Scapular Winging – A Schematic Review

Abstract

Scapular winging is a rare, painful and debilitating condition that leads to limited functional activity of the upper extremity. The composite scapular movement of rotation, abduction, and tilting is necessary for proper shoulder function. Weakness or loss of scapular mechanics can lead to difficulties with elevation of the arm and lifting objects. It can result from numerous causes, including traumatic, iatrogenic, and idiopathic processes that most often result in nerve injury of either the serratus anterior, trapezius, or rhomboid muscles. Diagnosis is easily made by inspection of the scapula from back, with serratus anterior paralysis resulting in medial winging of the scapula while lateral winging is caused by trapezius and rhomboid paralysis. Most cases of serratus anterior and rhomboid paralysis spontaneously resolve within 24 months, while conservative treatment of trapezius paralysis is less effective. Patients become candidates for corrective surgery if they fail a 6–24 month course of conservative treatment. This review explores the causes of scapula winging, with overview of the relevant anatomy, proposed aetiology and treatment.