Scapular Winging

Question 1

Neurogenic causes of scapular winging

Answer 1

• Serratus anterior
• Trapezius
• Rhomboid

Question 2

Neuromuscular cause of scapular winging

Answer 2

FSH dystrophy

Question 3

Mechanical cause of scapular winging

Answer 3

Congenital

Question 4

How to determine the likely etiology…

Answer 4

1st look at the position of the scapula relative to the midline!

Question 5

Serratus anterior winging

Answer 5

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

Question 6

Trapezius winging

Answer 6

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

Question 7

Trapezius winging etiology

Answer 7

• Not always spinal accessory nerve (motor)!

- May also be due to cervical spinal C3 and C4 (motor and sensory)

Question 8

Rhomboid winging

Answer 8

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

Question 9

What is the main winging you will see at rest?

Answer 9

Serratus anterior

Question 10

If there is a scapular winging due to weakness of __________, then at rest there is medial rotation of the inferior angle of the scapula.

Answer 10

• serratus anterior

- trapezius

Question 11

Rotation of the scapula as in full abduction of the arm is produced by the…

Answer 11

• trapezius

- serratus anterior

Question 12

In trapezius paralysis, the scapula shifts:

Answer 12

down and laterally

Question 13

The lateral displacement of the scapular in a trapezius paralysis is due in part to the unopposed action of the serratus anterior.

Answer 13

TRUE

Question 14

An injury of the long thoracic nerve may be associated with…

Answer 14

winged scapula

Question 15

The most disabling dysfunction in serratus anterior palsy is…

Answer 15

Instability of the scapula due to posterior displacement of the medial border of the scapula during active flexion and abduction