Winged Scapula | Serratus Anterior | Trigger Point Therapy
Trigger points in the Serratus anterior muscle can cause a variety of symptoms including pain referred across the chest and down the arm. They may also be the cause of scapula dysfunction.
Winged Scapula is a problem that affects a small, but wide-ranging, part of the population
The scapula, or shoulder blade, is the largest bone of the shoulder and has 17 different muscles attached to it.
These muscles both stabilize the arm and allow it to move. The muscles move together like a well-oiled machine but when things go wrong it can be difficult to address and can lead to the scapula “winging".
This is where the shoulder blade sticks out on the back, rather than lying flat against the back of the chest wall.
This gives the scapula a wing-like appearance, hence its name.
Some mild cases may produce no symptoms— there will be no loss of power or control and no pain.
More severe cases may be very painful and there can be significant loss of movement and control over the shoulder.
The scapula, or shoulder blade, is the largest bone of the shoulder and has 17 different muscles attached to it.
Common Causes
The winging can be caused by poor control or imbalance in the muscles, or by injury or dysfunction of the muscles or the nerves that supply the muscles.
It can also be symptomatic of muscle wasting, for example in people with muscular dystrophy.
Poor posture can contribute to or trigger the problem, and overuse of specific muscles can be to blame, for example with weightlifters.
It is a problem that affects a small, but wide-ranging, part of the population.
Common Symptoms
Ultimately it can lead to an inability to lift, pull, or push heavy objects or to perform daily activities such as brushing teeth, combing hair, or carrying things around.
While some people will experience little or no pain, for others the pain will be excruciating.
Treatment
Treatment will vary depending on the underlying cause. One common cause is weakness in the serratus anterior muscle or damage to the long thoracic nerve that supplies the serratus anterior muscle.
The serratus anterior is the muscle underneath the shoulder blade, lying over the top of and between the ribcage at the outside of the body and attaching to the ribs, from the second to the ninth.
The pectoralis minor is another common culprit. The "Pec Minor" is a downward rotator of the scapula and is often associated with glenohumeral dysfunction.
In some cases, where the pec minor is damaged, tight, or as a result of active trigger points, it can inhibit the serratus anterior.
This can lead to impingement syndrome and sometimes winging of the scapula.
Massage
While severe cases of winged scapula may need surgery, a lot of cases will respond well to strengthening exercises and to massage.
If the problem arises suddenly after a trauma or injury then the individual needs to be seen by a medical practitioner prior to any massage treatment being administered.
Less common causes of a winged scapula include loss of trapezius muscle function, this is extremely rare and usually only occurs following radical surgery, for example in removal of a tumor.
If this is the cause of a winged scapula then treatment should only be given by a professional trained therapist under the supervision of the patient’s medical practitioner or surgeon.
When the underlying cause of the winged scapular is overall muscle degeneration with a condition such as muscular dystrophy, then there will be a weakness in all the scapula stabilizers.
In this instance it is important to treat the arms, shoulders, and back on both sides and not just one. The muscles are likely to be tight and smaller owing to the muscle degeneration.
Proceed with Caution
Be careful not to slip off the muscles onto bone as this would be painful, and you may need to alter the area of your own body used to massage to suit the needs of the recipient—so a thumb may be needed in place of an elbow, depending on the size of individual’s muscles.
It is important to work all areas of the scapula so that tension in one area isn’t released at the expense of another.
Another cause of a winged scapular is dislocation of the acromioclavicular joint or a fracture of the outer third of the clavicle.
This would normally follow a specific trauma or injury; it isn’t painful and mainly affects athletes or people whose work requires them to have their hands stretched above their head for a prolonged period of time.
If you are treating an individual with this background it is important to liaise with his or her medical practitioner or physiotherapist before beginning treatment as this would normally involve severe ligament damage.
Dislocation
If there has been a repeated dislocation of the shoulder, for example with a football player, then the winged scapula is secondary to the shoulder dislocation and strengthening exercises under the supervision of a physiotherapist would normally be the treatment of choice.
If this is not successful then surgery may be required.
There are other, more rare, conditions that can result in a winged scapula, but all would follow trauma or injury so clients would be under the supervision of a medical practitioner.
Specific Contraindications
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If there has been a recent trauma to the area that has resulted in the winged scapula, this should be checked by a doctor prior to treatment. If the area is swollen or inflamed, wait until that has fully settled before treatment.
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If there is significant muscle degeneration around the shoulder due to a long-term condition, take extra care not to slip onto the bones when massaging.
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If there is a history of shoulder dislocation with a client, work with his or her physiotherapist.
The above is an edited extract from the NAT Master Course - Healing Massage which provides a detailed overview of more than 40 medical conditions including illustrated step by step massage treatment techniques.
This blog is intended to be used for information purposes only and is not intended to be used for medical diagnosis or treatment or to substitute for a medical diagnosis and/or treatment rendered or prescribed by a physician or competent healthcare professional. This information is designed as educational material, but should not be taken as a recommendation for treatment of any particular person or patient. Always consult your physician if you think you need treatment or if you feel unwell.
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