Health TipsHow to Treat a Winging Scapula

How to Treat a Winging Scapula – In patients suffering from breast cancer, scapular winging can occur following radical mastectomy. The long thoracic nerve, which lies close to the axillae, is particularly susceptible to injury during surgery. This nerve is commonly damaged in mastectomies that involve the removal of lymph nodes. In patients with scapular winging, this nerve can be severely damaged during surgery.

Repairing the Winged Scapula

Although many patients can live with a mild degree of loss of trapezius function, a weakened muscle in the upper trapezius can result in pain around the shoulder area and in the neck. A condition known as rotator cuff impingement syndrome is often the result of poor shoulder blade positioning. The tendons of the rotator cuff are squashed. The condition can be difficult to treat, but it is possible to correct a winging scapula.

The problem is not always immediately apparent. Some cases take weeks to become noticeable. In many cases, a diagnosis of winging scapula can take many months or even years. In some cases, this condition is a result of injury to the long thoracic nerve or other nerves of the neck. While it may seem odd, it is an important diagnosis for people who experience pain. Winging scapula may result from a lack of proper muscle coordination.

If you notice winging in your shoulder, your problem may be caused by weak muscle or nerve supply. There are several exercises to strengthen these muscles. You can learn more about the treatment of winging scapula by watching the video below. In the video, the scapula protrudes on the backside of the ribs. The Serratus anterior opposes the winging scapula, which makes it difficult to do wall push-ups.

Scapular Winging Due to LTN Injury

Aside from the scapula fusion, Dr. Nath treated 50 patients with scapular winging caused by LTN injuries. Half of the patients reported pain caused by winging. In these patients, 73% of them achieved full recovery in 24 hours or less, while 44 patients reported a significant improvement between one day and three months. The majority of patients completed a standard WHO quality of life survey. However, patients suffering from the condition for more than 8 years reported a poorer outcome.

Despite the rare nature of the condition, scapular winging is often associated with lesions of the spinal accessory nerve or the long thoracic accessory nerve. Both of these nerves innervate the trapezius and serratus anterior muscles. Most cases of scapular winging are due to traumatic injury to the nerve, although nontraumatic causes include viral illnesses and toxins. Rarely, apical lung malignancy can cause scapular winging.

During this surgery, the scapula is exposed to a 5 cm incision, and an incision is made over the inferior border. The patient is then placed in a lateral tilt position to the contralateral side, with the scapula exposed and the shoulder girdle fully mobile. The ipsilateral arm holder is placed over the tendon to help position the arm for harvesting the pectoralis major muscle.

Undergoing Surgery for Winged Scapula Treatment

Another less common treatment for winged scapula is scapulothoracic arthrodesis. In the study conducted by Krishnan et al., a total of 22 patients and 24 shoulders underwent this surgery. An autologous bone graft was used to create a wide fusion surface. The patient’s limited range of motion was preserved at two months after the surgery. Once the grafts were inserted, the scapula was stabilized to the chest wall.

Surgery is the most common form of treatment for scapular winging, but nonsurgical treatments may also be used. Surgery may be necessary if the condition is caused by traumatic trauma. Damage to the spinal accessory nerve also requires surgery. Surgical treatment options include nerve and muscle transfers, which involve removing parts of the shoulder and/or back muscles to restore function to the scapula. Patients with scapular winging should consult with their doctor before undergoing any type of surgical procedure.


Galano, Gregory J., et al. “Surgical treatment of winged scapula.” Clinical orthopaedics and related research 466.3 (2008): 652-660.

Iceton, J. O. H. N., and W. R. Harris. “Treatment of winged scapula by pectoralis major transfer.” The Journal of Bone and Joint Surgery. British volume 69.1 (1987): 108-110.


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