summary Scapular winging is a dysfunction involving the stabilizing muscles of the scapula resulting in imbalance and abnormal motion of the scapula. Diagnosis is made clinically with the presence of excessive medializing scapular retraction (medial winging) or excessive lateralizing scapular protraction (lateral winging). Treatment is generally observation, physical therapy and activity modification or operative depending on etiology of winging and presence of identifiable neurological lesion. Epidemiology Anatomic location Types of scapular winging login to view 17 more bullets Anatomy Scapulothoracic articulation not a true joint attached to thorax via ligaments at the acromioclavicular (AC) joint suction mechanism created by serratus anterior and subscapularis holds scapula closely to thorax allows scapular movement against the posterior rib cage login to view 1 more bullet Stabilizing muscles scapula serves as attachment site for 17 muscles login to view 1 more bullet serratus anterior login to view 12 more bullets trapezius login to view 9 more bullets rhomboid major and rhomboid minor login to view 4 more bullets levator scapulae login to view 3 more bullets Nerves long thoracic nerve login to view 8 more bullets spinal accessory nerve (cranial nerve XI) login to view 3 more bullets Medial Scapular Winging Pathophysiology deficit in serratus anterior function due to injury to the muscle itself or to the long thoracic nerve mechanical login to view 2 more bullets neurologic login to view 27 more bullets Presentation vague, nonspecific shoulder girdle pain and fatigue login to view 1 more bullet muscle spasms weakness when lifting away from body and overhead activity discomfort sitting against a chair may have neurologic symptoms due to traction on brachial plexus subjective shoulder instability login to view 1 more bullet Evaluation physical examination login to view 9 more bullets diagnostic studies login to view 2 more bullets Treatment nonoperative login to view 11 more bullets operative login to view 54 more bullets Lateral Scapular Winging Pathophysiology deficit in trapezius function due to injury to the spinal accessory nerve (CN XI) neurologic login to view 11 more bullets Presentation similar to medial scapular winging vague, nonspecific shoulder girdle pain and fatigue muscle spasms weakness with overhead activity discomfort sitting against a chair may have neurologic symptoms from traction on the brachial plexus subjective shoulder instability login to view 1 more bullet shoulder impingement login to view 1 more bullet Evaluation physical examination login to view 7 more bullets diagnostic studies login to view 2 more bullets Treatment nonoperative login to view 6 more bullets operative login to view 13 more bullets