Scapular winging involves one or both shoulder blades sticking out from the back rather than lying flat. It can happen as a result of injury or nerve damage.

The scapula, or shoulder blades, are flat bones that connect the upper arm to the collar bone. When they come out of place, it can cause scapular winging.

Scapular winging is a rare condition that can be painful.


A common cause of scapular winging is nerve damage. It may affect one of three major nerves in the shoulder:

the dorsal scapular nerve, which controls the rhomboid muscles.

the spinal accessory nerve, which controls the trapezius muscle.

the long thoracic nerve, which controls the serratus anterior muscle.

Injuries to these nerves or surrounding muscles can result from:

  • overuse of the shoulder, back, or neck
  • allergic reactions
  • illnesses, such as influenza
  • use of some medications, such as those for muscle dystrophy
  • surgery near the shoulders or ribs, such as a mastectomy or rib resection
  • blunt force trauma to the nerves of the shoulder, neck, or back


The symptoms of scapular winging can depend on the location of the nerve or muscle damage.

The main indication of scapular winging is one shoulder blade sticking out from the back.

The projection of the shoulder blade can make it difficult to sit on chairs with hard backs, wear some clothing, and carry bags with shoulder straps.

Scapular winging can also affect the persons ability to lift their arms over their head or carry heavy items. If there is nerve damage, it can also cause weakness in the arms, shoulders, and neck.

Some other symptoms include:

  • sagging of one or both shoulders
  • pain or discomfort in the shoulders, neck pain, and back pain
  • tiredness


A doctor will begin the diagnostic process by asking some general questions about symptoms.

They will then conduct a physical examination and examine the shoulder blades for signs of winging. During this, they will ask the person to perform some basic shoulder movements to show the range of motion.

If the doctor suspects nerve damage, they may then use a technique called electromyography to record the electrical activity produced by the skeletal muscles. This helps them assess nerve function.


Different causes of scapular winging require different treatments. There are surgical and nonsurgical options.

The variety and suitability of nonsurgical options depend on the type of nerve damage.

If the person has sustained damage to the long thoracic nerve, recovery may require little or no treatment. The doctor may recommend physical therapy and a support device, such as a sling.

In the case of dorsal scapular nerve damage, the doctor will likely suggest physical therapy. They may also recommend muscle relaxants, anti-inflammatory drugs, and pain relief medication.

Traumatic injuries and spinal accessory nerve damage are more likely to require surgery.

A doctor may recommend a nerve and muscle transfer, in which a surgeon transplants healthy muscles and nerves from another part of the body to repair the damage.

Or, they may recommend scapula thoracic fusion, which involves attaching the shoulder blades to the backs of the ribs. This procedure involves more risks than a nerve and muscle transfer.

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