Neurogenic causes of scapular winging
- Serratus anterior
- Trapezius
- Rhomboid
Neuromuscular cause of scapular winging
FSH dystrophy
Mechanical cause of scapular winging
Congenital
How to determine the likely etiology…
1st look at the position of the scapula relative to the midline!
Serratus anterior winging
At rest:
- medial translocation of the scapula (closer to the midline)
- medial rotation of the inferior angle
- winging of the inferior part of scapular
Active:
- accentuated by forward flexion and protraction of scapula against resistance
- less with abduction
Trapezius winging
At rest:
- less winging at rest
- winging primarily affects inferior angle
- lateral translocation (scapular further from the midline)
- medial rotation of inferior angle (same as serratus)
- true drooping of shoulder (shoulder is distinctly lower unlike serratus where is just appears to be lower)
- levator scapulae muscle usually prominent
Active:
- accentuated by abduction
- decreased by forward flexion
Trapezius winging etiology
- Not always spinal accessory nerve (motor)!
- May also be due to cervical spinal C3 and C4 (motor and sensory)
Rhomboid winging
At rest:
- minimal winging
- lateral translocation (further from midline)
- lateral rotation of inferior angle
- may be some rhomboid atrophy if longstanding
Presentation:
- PAIN along medial border of scapula
- Accentuated by slowly lowering arms from forward elevated position
- decreased by elevation overhead
What is the main winging you will see at rest?
Serratus anterior
If there is a scapular winging due to weakness of __________, then at rest there is medial rotation of the inferior angle of the scapula.
- serratus anterior
- trapezius
Rotation of the scapula as in full abduction of the arm is produced by the…
- trapezius
- serratus anterior
In trapezius paralysis, the scapula shifts:
down and laterally
The lateral displacement of the scapular in a trapezius paralysis is due in part to the unopposed action of the serratus anterior.
TRUE
An injury of the long thoracic nerve may be associated with…
winged scapula
The most disabling dysfunction in serratus anterior palsy is…
Instability of the scapula due to posterior displacement of the medial border of the scapula during active flexion and abduction
