WINGING OF SCAPULA

WINGING OF SCAPULA

DEFINATION:

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. As a result, the medial border of the scapula protrudes, like wings. The main reasons for this condition are musculoskeletal- and neurological-related.

Scapular-winging

CAUSES:

INJURIES:

A variety of injuries can damage important nerves and muscles, leading to a winged scapula.

1.Traumatic injuries
Blunt trauma to the nerves that control the muscles of your neck, upper back, and shoulder can lead to scapular winging. Examples of blunt trauma include dislocating your shoulder or twisting your neck in an unusual way.

2.Repetitive motion injuries
Repetitive movements can also cause injuries. This type of injury is common among athletes, but it can also be caused by everyday tasks, such as:
-washing the car
-digging
-trimming hedges
-using your arms to prop your head up while lying down
-Nontraumatic injuries
-Nontraumatic injuries aren’t caused by physical force. Instead, they can be caused by:

SURGERY

Rib resections, mastectomies, and procedures that require general anesthesia may cause nerve damage.

CLINICAL PRESENTATION:

Type 1:
A visible angulus inferior and a pronounced anterior tilt of the scapula can be observed.
The causes for this type are: shortening of the M.pectoralis minor, shortening of the posterior joint-capsule and muscular unbalance of the M.Trapezius pars ascendens and the M.serratus anterior.

TYPE 1

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.

TYPE 2

TREATMENT:

SURGERY:

There’re surgical treatments with patients being very satisfied about the result. But some studies prefer a non-operative treatment especially in case of older patients who are sedentary and with minimal symptoms.[20]

These treatments are:
• Split pectoralis major transfer.
• Modified version of the Eden-Lange procedure.
• Scapuloplexy.

PHYSIOTHERAPY MANAGEMENT:

muscle activation of scapular muscle:
-correction scapular position with tactile feedback and ask the patient to move scapula downward and inward.
-scapulothoracal feedback of muscle control.
-the patient put his fingers on the processus coracoideus, after this the patient move his scapula backward with his fingers on processus coracoideus.

SCAPULAR EXERCISES

dynamic scapulothoracic muscle training:
-push up with plus
-elevation in scapular flat
-elbow push-ups
-press up
-low rowing

LOW ROWING

-horizontal abduction
-retroflection against resistance
-serratus punch upright and prone
-elbow in the back pocket exercise

BACK POCKET EXERCISE

-dynamic hug

DYNAMIC HUG

PREVENTION:

1.avoiding repetitive shoulder or arm movements when possible
2.maintaining correct posture
3.using an ergonomic chair or pillow
4.using shoulder-friendly ergonomic bags and backpacks
5.avoiding carrying too much weight on your shoulders
6.stretching and strengthening the muscles in your neck, shoulders, and upper arms.

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