The scapula or shoulder blade is one of the 3 bones that make up the shoulder joint. It provides attachment for muscles that connect the upper arm to the body stabilizing the shoulder joint. These muscles act together to move the arm in different directions and hold the scapula in its correct position. When one of the muscles or nerves that supplies the muscles is injured, there is an imbalance in muscular force and the scapula may change position or protrude out giving it a wing-like appearance.
Scapular winging mostly happens when a muscle called the serratus anterior or its nerve, the long thoracic nerve, gets damaged. It can also happen when the shoulder is unstable and dislocates frequently or if the shoulder is painful for some other reason causing you to move it abnormally.
Besides the scapular deformity, one may experience pain, weakness and limited shoulder mobility with difficulty reaching overhead, but these symptoms are often absent and the condition may go untreated.
Your doctor will order nerve conduction studies or an electromyogram to see how much nerve and muscle damage has taken place. These tests can also show how well the nerves and muscles are recovering.
Application of cold packs to the shoulder blade can help reduce the pain. Your doctor will recommend an exercise program that targets the scapular muscles and other shoulder muscles to help correct the imbalance and restore the deformity. The serratus anterior muscle which arises from the side of the ribs and joins the inside of the scapula is strengthened by forward pushing or punching movements. If the position of the scapula is not restored with conservative treatment, surgery is performed to explore the muscles and nerves and decompress areas of nerve entrapment.