Winging Scapula: Physiotherapy Treatment and ExercisesWhat Is a Winging Scapula?

A winging scapula refers to a condition where the shoulder blade (scapula) protrudes abnormally from the back, especially when pushing against resistance. It is often caused by weakness or paralysis of the serratus anterior muscle, which is innervated by the long thoracic nerve. Less commonly, it may be due to trapezius or rhomboid muscle dysfunction.

Causes of Scapular Winging

  • Nerve damage (e.g., long thoracic, spinal accessory, dorsal scapular nerve)
  • Muscle weakness or atrophy (serratus anterior, trapezius, rhomboids)
  • Trauma or repetitive strain
  • Post-surgical complications (e.g., after lymph node dissection or mastectomy)
  • Neurological disorders

Symptoms

  • Visible protrusion of the shoulder blade
  • Shoulder or neck pain
  • Limited shoulder movement
  • Difficulty lifting objects or doing overhead activities

Physiotherapy Treatment Goals

Strengthen stabilizing muscles

Restore normal scapular movement

Improve posture and function

Reduce pain and discomfor

tPrevent further nerve/muscle injury

Key Physiotherapy Interventions

1. Muscle StrengtheningFocus on muscles involved in scapular stability:

Serratus anterior

Trapezius (upper, middle, lower fibers)

Rhomboids

Levator scapulae

2. Stretching and Mobility Exercises

Improve shoulder joint range of motion (ROM)

Stretch tight opposing muscles like the pectoralis minor

3. Neuromuscular Re-education

Promote proper movement patterns

Use of biofeedback, mirror therapy, or tactile cues

4. Postural Training

Emphasize scapular positioning and spinal alignment

5. Electrical Stimulation (if needed)

Used to stimulate weak or paralyzed muscles, especially early in rehab

Top Exercises for Winging Scapula

1. Wall Slides

Targets: Serratus anterior

How:

Stand with your back and arms against the wall

Slide arms up overhead like a snow angel

Focus on keeping shoulder blades flat

Reps: 2 sets of 10–15

2. Scapular Push-Ups (Wall or Floor)

Targets: Serratus anterior, shoulder stabilizers

How:

Start in a push-up position

Without bending elbows, squeeze shoulder blades together then push them apart

Progression: 

Begin against a wall → knees → toes

Reps: 2 sets of 10

3. Prone Y and T Raises

Targets: Trapezius (middle/lower fibers)

How:

Lie face down on a mat or bench

Raise arms in a “Y” or “T” shape while squeezing shoulder blades together

Keep thumbs pointing up

Reps: 3 sets of 8–12

4. Serratus Punches

Targets: Serratus anterior

How:

Lie on your back with a light dumbbell in one handPunch straight up toward the ceiling by protracting your shoulder

Don’t lift your shoulder off the floor

Reps: 2–3 sets of 12

5. Resistance Band Rows

Targets: Rhomboids, middle trapezius

How:

Anchor a resistance band

Pull it toward your body, squeezing shoulder blades together

Keep elbows close to sides

Reps: 3 sets of 10–15

Precautions

Always consult a physical therapist before starting exercisesAvoid overhead lifts or heavy weights early in rehabPain or worsening winging may indicate a need for reevaluation

When to See a Specialist

If scapular winging doesn't improve with conservative treatment over time, or if there's significant nerve injury, you may need:

Electromyography (EMG)Imaging (MRI or ultrasound)Referral to an orthopedic or neurology specialistConclusionWinging scapula can significantly affect shoulder function, but with a structured physiotherapy program, including targeted exercises for scapular stabilization, most patients see improvement. Early intervention, regular progress checks, and tailored exercise selection are key to successful recovery.