Scapula alata
definition
The term scapula alata comes from Latin. Scapula means shoulder blade and Ala means wing. It is the protrusion of one or both shoulder blades from the back of the chest (thorax). The shoulder blade protrudes like a wing, which gives this appearance its name. A scapula alata can be the result of various diseases that can affect muscles, nerves and the skeletal system.
causes
Scapula alata can have various causes. The wing position of the shoulder blades can be particularly noticeable in people who are very slim and at the same time very tall. In this case one speaks of a leptosome habitus. A physique that is very sinewy and thin. At the same time, there is often little cushioning subcutaneous fatty tissue, so that bone misalignments appear much more pronounced.
In addition, the scapula alata can also be the result of various nerve damage. Of the Serratus muscle, also called saw muscle (M. serratus anterior), is one of the most important muscles that the shoulder blade hold in position. The muscle pulls from the ribs to the middle edge of the shoulder blade, pulling it forward to the Rib cage approach. This muscle is made up of the nerve thoracicus longus innervated. If the muscle is injured, it can lead to paralysis, which ultimately protrudes the corresponding shoulder blade. Typical injuries to this nerve are trauma from blows, accidents, overstrain in bodybuilders or overstimulation from wearing a backpack for long periods of time, as the shoulder strap runs under the arm.
The paralysis can also occur idiopathically, which means that no clear cause is known. Other nerves such as the thoracodorsal nerve also innervate the shoulder blade. If this is damaged, the lower tip of the shoulder blade will stick out.
Furthermore, disease of the muscles themselves can also lead to the appearance of winged shoulder blades. Especially the progressive one Muscular dystrophy in the shoulder girdle area can lead to a scapula alata. Due to the increasing shrinkage of the muscles, the shoulder blade is no longer attached to the body and rotates outward so that it protrudes from the chest.
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Who am I?
My name is Carmen Heinz. I am a specialist in orthopedics and trauma surgery in the specialist team of .
The shoulder joint is one of the most complicated joints in the human body.
The treatment of the shoulder (rotator cuff, impingement syndrome, calcified shoulder (tendinosis calcarea, biceps tendon, etc.) therefore requires a lot of experience.
I treat a wide variety of shoulder diseases in a conservative way.
The aim of any therapy is treatment with full recovery without surgery.
Which therapy achieves the best results in the long term can only be determined after looking at all of the information (Examination, X-ray, ultrasound, MRI, etc.) be assessed.
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Which two nerve damages cause a scapula alata?
Scapula alata can occur in the context of various neurological diseases. Common nerve damage that causes the shoulder blade to protrude is damage to the long thoracic nerve and the dorsal scapulae nerve. If the long thoracic nerve fails, the serratus anterior muscle becomes paralyzed with the formation of a scapula alata, especially when the shoulder is raised.
Damage to the dorsal scapulae nerve leads to the loss of the rhomboid major and minor muscles on the same side, and occasionally the levator scapulae muscle. As a result of the nerve damage, the image of a scapula alata also occurs here. At the same time, damage to the accessory nerve can paralyze the trapezius muscle and trigger a scapula alata when the shoulder is spread apart.
Symptoms
The symptoms of an existing scapula alata depend on their extent and also on the cause. The visible sign is the wing-like protruding shoulder blade that protrudes from the body to different degrees depending on the cause. In the case of paralysis of the Serratus muscle occur in addition to the misalignment of the shoulder blade also one Reduced strength, such as Lifting weakness in the same arm up. This creates further restrictions in everyday life and in some sports.
Some patients also report a Feeling of pressure in the shoulder area. Generally the scapula shows alata in most cases no complaints (asymptomatic). However, since it is a malalignment in the skeletal system, it can lead to further problems in the muscles such as Bad posture and Tension.
Scapula alata pain
Pain may well occur with an existing scapula alata, but usually does not occur frequently. Pain can occur if the scapula alata is very pronounced and the chest as a whole is misaligned. In some patients, mobility in the upper body can be reduced. This can also cause further damage to posture.
Furthermore, pain occurs particularly in the context of nerve injuries to the long thoracic nerve, which can be caused by accidents or overload. If certain nerves are pinched because the chest is incorrectly positioned, deficits in the arm and hand can also occur.
Read more on this topic at: Shoulder blade pain
Why is the scapula alata predominantly one-sided?
The classic scapula alata occurs mainly on one side, as it is often based on the failure of a particular nerve. It is the long thoracic nerve, a nerve that supplies the serratus anterior muscle. This muscle is responsible for the fact that the shoulder lifts up when the arms are lifted forward. The nerve and muscle appear on both sides, left and right. Theoretically, both nerves can be damaged at the same time and cause a bilateral scapula alata.
However, one-sided nerve damage with muscle paralysis is more likely and more common. Possible causes of paralysis of this muscle are mechanical stress on the thoracic longus nerve, for example carrying heavy objects on the affected shoulder, such as a handbag.
Diagnosis
The first clue is often the visibly protruding shoulder blade. Find out what is causing the misalignment of one or both of the shoulder blades. Hence the eligible ones Muscles around the shoulder blade be tested for functionality. The verification is based on the measurement of the Nerve conduction velocity. This is the time measurement of the transmission of a nerve impulse. Therefore there is age-dependent normal values. Significantly lower values can be an indication of damage or even paralysis of the nerve. The muscles themselves can also be checked for their function. As part of a Electromyography the electrical muscle activity is measured. Injuries in the area of the flank are often visible and can also damage the nerves. If you suspect a Nerve damage The doctor can also assess the extent by checking the mobility of the shoulder girdle. These include lifting your arm, lifting your shoulders, as well as various Strength exercises.
therapy
When treating a scapula alata, conservative (non-surgical) measures are preferred. These include besides physical therapy also strengthening the muscles and the Electrotherapy. With targeted exercises, the progression of the symptoms should be counteracted. At the same time, by strengthening the muscles, further bad postures should be avoided. In the case of nerve damage or traumatic injuries, electrotherapy can be particularly stressful Serratus muscle have a relaxing effect. In addition, medication can be used to relieve pain and reduce inflammation when pain occurs. In very pronounced cases, an operation can also be performed in which the shoulder blade is fixed to the chest.
Can a scapula alata be trained away?
In the case of a slight scapula alata, which has arisen due to poor posture and is not due to nerve damage or muscle paralysis, physiotherapy exercises can be helpful. The aim is to strengthen muscular weak points and in this way to correct the protruding shoulder blades. Straightening the thoracic spine, strengthening the upper back and targeted training of the serratus anterior muscle are training points that can help to train partially or completely away a scapula alata caused by poor posture.
Exercises
Scapula alata can be reduced by regular practice of various exercises under specific guidance. Affected patients can learn the exercises from physiotherapists or in rehabilitation clinics. The aim of the training is to strengthen the muscles of the shoulder girdle, whereby the shoulder blade remains in the correct position and is pulled closer to the chest again.
The process requires continuous training. Many exercises are carried out with the help of equipment or a Thera-Band. To increase strength endurance, the patient sits upright and has the Thera-Band in front of him at the height of the shoulders.
By pulling and releasing, the elbows are bent at a 90 degree angle to the upper body, the patient strengthens the shoulder muscles and also the arms. Another exercise can be done in a similar manner. To do this, the patient stands upright and pulls the Thera-Band with an outstretched arm. In another exercise, the Thera-Band is fixed near the floor. Now the patient stands to the side and pulls the strap with an oblique movement so that the upper body rotates in the other direction. As a result, the laterally running muscles such as the saw muscles and the back muscles are trained. Further exercises can be pure holding and stretching exercises.
In addition, exercises are carried out on devices in which the arm movement is from top to bottom and thus trains the shoulder and neck muscles. The patient can find out which exercises are individually suitable from a trained physiotherapist or his doctor. Careful and correct execution of the exercises significantly influences the success of the therapy.
Can Surgery Help?
If the cause of the scapula alata is damage to a nerve, for example the long thoracic nerve or the accessory nerve, an operation can help to alleviate the symptoms. In the case of nerve damage, various surgical procedures are possible, such as a nerve transplant or an Eden-Lange operation. If the scapula alata is part of a neurological disease such as muscle dysrtrophy or is caused by poor posture, other treatment methods are indicated.
Prognosis / healing
There are several healing options for treating a scapula alata. The therapy is mainly aimed at the cause of the disease. A slight scapula alata can result from poor posture and can be improved with targeted exercises. If there is nerve damage, the prognosis depends on the extent of the damage. There are conservative and surgical treatment options which, in the best case scenario, can also relieve the symptoms of nerve damage. Muscular dystrophy can also be associated with a scapula alata. This is a serious clinical picture with limited therapy options.
Scapula alata in children
As in adults, a scapula alata can also occur in children. The causes are similar. Often slender children have a distinct protrusion of the shoulder blades for no apparent cause. In many cases this phenomenon regresses with the growth spurt. Muscular dystrophy can also be present in children, in which muscle breakdown causes the shoulder blades to stick out on both sides.
Congenital malformations or poor posture can also lead to the formation of a scapula alata. They are particularly common in school-age children. Regularly carrying a heavy rucksack or school bag puts a lot of strain on the muscles, but also on the nerves. This often results in various bad postures. These can also regress with increasing age. In many cases it makes sense to do specific exercises with the child to reduce or avoid a scapula alata. Parents should also pay attention to the posture and suitable backpacks.
