The scapula, or shoulder blade, is a triangular bone that connects the body to the shoulder and arm. It serves as the main attachment point for 17 different muscles, enabling movement and stability of the shoulder. This coordinated action allows the arm to move through a wide range of motion.
When the muscles controlling the scapula are weakened or impaired, the shoulder blade can move abnormally, protruding from the back and resembling a wing. This condition is known as scapula winging.
What is Scapula Winging?
Scapula winging occurs when the inner border (medial border) and bottom tip (inferior angle) of the shoulder blade stick out away from the rib cage. This position affects the normal movement pattern of the scapula during arm motions.
While minor variations in scapular movement are common and not always harmful, significant winging may indicate an underlying problem and can contribute to shoulder pain, weakness and instability in the area.
Causes of a Winged Scapula
A winged scapula often results from a nerve supply disruption to the muscles that stabilise the shoulder blade. The two main types of winged scapula are medial winging and lateral winging.
Medial Scapula Winging
This is caused by damage to the long thoracic nerve, which powers the serratus anterior muscle. The serratus anterior attaches the scapula to the rib cage and keeps it in place during movement.
When this nerve is damaged, due to compression, trauma or neurological conditions, it can cause paralysis of the serratus anterior, resulting in the inner edge of the scapula protruding. Long thoracic nerve palsy is very rare.
Lateral Scapula Winging
This results from injury to the accessory nerve, which supplies the trapezius muscle. The trapezius has three parts which are responsible for rotating, retracting and depressing the scapula.
Accessory nerve injury, caused by compression, trauma or neurological issues, can lead to shoulder droop, altered scapular positioning, and reduced shoulder function. Accessory nerve palsy is also very uncommon, but changes to the normal movement of the shoulder blade can result in pain and dysfunction.
Secondary Scapula Winging
Sometimes scapula winging is a secondary effect of other shoulder problems such as frozen shoulder, arthritis or rotator cuff injuries.
This can occur when pain, stiffness or muscle weakness alters normal shoulder movement patterns, forcing the scapula to compensate. Over time, this abnormal motion can become more pronounced.
Symptoms of a Winged Scapula
People with a winged scapula may experience:
- Shoulder or scapula pain (at rest or during movement).
- Abnormal protrusion of the shoulder blade.
- Reduced range of motion in the shoulder.
- Weakness or loss of strength.
- Changes in shoulder function.
- A feeling of instability in the shoulder.
Physiotherapy Assessment & Treatment
A thorough physiotherapy assessment is essential to identify whether the winging is primary (nerve-related) or secondary (due to another shoulder condition). The physios at Melbourne Sports Physiotherapy in St Kilda, Essendon, Blackburn and Malvern East are experienced with all shoulder injuries and pain.
They can provide an accurate diagnosis which allows for a targeted rehabilitation program designed to restore shoulder strength, improve movement patterns and reduce pain.
Treatment for Primary Scapula Winging
Primary winging caused by long thoracic or accessory nerve palsy often improves over time without surgery. However, physiotherapy plays a key role in maintaining function and preventing further weakness.
Treatment may include:
- Strengthening exercises for surrounding muscles to compensate for weakness.
- Control-focused exercises to restore smooth, coordinated scapular movement.
- Pain management strategies to reduce discomfort during activity.
- Referral to a sports doctor or shoulder specialist if necessary.
Treatment for Secondary Scapula Winging
For secondary winging, physiotherapy aims to treat the root cause, whether that’s muscle imbalance, poor control or joint stiffness.
A customised rehabilitation plan may include:
- Specific strength training for weak scapular muscles.
- Movement retraining to restore proper coordination.
- Taping techniques to support normal scapula movement while strength improves.
- Activity modifications to avoid aggravating the problem.
- A structured home exercise program integrated into daily routines.
Why Early Intervention Matters
Delaying treatment can lead to ongoing pain, reduced mobility and compensation patterns that lead to other injuries. Early physiotherapy can speed up recovery, prevent secondary issues and help you return to normal activities sooner.
At Melbourne Sports Physiotherapy, their focus is not only to get you pain-free quickly but also to help you move better, stay stronger and prevent recurrence. Whether your scapula winging is nerve-related or secondary to another injury, physiotherapists can design a program tailored to your needs and goals.
The team also works closely with remedial massage therapists to address muscle tightness, improve circulation and enhance recovery. If you suspect you have a winged scapula, or want to reduce your risk of it developing, book an appointment with the experienced team by calling for a chat or you can make a booking online.
