A winged scapula is almost always a symptom of damaged nerves that control the muscles in your arms, back or neck. The most commonly injured nerve that causes scapular winging is the long thoracic nerve. There are other nerves that when injured can cause scapular winging, including types of muscular dystrophy, but these are less frequently seen. Injury to the long thoracic nerve can be caused by a number of things, including blunt trauma to the nerves that control the muscles in the neck, upper back and shoulder, as well as repetitive movements in athletes or in everyday activities such as digging, washing the car, trimming hedges, etc. Some non-traumatic injuries that could result in scapular winging could be a viral illness, an allergic reaction to medication, exposure to toxins, or certain medical conditions such as muscular dystrophy.
Patients usually feel a burning around the shoulder blade along with muscle weakness and fatigue. This can be highly debilitating in everyday life, particularly with overhead activities. Most patients with a long thoracic nerve palsy do not require surgery. Patients can do physical therapy to strengthen the muscles and help stabilize the scapula. Sometimes a special shirt or brace is used to help keep the scapula compressed to the back. If conservative treatment fails, the recommended surgery is a tendon transfer.
Tendon transfer for scapular winging
If the patient has failed to improve with therapy and has elected to move forward with surgery, the recommended surgery is a split-pectoralis tendon transfer. This surgery is performed by making a small incision near the patient’s armpit, on the arm. Through this incision, the pectoralis tendon is identified. Either a portion of the tendon, or the entire tendon is then taken off the bone. Sutures are placed in the end of the tendon to help guide the tendon while being moved. A second incision is then made near the bottom of the scapula. The tendon and sutures are passed under the arm, and back to the second incision. Here, with the aid of some donor tissue, the tendon is then inserted onto the scapula. The purpose of the tendon transfer is that when contracted, the scapula will remain flat against the back as the arm is moved.
This surgery is done on an outpatient basis, meaning you would come in and go home on the same day of surgery. After surgery, you are placed in a sling for six weeks to allow the tendon to heal in its new location. After six weeks, the sling would be discontinued and physical therapy would begin. Full recovery is typically six months after surgery.
Physical Therapy Protocols
Anthony Romeo, MD
Dr. Anthony Romeo is one of the nation’s leading orthopaedic surgeons specializing in the management and surgical treatment of shoulder and elbow conditions. His state-of-the-art practice employs minimally-invasive arthroscopic techniques to accelerate the recovery process for a range of challenging conditions.