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Scapular Winging Test

 Scapular Winging Test

Scapular Winging is a clinical syndrome that is caused by a loss of the normal scapular stability that make the inferior border of scapula moves medially or laterally.

Medial Scapular Winging is seen in:

  1. Serratus anterior muscle weakness.
  2. Long thoracic nerve dysfunction.

While Lateral Scapular Winging is seen in:

  1. Trapezius muscle weakness.
  2. Spinal accessory nerve (CN XI) dysfunction.

The Long thoracic nerve can get directly injured during thoracic surgery (first rib resection, introduction of chest drain etc.) or in case of direct trauma of the chest wall. Indirect injury can happen when the arm is overstretched in elevation. When there is no injury in the history, virus infection may be the reason of the nerve lesion.

See Also: Rotator Cuff of the Shoulder

How would you test for winging of scapula?

While standing, have the patient forward flex their arm to 90 degrees and push against a wall (or other stationary object).

Scapular Winging test
Scapular Winging Test

What does a positive Scapular Winging Test mean?

Related Anatomy

Scapula:

Scapula is a flat bone that spans from the second rib to the seventh rib and serves as an attachment for 17 muscles. It is anteverted on chest wall approximately 30 degrees relative to the body.

Long thoracic Nerve:

Long thoracic Nerve is the first branch of the C5-C6-C7 roots of the Brachial Plexus, it’s the motor nerve to the serratus anterior muscle. It’s 24 cm in length from origin to the serratus anterior muscle, which makes it susceptible to mechanical injury.

See Also: Brachial Plexus Anatomy

Serratus anterior Muscle:

Trapezius Muscle

This muscle traditionally is divided into middle, upper, and lower parts, according to anatomy and function:

  1. The middle part originates from C7 and forms the cervicothoracic part of the muscle.
  2. The lower part, attaching to the apex of the scapular spine, is relatively thin.
  3. The upper part is very thin, and yet it has the most mechanical and clinical importance to the cervical spine.

Scapular Winging Syndrome

This syndrome is characterized by an inability to elevate and/ or lower the arm without the scapula winging or its inferior angle tilting. This syndrome results from a weakness and adaptive shortness of the serratus anterior, with accompanying shortness of the pectoralis minor and scapulohumeral muscles.

Intervention should focus on stretching the pectoralis minor to correct the tilting and serratus anterior for strengthening and retraining.

Reference


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