A winged scapula (scapula alata) is an orthopedic condition where the shoulder blade protrudes visibly from the back, particularly along its medial border, giving it a “wing-like” appearance. This abnormal positioning disrupts the smooth, coordinated movement of the shoulder complex. It can lead to pain, fatigue, and difficulty performing daily activities involving lifting or pushing. Effective non-surgical solutions, primarily focusing on targeted muscular strengthening, can often correct this issue and restore normal function.
Identifying the Muscular Causes
The visible winging of the scapula is a symptom of an underlying failure in the muscles designed to anchor the shoulder blade flat against the rib cage. The most frequent cause of true medial winging is a weakness or paralysis of the Serratus Anterior muscle. This large, fan-shaped muscle wraps around the rib cage and is responsible for protraction—pulling the scapula forward and holding it securely against the body. When the Serratus Anterior is not functioning correctly, the medial edge of the shoulder blade lifts away from the thoracic wall, making the winging apparent. This dysfunction is most often linked to damage or injury to the Long Thoracic Nerve, which supplies the muscle. The Trapezius muscle, specifically its middle and lower fibers, also plays a significant role in stabilizing the scapula by retracting and depressing it.
Postural Adjustments and Supportive Measures
The first step in addressing a winged scapula is seeking a professional assessment from a physician or physical therapist to determine the precise cause. This is important to rule out severe issues, such as significant nerve damage, which might require more intensive medical intervention. A professional can also accurately diagnose whether the winging is “primary” (due to nerve or muscle failure) or “secondary” (due to another shoulder problem like instability). While strengthening exercises are performed, conscious postural correction throughout the day provides immediate support to the shoulder complex. Avoiding common slumped positions, where the shoulders round forward, helps maintain a better starting position for the scapula. Simple adjustments to a workstation, such as ensuring your computer monitor is at eye level and your chair supports an upright posture, reduce the constant strain that can exacerbate the muscle imbalance. Temporary supportive measures, like kinesiology tape applied by a trained professional, can offer sensory feedback to the muscles. Specialized braces are sometimes recommended, but these aids are primarily for temporary assistance and do not build the necessary muscle strength for long-term correction.
Specific Strengthening and Stabilization Exercises
Fixing a winged scapula requires consistently performing exercises that specifically target the weak Serratus Anterior and Trapezius muscles. These exercises focus on improving both strength and neuromuscular control, teaching the muscles to engage correctly during movement. Consistency is paramount, with a common recommendation being 3 sets of 10 to 15 repetitions daily, or as directed by a physical therapist.
Push-up Plus Variations
The Push-up Plus is highly effective for isolating and strengthening the Serratus Anterior muscle. It is a modified push-up that incorporates an extra “plus” motion at the top of the movement. Begin in a push-up position, either on your knees, on a wall, or on the floor, keeping your elbows locked straight.
From the top position, allow your chest to drop slightly between your shoulder blades without bending your elbows, causing the scapulae to retract or move toward each other. Then, forcefully push your hands away from the floor or wall, rounding your upper back slightly and spreading your shoulder blades as far apart as possible. This protraction phase, where you push past the typical top of a push-up, maximally activates the Serratus Anterior. To safely progress this exercise, start with the Wall Push-up Plus, which minimizes the load, and gradually move to the Knee Push-up Plus, then the full Floor Push-up Plus. Focus on keeping the core engaged to prevent the lower back from arching. The goal is to perform the “plus” motion slowly and with complete control.
Prone Y/T/I Raises
Prone raises target the middle and lower fibers of the Trapezius, which are crucial for scapular retraction and depression. Lie face down on the floor or a treatment table, with your forehead resting on a small towel to maintain a neutral neck position. Keep your arms straight and your thumbs pointing toward the ceiling.
The three variations involve lifting the arms a few inches off the floor by squeezing the shoulder blades together:
- The “T” raise: Extend arms out to the sides to form a ‘T’ shape.
- The “Y” raise: Move arms diagonally forward to form a ‘Y’ shape, engaging the lower Trapezius.
- The “I” raise: Lift arms straight overhead and close to the ears, emphasizing the lower Trapezius.
Execute these movements slowly, avoiding the use of momentum. Ensure that the lower back does not arch excessively; the movement should be generated by squeezing the shoulder blades together and down, not by lifting the chest or shrugging the shoulders toward the ears. Start with no weight and gradually introduce very light dumbbells, such as one to three pounds, once proper form is mastered.
Scapular Wall Slides
Scapular Wall Slides improve the coordinated movement of the scapula and humerus, which is often impaired with winging. Stand with your back against a wall, pressing your lower back and head against the surface. Place your forearms flat against the wall, with your elbows bent at a 90-degree angle, resembling a goalpost.
Slowly slide your arms up the wall, keeping your forearms and the back of your hands in contact with the wall for as long as possible. As you slide up, actively depress your shoulders, preventing them from shrugging toward your ears. This encourages the Serratus Anterior to rotate the scapula upward and hold it flush against the rib cage during overhead motion. Once your arms are fully extended overhead, slowly reverse the motion back to the starting goalpost position, maintaining wall contact.