winging of scapula anatomy

Like their connected bones, the scapulae are paired, with each scapula on either side of the body being roughly a mirror image of the other. The elevated scapula is visually noticeable and there is an associated restriction in the motion of the scapula and glenohumeral joint. Find out what's causing your shoulder blade pain and how to relieve your pain. Healthline Media does not provide medical advice, diagnosis, or treatment. Anteriorly, on the costal surface, is the shallow subscapula… Anatomy and Biomechanics. Injury to the scapula and its musculature is not uncommon. These muscles both stabilise the arm to the body and move the arm around in space. It may be related with pain around the scapula, or general pain around the whole shoulder region . The articulation takes place at … The Cavendish classification 2,6is one method used for grading: 1. grade I 1.1. very mild deformity is observed 1.2. when covered with clothes the deformity is almost invisible 2. grade II 2.1. the deformity is still mild but appears as a bump 2.2. the superomedial portion of the high scapula i… Make sure to talk to your doctor as soon as you start experiencing symptoms to improve your chances of making a full recovery. The cuts may not be in the correct plane, the detachment scar is not easily demonstrated, the lower trapezius is detached from the spine but then lays back over in the supine retracted imaging position, or the chronic changes are too subtle for the static imaging processes. It lies in the upper back between the second and eighth rib. In most cases, scapular winging can be fixed through physical therapy, massage, stretching and strength exercises. The most common surgical treatments for scapular winging are nerve and muscle transfers. The three nerves most often involved include the long thoracic, spinal accessory, and dorsal scapular nerves. If nonsurgical treatment options aren’t providing any relief, your doctor may recommend surgery. That weakness can make lifting, pulling, and pushing heavy objects hard. Snapping scapula most frequently represents a disruption of the smooth gliding of the scapula over the thoracic cage and periscapular muscles [, Click to share on Twitter (Opens in new window), Click to share on Facebook (Opens in new window), Click to share on Google+ (Opens in new window), Pathoanatomy of AcromioclavicularAcromioclavicular Joint Instability, Sternoclavicular Joint Anatomy and Pathology, Surface and Cutaneous Anatomy of the ShoulderShoulder, Normal and Pathological Anatomy of the Shoulder. 'Winging' of the scapula describes the abnormal lifting of the medial (vertebral) border of the scapula away from the thoracic wall. 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. The rotator cuff muscles lie directly above the scapula, along with the top portion of the upper arm muscles, including the deltoids and biceps tendons. Neurological Musculoskeletal The most common perception of the “winged” scapula, with prominence of the medial scapular border, is that it occurs as a result of damage to the nerves supplying the scapular stabilizing muscles. Among the 112 surveyed, 8 percent exhibited scapular winging 15 days after surgery. Try scapular stabilization exercises to strengthen your shoulders. A variety of injuries can damage important nerves and muscles, leading to a winged scapula. Scapular winging occurs when a shoulder blade sticks out. The scapula (shoulder blade) is the largest bone of the shoulder complex and has the greatest number of muscles attached to it. The…, The ankle bones include the calcaneus, cuboid, external cuneiform, internal cuneiform, middle cuneiform, navicular, and talus. Anatomically, it is the “G” of the glenohumeral (G-H) joint and the “A” of the acromioclavicular (A-C) joint. On physical examination, some patients may have tenderness to palpation along the scapula border; others may have no tenderness. Scapula winging can be corrected, though the treatment that works will depend on the nerve and muscle causing it. A clinical understanding of the possible causes of winging will assist practitioners in determining the correct means of resolving the abnormal scapular position and/or motion. The condition has been estimated to be present in up to 30 % of asymptomatic individuals yet can cause crippling pain. Treatment of the winged scapula depends on the severity of the patient's complaints, and the exact treatment required is … Peripheral nerve disorders, cervical spine disease could also mimic scapular winging and should be ruled out. … The scapula plays many roles in shoulder function. The exact frequency of neurologically based winging is poorly defined. Anatomy. Your doctor may also recommend light physical therapy or using a brace for several months early in your recovery. The serratus anterior gets a lot of attention because it’s anterior to the scapula, and attaches to the scapula. What are the symptoms of scapular winging? If the winged scapula is the result of nerve damage, it can cause weakness in the muscles of your neck, shoulders, and arms. Scapulothoracic fusion has been considered and may result in satisfactory results. Scapular winging symptoms vary from person to person depending on the underlying cause as well as the muscles and nerves involved. Example of long thoracic nerve palsy creating scapular winging, Surgery for long thoracic nerve palsy may be indicated for patients with 1 year of symptoms, functional deficits, and no signs of recovery. Frequently, the observational and functional result of the injury is prominence of the medial scapular border, commonly called “winged scapula”. Stretching at home may help you improve your strength and range of motion. … Anatomy of the Scapula. It articulates with the humerus at the glenohumeral joint, and with the clavicle at the acromioclavicular joint. The scapula, also known as the shoulder blade, is a flat triangular bone located at the back of the trunk and resides over the posterior surface of ribs two to seven. Here are four trapezius exercises you can perform using your own…. If the long thoracic nerve is damaged or bruised it can cause paralysis of the serratus anterior muscle. It can affect a person's ability to lift, pull, and push weighty objects. The result is medial winging of the scapula and limitation functionality of the upper extremity. To develop exercises to prevent scapular winging it helps to understand some basic shoulder girdle anatomy. Maximum strength is not regained for about 6–9 months, probably reflecting the chronic muscle disuse and atrophy. Anatomy of Scapula: Scapula serves as the attachment site for 17 muscles Its normal function to stabilize the scapula to the thorax, provide power to the upper limb … The physical exam also exhibits a consistent cluster of findings including the localized tenderness, often a noticeable and palpable soft tissue defect, either due to the detachment or the muscle atrophy, altered scapular resting position as well as dynamic dyskinesis including snapping scapula , shoulder impingement and weakness in forward flexion, and clinical decrease or relief of symptoms with scapular corrective maneuvers. Reattachment of the rhomboid muscle is performed initially (, Postoperatively, the arm is protected in neutral rotation for 4 weeks but gentle scapular retraction is encouraged immediately. Consistency of the history and physical exam findings allows for a reliable clinical diagnosis. Cases of scapular winging caused by damage to the serratus anterior nerve sometimes heal on their own within two years. A winged scapula is a skeletal medical condition in which the shoulder blade protrudes from a person's back in an abnormal position. The scapula is highly mobile and comprises of four parts : a body and three processes namely – spinous, acromion, and coracoid.According to some experts scapula can be divided into three components, viz. In rare conditions it has the potential to lead to limited functional activity in the upper extremity to which it is adjacent. The main reasons for this condition are musculoskeletal- and neurological-related. This can make sitting in a chair or wearing a backpack uncomfortable. There is a risk that the sling will stretch out over time, causing the winged scapula to return. These surgeries involve taking all or part of a nerve or muscle and moving it to another part of the body. Posteriorly, the scapula is divided into a supraspinous fossa and infraspinous fossa by the scapular spine. The head of the humerus (upper arm bone) is the ball and the scapula (shoulder blade) forms the socket where the humerus sits. I’ll say this from the beginning though, there’s this book called Functional Anatomy of Yoga, and on page 216 (1st ed. The composite scapular motion of rotation, abduction, and tilting is necessary for proper shoulder function. Scapular winging occurs when a shoulder blade sticks out. They may also ask you to perform certain arm or shoulder movements. Nerve and muscle transfers for scapular winging usually focus on the shoulder, back, or chest. When the diagnosis is scapular winging, however, it is the instability of the scapula rather than the glenohumeral joint. May 21, 2013 Dr. Tushar Mehta For Students / PG Aspirants. Winging can be due to disease in the nerves, muscles, bones, and joints in the periscapular area and may be either a static or dynamic deformity. It connects the upper limb to the trunk and articulates with the humerus or upper arm bone. In anatomy, the scapula (plural scapulae or scapulas), also known as the shoulder bone, shoulder blade, wing bone or blade bone, is the bone that connects the humerus (upper arm bone) with the clavicle (collar bone). Your doctor may recommend a procedure called scapulothoracic fusion if other treatments don’t work. Scapula is the anatomical term for the shoulder blade. These can all be organized as manifestations of scapular dyskinesis (abnormal scapular motion during arm movement) which can be seen as causes or results of various types of shoulder injury. Tell your doctor about any recent injuries, illnesses, or surgeries that could affect your neck, arms, or back. The Shoulder Girdle and The Ribcage. At 4 weeks, closed chain activation up to 90° abduction with the hand stabilized is started. All these muscles act at the same time sometimes and oppose each other at other times, but work together like a well trained team to allow the arm to move in space. As a result, the medial border of the scapula protrudes, like wings. Blunt trauma to the nerves that control the muscles of your neck, upper back, and shoulder can lead to scapular winging. This procedure involves using a sling to attach the scapula to either the ribs or the vertebral spinous processes, which are bony parts that stick out of your vertebrae. These two bones attach to the shoulder blades to form a collar like structure for the neck. This involves attaching the scapula directly to the ribs. Clinical presentations of scapular winging include neurologically based scapular winging, scapular muscle detachment, snapping scapula , and kinetic chain or muscle inhibition based scapular dyskinesis. A winged scapula is associated with damage or a contusion to the long thoracic nerve of the shoulder and/or weakness in the Serratus Anterior muscle. Examples of blunt trauma include dislocating your shoulder or twisting your neck in an unusual way. The talus sits at the…, The vastus lateralis muscle is located on the side of the thigh. Weakness or loss of scapular mechanics can lead to difficulties with elevation of the arm and lifting objects. Scapula is the anatomical term for the shoulder blade. All right Matt. The clinical assessment of the position of the scapula at rest as well as during dynamic arm motion, including medial border prominence, should be observed. In some serious cases, the ability to perform activities of daily living such as changing one's … The diagnosis of serratus anterior palsy is easy to make via visualization of the scapula, and the winging can be accentuated by asking the patient is to push against a wall. This article will review the relevant anatomy, etiology, clinical evaluation, diagnostic testing, and treatment of scapular winging. People with winged scapulae may feel weak when trying to lift something out and away from their body, or … Supports such as braces and slings can also be helpful during recovery. Patients may also have scapular winging (see Scapular Winging below). It’s simple and complicated at the same time, which is how anatomy often is. The adductor hallucis is a two-headed muscle that is responsible for flexing and contracting the big toe, and reinforcing the arch of the foot. Sprengel deformity is usually noticed at birth and has both cosmetic and functional implications. Most people with scapular winging have a shoulder blade that sticks out. Anatomy, Etiology, and Management of Scapular Winging. Scapular winging isn’t always preventable, but you may be able to reduce your risk by: Recovering from scapular winging can take anywhere from a few months to several years, depending on the initial cause, treatment method, and nerves and muscles affected. Frequently, the observational and functional result of the injury is prominence of the medial scapular border, commonly called “winged scapula”. The scapula is a triangular bone overlying the second to seventh ribs on the posterior thorax. Two important arteries, the axillary artery and the subclavian artery, run anterior to the scapula and posterior to the clavicle… Together with other muscles, it is part of the fleshy mass in the first web…, The zygomaticus major muscle is a muscle that controls facial expression, drawing the mouth's angle upward and outward. Results: Scapula winging was severe in 10 of 16 patients (63%), moderate in 2 patients (12%), and mild in 4 patients (25%) in our present study. Scapular winging is a painful and debilitating condition. OptimumCareProviders offers great exercise videos, including one for strengthening the serratus anterior muscle under your shoulder. While scapular winging can usually be improved, you may experience a permanent decreased range of motion in rare cases. Our website services, content, and products are for informational purposes only. Most reviews and teaching focus on … MRI and CT imaging are of minimal benefit. However, acute traumatic tears of the serratus anterior, trapezius, and rhomboids off of the scapula are important and under-recognized causes of scapular winging and dysfunction. Instead, they can be caused by: Rib resections, mastectomies, and procedures that require general anesthesia may cause nerve damage. The scapula, a flat, triangular bone that contributes to the posterior aspect of the shoulder girdle, is found bilaterally on the dorsal surface of the body and is stabilized through the actions of both the serratus anterior and the trapezius muscles .. ), I’m winging my scapulas for you there. In some cases, stretching and exercise can make scapular winging worse, so always check with your doctor before trying any home exercises. In more serious cases, surgery may be required. The scapula is described as having superior, medial, and lateral borders. Scapula Winging. The most common causes reported in the literature for scapular winging are dysfunction of the serratus anterior from long thoracic nerve injury causing medial winging or dysfunction of the trapezius from spinal accessory nerve injury causing lateral winging. Scapulothoracic dissociation has the potential to lead to difficulties with elevation of the scapula ( acromion is... 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