Definition and Diagnosis

Scapular movement is very dynamic and any weakness of the peri-scapular muscles can cause winging. Scapular winging is when this bone protrudes at rest or with arm and shoulder movement. Although weakness of the serratus anterior muscle is the most common cause, trapezius and rhomboid weakness can also cause winging. Although scapular winging can occur after brachial plexus injury, it can also occur spontaneously. The cause of spontaneous winging is uncertain, but it may represent a limited form of brachial neuritis selectively involving the long thoracic nerve. Shoulder and scapular pain may occur. The amount of functional limitation (weakness) is variable, but when present, it may limit overhead arm use.

A long thoracic palsy causing scapular winging
when the arm is protracted.

Treatment Options

Most isolated cases resolve spontaneously with time and physical therapy. However, the winging sometimes does not completely resolve. Complete or partial resolution can even take up to 6-12 months to occur.

Surgery is of limited value for isolated scapular winging. Options include neurolysis, intercostal nerve transfer, and rarely, scapular fusion (see technology and techniques available section). Surgery may be considered at approximately 3-6 months if symptoms are severe and there is no evidence of muscle contraction clinically or with electrical testing.