Winged Scapula
What is Winged Scapula?
Winged scapula is a condition in which the inner border of the shoulder blade protrudes abnormally from the back of the chest wall, resembling a wing. This occurs when the muscles responsible for holding the scapula flat against the rib cage are weakened or paralysed. Without normal scapular control, shoulder movement is impaired. Pain, weakness and functional limitation can result.
The most common cause is palsy of the long thoracic nerve. This nerve is vulnerable to injury through direct trauma, stretch injury, viral illness and surgical procedures in the armpit or chest. Spinal accessory nerve palsy is another important cause. Specialist Hand Therapy is the primary treatment and can achieve excellent recovery in many cases.
What causes Winged Scapula?
- Long thoracic nerve palsy: the most common causing medial winging
- Spinal accessory nerve palsy: lateral winging
- Direct trauma to the nerve: from a blow to the chest, shoulder surgery or axillary dissection
- Stretch injury: from prolonged or awkward shoulder positions, heavy lifting or repetitive overhead work
- Viral neuritis: inflammatory nerve injury following viral illness
- Muscle disorders
Signs & symptoms
- Visible protrusion of the inner border of the shoulder blade, particularly during arm elevation
- Aching and fatigue around the shoulder and shoulder blade during overhead and forward-reaching activities
- Weakness of shoulder elevation: reduced ability to raise the arm above shoulder height
- A feeling of the shoulder being unstable or giving way
How Hand Therapy can help
Ms Razo provides specialist assessment and evidence-based treatment for Winged Scapula. Following a thorough initial assessment, a personalised treatment plan will be developed to address your specific needs and goals.
Targeted exercises to re-educate and progressively strengthen the affected and accessory muscles are the cornerstone of rehabilitation. Ms Razo designs a specific programme matched to the degree of muscle weakness, with meticulous attention all exercises prescribed.
While the primary paralysed muscle recovers, a process that can take months to years, strengthening of compensatory muscles reduces pain and maintains shoulder function. Ms Razo incorporates this alongside the targeted nerve recovery programme.
A custom or off-the-shelf scapular brace or taping technique can provide external support to the shoulder blade during daily activities, reducing pain and improving arm function while nerve recovery progresses. Ms Razo assesses and prescribes the most appropriate support for each patient's presentation.
Long thoracic and spinal accessory nerve palsies recover spontaneously in the majority of cases. Recovery can be slow, often taking months. Ms Razo monitors nerve recovery progression, adapts the rehabilitation programme to the patient's evolving strength and provides education and support throughout the recovery journey.
Frequently asked questions
-
The prognosis depends on the underlying cause and severity of nerve injury. Neuropraxia, where the nerve is stunned but structurally intact, typically recovers fully within 6–12 months. More severe nerve injuries (axonotmesis) take longer, with recovery progressing at approximately 1mm per day from the site of injury.
-
The majority of winged scapula cases are managed non-operatively with specialist rehabilitation. Surgery is considered for cases that have failed adequate Hand Therapy management, where nerve recovery has plateaued.
-
Yes. Scapular taping techniques can provide temporary external support to the shoulder blade, improving arm function and reducing muscle pain during daily activities and rehabilitation. Taping is used as an adjunct to exercise and muscle re-education, not as a standalone treatment. Ms Razo will assess whether taping is appropriate for your presentation and teach you self-application techniques for use at home.
Ready to take
the first step?
Book a consultation with Ms Razo and receive a thorough assessment, precise diagnosis and a personal treatment plan.