Scapula alata: What is it (How to correct naturally?)

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Article reviewed and approved by Dr. Ibtissama Boukas, physician specializing in family medicine

The term "scapula alata" is used when the muscles of the scapula cannot perform their function of stabilizing the scapula. As a result, the edges of the scapula protrude backwards, resulting in a characteristic deformity resembling an angel's wing.

The main causes of this condition are musculoskeletal and neurological. This can cause limitation of range of motion in the upper limb, loss of strength and functional incapacity during activities of daily living (such as changing clothes or brushing hair).

In this popular article, we will cover everything you need to know about this condition (anatomy, symptoms, diagnosis), as well as suggest treatment approaches related to the scapula alata.

Definition and anatomy

To understand the scapula alata (also called the winged scapula or "Winged Scapula"), it is essential to understand theanatomy of the scapulothoracic region (where the scapula attaches with the rib cage and shoulder complex).

You should know that the scapula is a muscle attachment point of 17 muscles different. This stabilizes the scapula on the chest, in addition to providing strength to the upper limb and synchronizing the movement of the glenohumeral (the joint that moves the shoulder).

Some of the most important muscles that attach to the shoulder blade and help stabilize it include:

  • the serratus
  • the trapeze
  • the rhomboids
  • the levator scapula

These muscles can exercise their function thanks to the innervation of certain nerves, the most important of which are:

Therefore, any malfunction of these muscles or nerves can cause scapula alata. Note that serratus palsy is the most common cause of scapula alata, due to damage to the long thoracic nerve. Be that as it may, a characteristic deformation with a different orientation will be observed depending on the structure affected.


How can the stabilizing nerves and muscles of the scapula be damaged, and lead to a scapula alata? Here are the most common causes:

Traumatic cause

Often related to sport, it can occur following a acute trauma like a fall on the shoulder. This affection can also come from an automobile accident where the arm underwent a sudden pull (more than 50% of cases).

A scapula fracture, although rare, can affect surrounding muscles and nerves, and cause a scapula alata-like deformity.


Personalized repeated movements (in a sports setting or otherwise) can affect the nerves that stabilize the scapula, and cause scapula alata. For example, a tennis player may irritate his long thoracic nerve from repeated serves. Or a schoolboy might irritate his accessory nerve from carrying a heavy backpack.

Post infection

Some infectious conditions can cause scapula alata. We think for example of influenza infections, tonsillitis-bronchitis, poliomyelitis, etc.

Iatrogenic cause

All surgical intervention near the axillary, cervical or shoulder region is at risk of affecting a nerve involved in stabilizing the scapula. Moreover, nearly 10% of patients with scapula alata have had surgery. This pathology could be a complication of one of the following operations:

  • Placement of chest tube
  • Mastectomy following breast cancer
  • Surgery for pneumothorax
  • Thoracic surgery
  • Cervical surgery or biopsy
  • General anesthesia for various procedures
  • Etc


Some dystrophies can cause scapula alata.


Sometimes you don't fully understand the cause.

Symptoms of the disease

The signs and symptoms of scapula alata are as follows:

  • Pain : If the scapula alata is from nerve damage, back pain (or between the shoulder blades) is often intense and even limits sleep.
  • Difficulty lifting the arm above the horizontal.
  • Difficulty carrying objects, especially when it is necessary to move them away from the body.
  • Deformation 'angel wing' type feature at shoulder blade.
  • Scapular dyskinesia
  • Spasms muscle
  • In the presence of nerve damage, paresthesias tingling, numbness, etc.
  • Feeling ofinstability from the shoulder
  • In some cases, a atrophy muscular will be visible.
  • Many patients complain of fatigue and difficulty performing certain daily tasks.


The scapula alata usually results from a clinical diagnosis. The deformity is more or less obvious depending on the lesion and the stage of the injury. Most often, we will notice that the scapula is not anchored at the level of the rib cage, especially when trying to raise the arm to the sky or push against something.

Some clinical tests will determine which anatomical structures have been affected.

For example, a trapezius palsy will manifest as a drooping shoulder and an inability to raise them up. It should be noted that the difference is sometimes subtle, and difficult to objectify. Certain movements (such as shoulder abduction) will accentuate the deformity.

A rhomboid paralysis, meanwhile, will be accompanied by a slight outward translation of the scapula (lateral translation), as well as a lateral rotation of the lower edge of the scapula. It may be more evident during certain movements aimed at the contraction of the rhomboid muscles.

Muscle damage serratus anterior is usually detected by asking the patient to push against the wall with the palm of the affected limb. There is typically a detachment of the medial border of the scapula indicative of serratus palsy (also called palsy of the long thoracic nerve or nerve of Charles Bell).

In addition to clinical tests, the doctor may prescribe electro-diagnostic tests. For example, an EMG will assess nerve conduction, and identify nerves potentially responsible for the scapula alata.

Finally, some testsmedical imaging such as MRI or ultrasound can be used to learn more about the integrity of the nerves and muscles involved in stabilizing the scapula. An x-ray, on the other hand, eliminates the risk of fracture or joint damage.


Unfortunately, no treatment method is considered 100% effective today in correcting scapula alata. The therapeutic objective, especially in the initial phase of the pathology, will be to control pain and maximize function.

This initial treatment is very important to avoid future complications., such as shoulder capsulitis, subacromial impingement, brachial plexus, etc. The treatment is generally long, and can take between 6 months and 2 years to observe significant results. 

Most often, the doctor will immediately prescribe sessions of physiotherapy rehabilitation (physiotherapy). The purposes and processing methods will be as follows:

  • In the initial phase, avoid repetitive movements (especially those in elevation) so as not to aggravate the pain.
  • Personalized medications anti-inflammatories, pain relievers or muscle relaxants may be prescribed to control the pain.
  • In some rare cases, a orthosis aimed at passively stabilizing the scapula against the rib cage will be prescribed. It is generally poorly tolerated, which makes its use difficult for many.
  • An important initial goal is to regain active and passive mobility of the shoulder and neck. Exercises while lying down will reduce the involvement of gravity, making movement much easier.
  • If the scapula alata comes from nerve damage, it will be necessary avoid some stretching initially, as a pulled nerve could aggravate the symptoms and cause disabling symptoms (sharp pain, paresthesias, numbness, tingling, etc.).
  • When the nerve is less fragile, progressive stretches can be integrated in order to avoid muscle contractures.
  • Personalized strengthening and stabilization exercises of the shoulder blade will be essential throughout the process. They will have to be adapted according to the condition and the symptoms. For example, a scapula alata caused by an attack of the rhomboids will have to be compensated by a work of the trapezius (especially the middle portion).
  • Personalized massage treatments can be used to reduce the tensions of certain compensatory muscles (such as the trapezius when the cause comes from the rhomboid or nerve damage).

If conservative treatment does not produce results after 6 months, and the patient continues to complain of daily limitations, some more drastic methods could be considered. An orthopedic doctor can offer you surgical solutions at the moment. These could be:

  • Post-traumatic surgical correction
  • A neurolysis  (e.g. long thoracic nerve)
  • A muscular transfer (for example of the pectoral or rhomboid muscle)
  • A nervous transfer
  • A scapulo-thoracic arthodesis or scapuloplexy

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