, this is often with a muscular scapula alata. The upper fibers “anchor” it to the ribs and allow the scapula to “pivot”. Oefentherapie bij schouderaandoening. Treatment of winged scapula by pectoralis major transfer. Commonly, scapular winging is thought of being the result of muscle weakness or imbalance, as well as poor timing of muscular contraction. Applying ice or cold therapy may help reduce the shoulder blade pain although the back isn’t the easiest place to apply a cold pack. The causes are damage to the N.accessorius and insufficiency of the M.trapezius pars descendens. Type 2:A visible margo medialis and an intern rotation of scapula can be observed.The causes are: shortening of the posterior joint-capsule, shortening of the M.latissimus dorsi and muscular unbalance of the M.trapezius and the M.serratus anterior. 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. Treating a scapula that has dysfunctional motion is very common in the out –patient orthopaedic physical therapy setting. The bones of the joint need to move together as a “team” or an injury can occur. Scapulothoracal feedback of muscle control with feedback on the level of the sternum. In the case of dorsal scapular nerve damage, the doctor will likely suggest physical therapy. The symptoms that get the patient to seek medical attention are usually pain and weakness in the involved shoulder. The shoulder joint is a complex joint that has the capability to move in every plane of motion. The most important muscle to strengthen if you have a Winged scapular is the serratus anterior muscle. ACE Physical Therapy and Sports Medicine Institute, ACTIVE EXTENSION: ONE CAUSE OF LOW BACK PAIN IN ATHLETES, RUNNING INJURY PREVENTION: THE BEST MEDICINE. The “winging” position places abnormal stress and strain on all of the soft tissues of the shoulder. Scapula is the anatomical term for the shoulder blade. Other patients feel a moderate pain and some are experiencing no pain at all. [1], Any infringement of the plexus brachialis, N.accessorius or N. Thoracicus longus is susceptible to provoke the winging of the scapula. One of the key components to proper shoulder motion is the position of the shoulder blade (scapula). 2005, 104-135. If this nerve is damaged in any way, the SA can be adversely affected and lead to improper shoulder motions due to abnormal scapula function. Abnormal scapula motion is referred to as scapular “dyskinesis.”. Clinical Orthopaedics and related research 2008 (466), 652-660. With a type 1 the angulus inferior becomes visible. The main reasons for this condition are musculoskeletal- and neurological-related.[1][2]. The SA’s capability to perform its functions is dependent upon the long thoracic nerve. Scapular … Crielaard, J.L. Then the therapist asks the patient to execute a protraction, afterwards he repeats the resistance-test. The doctor may recommend physical therapy and a support device, such as a sling. The capsular tension will bring the scapula to the front. The … Symptoms of Winging Scapula This phenomenon is called the ‘shrug-phenomenon. 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. Received vovember 27, 2007; accepted November 27, 2007; published online January 8, 2008.fckLREvidence levels: A2, John Iceton, W.R. Harris. Physical exercises for the scapula. If you believe that this Physiopedia article is the primary source for the information you are refering to, you can use the button below to access a related citation statement. Scapular winging, sometimes called a winged scapula, is a condition that affects the shoulder blades. Winging can occur on one or both of your shoulders where the winged scapula protrudes outwards. The shoulder joint is comprised of three bones: scapulae, clavicle, and humerus. 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.