Is your shoulder blade protruding? (Winged Scapula)

Have you ever noticed that one of your shoulder blades seems to stick out a little more than the other? Sometimes this can cause pain and stiffness when you move your shoulder. Today we are going to talk about this condition called ``winged scapula'' or as doctors call it. It is nothing to be afraid of, once you know about it properly, a lot of things will become clear.

What does this protruding shoulder bone mean? (`Winged Scapula`)

Simply put, the shoulder bone on your back (doctors call it the ``Scapula'') is what we call ``Winged Scapula'' or ``Scapular Winging'' when it sticks out from behind, rather than being flat and attached to your body. Think of it like a bird's wing, with the shoulder bone protruding from behind. This is where the name ``winged'' comes from, because it looks like a wing.

When the shoulder blade is dislocated like this, it can be a little difficult to move the shoulder on that side or lift the arm. You may feel pain, and maybe even feel like your arm is numb. Imagine you're about to lift a weight, and suddenly you feel something inside your shoulder getting stuck. That's what it can be.

The most important thing is, if you feel that one shoulder bone looks different than the other, or if you have shoulder pain, stiffness, or difficulty lifting your arm for more than a week, you should definitely see a doctor . The earlier you recognize it, the easier it is to treat.

Are all dislocations serious? Let's also learn about `(Scapular Dyskinesis)`

Scapular winging is actually a rare condition. Most of the time, we see something a little less pronounced, where the shoulder blade is slightly out of place. Doctors call this Scapular Dyskinesis, which means the shoulder blade is slightly out of place and has some irregularity in its movements.

If you have a condition called `(Scapular Dyskinesis),` your shoulder blade may look slightly different than normal. It doesn't come out all the way when you raise your arm. However, similar to the `(Winged Scapula)` condition, symptoms – such as pain and stiffness – can occur, but they are usually less severe. You may feel a little weak in your shoulder, or you may feel like something is wrong when you raise your arm.

What are the symptoms of this `(Winged Scapula)` condition?

The main thing is that one shoulder bone is protruding more than the other. That's what most people notice first. In addition, you may feel things like:

• Shoulder pain: This is the most common symptom. The pain may also radiate to the neck.
• Shoulder stiffness: It can feel like you've been stuck with a wrench.
• Difficulty raising the arm: Pain may increase, especially when trying to raise the arm above the head, or the arm may not be able to be raised at all. This is called a decrease in ``Range of Motion''.
• Feeling weak: You may feel like your arms are weak and you may feel like you can't lift anything.
• Hearing a noise when shrugging the shoulders: You may hear or feel a "squeaking" sound, or something like something being twisted.
• Feeling like one side of the neck is being pulled: When you raise your arm, you may feel like the neck muscles are being pulled to one side.

If you have one or more of these symptoms, it's a good idea to be concerned.

Why does the shoulder blade protrude like this? What are the causes?

Most often, this ``Winged Scapula`` condition is caused by damage to the muscles that hold your shoulder blade in place or to the nerves that control those muscles .

Think of it like a system that works together. When we raise our arm, lower it, or rotate our shoulder, the muscles involved contract, relax, and help each other. This is something that should be in balance. Now, if a nerve or muscle that controls these muscles is damaged, that balance is lost. Then the muscles can't hold the shoulder blade against the chest and keep it flat.

To give you another simple example: Imagine you're trying to close a cardboard box. You want to fold all four sides of the box together and close them neatly. Now imagine that one side of the box is crushed or broken. Then, even if you try to put one of the four sides back in, it will pop out and come up, right? That's how it is. When one or more of the muscles around the shoulder become weak, the shoulder bone "pops out."

There are several muscles and nerves that can be primarily affected by this condition:

• Serratus Anterior Muscle: This is controlled by the Long Thoracic Nerve. Damage to this nerve is what most commonly causes Winged Scapula.
• Trapezius Muscles: This condition can occur if any of these muscles are damaged, or if the spinal accessory nerve that controls them is damaged.
• Rhomboid Muscles: These are controlled by the Dorsal Scapular Nerve. Other injuries can also cause this.

So, how can these nerves or muscles be damaged?

• Sports accidents: Sports that put a lot of pressure on the shoulders, such as cricket and volleyball.
• Repetitive Strain Injuries: When you continue to do the same type of work, for example, someone who paints or works on the computer in the same way.
• Dislocated Shoulders.
• Accidents: Things like car accidents, falls.
• Side effects of surgery: Sometimes, during breast surgery, especially mastectomies, the nerves involved can be damaged, or it can be a reaction to the anesthesia.

Who is most at risk for this condition?

True scapular winging, which is a condition in which the shoulder blade protrudes significantly due to nerve or muscle damage, usually occurs as a result of an accident. People who have had chest surgery, especially mastectomies, are at higher risk.

However, the condition I mentioned earlier, called ``Scapular Dyskinesis,'' where the shoulder blade is only slightly pulled, can be caused by the following factors:

• Playing sports that put pressure on the shoulders.
• Physically strenuous work.
• Always carrying a heavy bag (school children should be careful about this).
• Slumped Posture, meaning standing as if hunched over.
• One shoulder being much weaker than the other.

How do doctors detect this?

When you go to see a doctor, they will first ask you questions and examine your back. Usually, when you are standing, you can see this ``Winged Scapula'' condition when you compare it to the other shoulder blade.

Tests for `(Winged Scapula)`

The doctor will ask you to perform various movements and check your shoulder's range of motion and strength. The main test to diagnose winged scapula is the wall pushup test .

What happens in this is, you are asked to face a wall and place your palms on the wall. Then, as if doing a ``Pushup`` on the floor, you are asked to move away from the wall with both hands at once. If you have ``Winged Scapula``, when you do this, that protruding shoulder bone will be clearly visible.

In addition, the following tests can be done to check for Scapular Dyskinesis:

• Scapular Assistance Test (SAT): The doctor will ask you to raise your arm straight above your head. As you do so, he or she will gently push under your shoulder blade. If this helps reduce your pain or makes it easier to raise your arm, you may have dyskinesis.
• Scapular Retraction Test (SRT): In this test, the doctor places his or her hand on top of your shoulder and presses your shoulder blade back with his or her forehead. This means that the shoulder blade is pulled back to where it should be. Then, you are asked to extend your arm out to the side. The doctor then applies gentle pressure to your shoulder and arm. If your pain is reduced after you pull your shoulder blade back, or if you feel more strength in your arm, this could also be a sign of dyskinesis.

Imaging tests are not always needed. But sometimes the doctor may need to look inside the shoulder blade or shoulder. They may use things like:

• Shoulder X-ray
• `(MRI)` (Magnetic Resonance Imaging)
• EMG (Electromyography) - This measures the electrical activity of muscles.
• Nerve Conduction Study - This looks at the speed at which messages travel through the nerves.

How is this condition `(Scapular Winging)` treated?

Your doctor will recommend treatment based on the cause. The most common treatments are:

• Pain management: Medications are given to reduce pain and swelling. Most people are given over-the-counter medications called NSAIDs (Non-Steroidal Anti-Inflammatory Drugs). Some people may also be given muscle relaxants.
• Physical Therapy (PT): This is very important. A physical therapist will teach you exercises and stretches to strengthen your shoulder muscles and increase flexibility. While PT cannot correct nerve damage, it can help increase your range of motion and control other symptoms.
• Surgery: Most people do not need surgery. However, if other treatments do not help, if you have severe pain, or if you cannot move your shoulder at all, surgery may be necessary. Surgery is usually considered after an accident. You may need a muscle or nerve graft (a procedure that involves taking healthy tissue and grafting it to the damaged area). Or you may need a procedure called a scapular arthrodesis (joint fusion). Your surgeon will explain to you which surgery is right for you and what to expect.

What happens if left untreated?

If left untreated, winged scapula can put unnecessary pressure on your shoulder and the surrounding tissues. People who don't get treatment are at higher risk of developing a condition called frozen shoulder (adhesive capsulitis).

If ``Winged Scapula`` is caused by nerve damage, there is a possibility of loss of sensation and movement in the relevant muscles. The risk increases the longer it is recognized and treated. That is why it is recommended to see a doctor as soon as possible if you have symptoms.

What can you expect if you have a ``Winged Scapula'' condition?

Many people can manage this condition without surgery. Your doctor and physical therapist will help you find treatments to help manage your symptoms. They will also recommend changes to your work or activities to reduce stress on your shoulder and prevent injury.

How long does `(Scapular Winging)` last?

How long this lasts depends on the cause and whether there is nerve or muscle damage. You may need several months of physical therapy to get your shoulder back in shape and regain range of motion.

Some people, especially those who develop the condition after an accident, may have symptoms for several years. About a quarter of people with winged scapula may still experience some degree of pain after recovery.

Can Scapular Winging be prevented?

This often happens due to unforeseen accidents, so it may not be possible to completely prevent it.

However, it is best to follow these general safety tips to reduce the risk of accidents:

• Always wear your seat belt when riding in a vehicle.
• Wear appropriate safety equipment when playing sports and other activities.
• Keep your home and workplace free of clutter that could pose a hazard.
• Always use a suitable tool when picking up something from above. Do not climb on chairs or tables.
• If you have difficulty walking or are at high risk of falling, use something like a cane.

When should I see a doctor?

If you have shoulder pain, stiffness, or other symptoms for more than a week, see a doctor.

If you are unable to move or use your shoulder, go to a hospital emergency room immediately. If you feel like your shoulder is dislocated, never try to force it back into place. Keep your arm and shoulder as still as possible, support them, and go to a hospital immediately.

What questions should I ask my doctor?

• Why do I have ``Winged Scapula''?
• Do I have nerve or muscle damage?
• What kind of treatment do you suggest?
• How long will I have to do physical therapy?
• Can you tell me what exercises or stretches I can do at home?

So, what do we take home from this?

When you find out you have ``Winged Scapula'', you may remember your childhood dream of flying. But, in reality, you're probably thinking mostly about the pain and stiffness in your shoulder.

Scapular winging is a condition that occurs when the muscles and nerves in your shoulder are unable to properly hold your shoulder blade against your chest. Don't panic. Your doctor will explain what causes it and how to manage symptoms such as pain and difficulty moving. The most important thing is to seek medical attention as soon as possible if you have symptoms. This will help you recover quickly.

` Shoulder dislocation, winged scapula, shoulder pain, scapular dyskinesis, nerve disorders, physical therapy, shoulder exercises