Winged scapula issue

Patient

Q: My doctor told me I had winged scapula (right side) 6 months back. He recommended me medicines & exercises which I did regularly. The winging of scapula is no more visible. But now I hear cracking, grinding at my back (near scapula) and feel weakness in my shoulders too. Sometimes, I get sharp pain on twisting or moving my back.

Do you think this is the last stage of my winged scapula treatment? Or Is it something else?

Symptoms:  Back pain
weakness in shoulders
sharp pain
sound when moving/twisting shoulders
stiffness in neck
Doctor

A:   Thank you for writing to us.

Winged scapula is a condition which causes the protrusion of the scapula or the shoulder blade. This can prevent the person from being able to change clothes and lift objects.

The cause of Winged scapula is the paralysis of the Serratus Anterior muscle which is innervated by the long thoracic nerve. The nerve is paralysed by trauma or damage because of unknown causes. Here are a few symptoms of Winged scapula:
Fatigue
Deformity of the back
Muscle weakness around the scapula

I believe that the Serratus Anterior paralysis is causing the other muscles to become weak and the bone and cartilage to grind into each other. The joints are not kept at an optimum distance from each other and hence you can hear this sound.

If the problem does not resolve after some time, you can talk to a Doctor and get operated for the Winged Scapula. The treatment options are:
Physical therapy or massage and stretching.
Sticking the scapula to the back of the ribs surgically.
Innervation of the Serratus Anterior muscle with another nerve.

This should help you. The stiffness in the neck can also be explained by the weakness of the muscles near the Serratus Anterior which use it as an anchor for their movement.

All the best.

Comments / Follow Ups

Patient: Like I said I don't see protruding at my back anymore. But I have started hearing clicking sounds when twisting shoulders.

1)Is this improvement or things are worsening out?
2)Should I continue exercising that my doctor told me for winged scapula or stop it?
3) Can you tell me exercises/stretching exercises for this?
Doctor: Thank you for the follow up.

To test the winging, you need to push a wall with your hand outstretched. This will cause the winging if the nerve or muscle is damaged. If you do not have this winging anymore, then it is definitely an improvement.

If that is the case, then the clicking sounds may be due to adhesions or fibrosis that have occurred in the healing process of the winging of the scapula.

You can continue the exercises given by your Doctor. Along with this, good amount of stretching and massage will help. You can stretch the shoulder in all directions. Search the internet for these stretches. Use warmth and get a massage done by a physiotherapist to release the adhesions and fibrosis.

One exercise I recommend is to go on you elbows and knees.
You should be facing the floor. Ensure that elbows and knees are shoulder width apart. Then, you do a push up where lean forward and reduce the angle of your elbow. This will put strain on the Serratus Anterior. After a while, you can start doing this with one hand and the other hand in the air.

Hope this helps you.

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