Scapular winging associated with neurological causes

Scapular winging, sometimes called a winged scapula, is a disorder of the shoulder in which the shoulder blades are raised out instead of lying flat against the back of the chest wall. This condition causes a drooping shoulder and pain or discomfort in your neck, shoulders, and back, making everyday activities involving lifting the arms, difficult.

What are neurological causes associated with scapular winging?

The shoulder blade is a large triangular-shaped bone that lies in the upper back, with many muscles attached to it, controlled by nerves. The long thoracic nerve runs through the shoulder, but due to its length and superficial position, is susceptible to neuropraxic stretch injury or trauma. Injury to other nerves such as the dorsal scapular nerve and the spinal accessory nerve may also be responsible for scapula winging.

Non-traumatic injuries resulting in scapula winging may include viral illnesses, drug overdose, certain medical conditions, drug allergies or exposure to toxins.

How is scapula winging treated?

Depending on which nerve was damaged, non-surgical treatment will involve braces, slings, medication, light physical therapy and massage therapy.

In cases where non-surgical methods fail to provide relief, or in cases of trauma, you may be advised to undergo surgical repair. The most common treatment of scapular winging is nerve and muscle transfers. This involves the whole, or a part of the nerve or muscle is transferred to the shoulder from another area of the body (most likely the shoulder, back or chest).

In other cases a sling may be used to attach the scapula to the vertebrae or ribs, to pull the scapula back into place. This is known as a static stabilisation.

A scapulothoracic fusion may also be suggested if alternative fail. This is used as a last resort as involves attaching the scapula directly to the ribs, making lifting your arms thereafter no longer possible. Which of these surgeries would be best suited for your case will be decided by your specialised orthopaedic surgeon on an individual basis.