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Scapula alata: Causes, Symptoms & Treatment
Scapula alata, also known as winged scapula, describes a condition where the shoulder blade protrudes from the back. It is usually caused by weakness or paralysis of the muscles stabilising the scapula.
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Scapula alata, also known as winged scapula, describes a condition where the shoulder blade protrudes from the back. It is usually caused by weakness or paralysis of the muscles stabilising the scapula.
What is Scapula alata?
Scapula alata (Latin for “winged scapula”) is a medical condition in which the shoulder blade (scapula) protrudes away from the back, resembling a wing. Normally, the scapula lies flat against the rib cage. When it lifts off, it causes a visible deformity and can significantly impair shoulder movement. The condition may affect one or both sides.
Causes
The most common cause is weakness or paralysis of the muscles that anchor the scapula to the thorax. Key causes include:
- Long thoracic nerve palsy: This nerve supplies the serratus anterior muscle, which holds the scapula against the chest wall. Damage leads to the classic form of winged scapula.
- Accessory nerve palsy: Affects the trapezius muscle, causing a different pattern of winging.
- Muscular diseases (myopathies): Such as muscular dystrophies, in which shoulder muscles progressively weaken.
- Trauma and injuries: Blunt trauma, rib fractures, or surgery may damage the relevant nerves or muscles.
- Inflammatory conditions: Neuralgic amyotrophy (Parsonage-Turner syndrome) can damage the nerves involved.
- Postural imbalances: Muscular imbalances due to poor posture may cause milder, functional winging.
Symptoms
The hallmark sign of scapula alata is the visible protrusion of the shoulder blade from the back. Additional symptoms may include:
- Pain in the shoulder and neck region
- Restricted range of motion, especially when lifting the arm overhead
- Muscle wasting around the shoulder
- Tingling or numbness in the arm (if nerves are affected)
- Fatigue and weakness in the shoulder area during activity
Diagnosis
Diagnosis is primarily clinical. The physician observes the position of the shoulder blade at rest and during movement. A classic test is the wall push-up test: the patient presses both hands against a wall with arms extended – the protruding shoulder blade becomes clearly visible.
Additional diagnostic tools include:
- Electromyography (EMG): To assess muscle and nerve function
- Nerve conduction studies (NCS): To measure nerve conduction velocity
- MRI or ultrasound: To evaluate muscles, tendons, and nerves in detail
- Blood tests: To rule out inflammatory or muscular diseases
Treatment
Treatment depends on the underlying cause and can be conservative or surgical.
Conservative Treatment
- Physiotherapy: Targeted strengthening of the scapula-stabilising muscles (e.g., serratus anterior, trapezius) is the cornerstone of treatment.
- Orthoses: Specialised shoulder braces can help stabilise the scapula and relieve symptoms.
- Pain management: Non-steroidal anti-inflammatory drugs (NSAIDs) or physical therapy to reduce pain.
- Watchful waiting for nerve injuries: Many nerve injuries recover spontaneously over months to years.
Surgical Treatment
If conservative measures fail over an extended period (6–24 months), surgery may be considered:
- Muscle transfer: Repositioning a neighbouring muscle to stabilise the scapula
- Scapulodesis: Surgical fixation of the scapula to the chest wall (rare, reserved for severe cases)
Prognosis
The prognosis depends on the underlying cause. Many patients with traumatic or overuse-related nerve injuries recover fully within 1–2 years. In cases of myopathy or permanent nerve damage, recovery is more limited. Early physiotherapy significantly improves outcomes.
References
- Wiater J.M., Flatow E.L. (1999): Long thoracic nerve injury. In: Clinical Orthopaedics and Related Research, 368, pp. 17–27.
- Panse N., Bhatt J. (2012): Scapular winging – a clinical review. In: Indian Journal of Orthopaedics, 46(4), pp. 358–362.
- Martin R.M., Fish D.E. (2008): Scapular winging: anatomical review, diagnosis, and treatments. In: Current Reviews in Musculoskeletal Medicine, 1(1), pp. 1–11.
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