Scapula Winging

Scapula winging
Scapula Winging
Normal scapular positioning

“Shoulders Down!”

You’ll very likely recognize this remark as a dancer or dance teacher. Why is it so difficult to maintain control over your shoulders during daily life and especially during dancing?

You can immediately recognize an experienced dancer by the beautiful back and down shoulder position and the control over the sometimes-subtle shoulder movements. During my college studies of modern dance, I regularly had difficulties with shoulder movement control. How difficult it was for me to keep control of my shoulders became clear to me when I started experiencing a lot of complaints and pain at the front of my shoulder and my collarbone during dance lessons. I wrongly paid too little attention to my complaints at the time. Only when I started to feel stabbing and shooting pain did I start looking for help. Fortunately, I came across an experienced physiotherapist who immediately pointed out my scapula winging. The shoulder blades normally rest quite flat against the rib wall at the back. Scapula winging occurs when the shoulder blade protrudes backward due to muscular imbalances, for example, with possible injuries as a result.

Scapular dyskinesia: the often forgotten culprit of shoulder pain
The incidence of scapular winging is unclear, but most likely it is more common than described. It is sometimes difficult to obtain the diagnosis, because a related and also common complaint of the shoulder and / or neck is sometimes more apparent during a physical examination. Often though, the scapular winging lies at the base of the problem. Therefore, an unrecognized continuous scapular dysfunction can be a reason for a difficult recovery. A diagnosis can be easily achieved through a targeted physical examination and specific provocative manoeuvres. One of these is forward (anterior) elevation of the arm against resistance, with which the protrusion of the scapula becomes more prominent. These tests can also be combined with an electromyographic examination. Rapid diagnosis and recognition of this problem can prevent further shoulder dysfunctions. (Srikumaran et al., 2014)

Correct positioning of your scapula (shoulder blade) is essential to achieve optimal function of the upper limbs. This positioning should be as good as possible in relation to the humerus (upper arm) and the thorax (chest; rib cage). This then ensures optimal and correct positioning of the glenoid fossa*, which can guarantee the mobility and stability of the glenohumeral joint**. The scapulo-humeral rhythm during a shoulder movement is the simultaneous movement of the shoulder blade and the humeral head in the glenohumeral joint. These should move smoothly relative to each other at times in a motion with glenohumeral abduction and scapular upward rotation. So, if your shoulder blade is in a non-optimal position at rest – such as with scapula winging – this causes an abnormal rhythm and can cause all kinds of complaints such as, for example, a subacromial impingement syndrome or shoulder instability. With a changed rhythm one also speaks of scapular dyskinesia. (Nijs, Roussel, Struyf, Mottram, & Meeusen, 2007) (Martin & Fish, 2007)

The muscular system makes the greatest contribution to ensuring a correct scapular position at rest and during movement. If these do not exercise good control over this, this often causes shoulder and neck complaints. In the video below you can find exercises to obtain improved stability and control over the scapulo-humeral joint.

If you experience complaints from scapula winging, seek the help of a medical professional.

Feel free to contact me if you have any questions!

 

*Glenoid fossa: Fossa Glenoidalis. It is an articular part of the shoulder blade, part of the gleno-humeral joint.
**Gleno-humeral joint: Part of the shoulder complex; the joint built between the shoulder blade and the humerus (upper arm).

Martin, R. M., & Fish, D. E. (2007). Scapular winging: Anatomical review, diagnosis, and treatments. Current Reviews in Musculoskeletal Medicine, 1(1), 1-11. doi:10.1007/s12178-007-9000-5
Nijs, J., Roussel, N., Struyf, F., Mottram, S., & Meeusen, R. (2007). Clinical Assessment of Scapular Positioning in Patients with Shoulder Pain: State of the Art. Journal of Manipulative and Physiological Therapeutics, 30(1), 69-75. doi:10.1016/j.jmpt.2006.11.012
Srikumaran, U., Wells, J. H., Freehill, M. T., Tan, E. W., Higgins, L. D., & Warner, J. J. (2014). Scapular Winging: A Great Masquerader of Shoulder Disorders. The Journal of Bone and Joint Surgery-American Volume, 96(14). doi:10.2106/jbjs.m.01031

serratus anterior
m. serratus anterior - bron: KenHub
Scapulahumerale bewegingen

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