Thank you for not just stating "do these 3 exercises and you will be fine" as many others do. They often assume you have a weak serratus, whilst you clearly show that there can be multiple causes (and the animations make it easy to spot yours).
Sir, a brilliant video, very informative, superb. Perhaps you could consider using a clip of a real human to demonstrate the different aspects of winging as this would really contectualise your excellent video; just a thought. Shalom.
Thanks so much! I'd really like to show real life examples which is far more informative and interesting. However, here in the UK it's very difficult to adequately consent patients and meet various regulatory requirements for these types of videos, so I just avoid it altogether. Bw Simon
@@DrSimonFreilichHello Dr. By any chance do you diagnose people with scapular winging by just looking at his picture? I am curious to know the condition of my brother since no local doctors around could actually identify his condition. And I do think that it might be scapular winging. Thanks and I hope you recognize my question. 💗
Thanks for the question. Unfortunately I can't give you specific exercises as, being on the Medical side of health care, it's not something I have expertise on. In general though, in this scenario, it's about strengthening compensatory movements and muscles and simultaneously not overusing them either, which is quite a challenging balance act. Bw Simon
This is indeed, wonderful information. Dr, I’ve had this pain for 15 years now and my frustration has begun to turn into depression. I’ve tried every stretch, every exercise, every medication including opiates, witch make you feel good, but do nothing to stop the pain. I’m a roofer by trade and it would be very difficult to step away from working long enough to let it try and heal. I’ve always assumed that by this point so many years later, healing isn’t something that’s even possible. I pretty much try to overcome the pain by simply focusing on ignoring it. But as I said, it’s getting harder to deal with mentally. Every minute of every day I live with words “it hurts”. Thanks for posting the info ! .......sending love from Memphis Tennessee USA
My goodness that does not seem good for you. I have been very disappointed as the strong tramadol that I have for my chronic lower back problem do nothing at all to take away the pain for my winged scapula. Have you managed to find any relief as yet.?
Try to find a good PT if you can, but if you can’t, there are great exercise experts and PTs on RUclips. Look at squat university, saturnomovement, or fitnessfaqs.
The three most important scapular stabilizers: 0:36 Serratus anterior (long thoracic nerve) Trapezius (spinal accessory nerve) Rhomboids (dorsal scapular nerve) STR If one muscle becomes weak due to nerve injury, the opposite muscles will contract to compensate that. Different rotational patterns: *Weak serratus* 1:34 •Traction against the chest wall (becomes obvious at rest). •The rhomboids and trapezius pull the scapula inwards. •The trapezius pulls the shoulder blade upwards. •In general terms, the whole bone (scapula) will move towards the midline and upwards (when stretching the arm forward, the winging becomes very evident). *Weak trapezius* 2:04 •The scapula drops downwards. •The winging is not very evident at rest. •The strong serratus pulls the scapula outwards and the rhomboids will rotate the bottom part of the scapula inwards (best appreciated when looking at the upper pole of the trapezius, which rotates outwards and downwards and magnifies with arm abduction. 2:11 •Winging may be reduced in forward flexion, pulling the serratus towards the chest wall. 2:27 *Weak rhomboids* 2:35 •The serratus pulls the scapula outwards and around the chest on opposed. •The trapezius will pull and rotate the scapula outwards. •The winging can be accentuated by drawing the shoulder blades in or by pushing the elbows backwards against an external force (asking a person to hold your elbows from your back and push against their hands). 2:54
TY. This was incredibly helpful in the search for a diagnosis for my ancient injury and the battle it has been to still need an MRI on this area of my left scapula. I have had a few muscle tears in this region on my left side, once on my right side but the significant damage that has been there for 20 years is on the left. I have had serious muscle tears and rehabbed them before, and this feels like when it recurs a rib is flopping around which is why I have long suspected a significant serratus tear and just as likely, detachment.
I don't know what to do. My doctor told me 10 years ago that my scapular winging would heal by itself. Well, that hasn't happened. I still have it. My right side is the issue. My right trap & neck are sore. I hope there is something I can do. It definitely wings out.
Thank you for explaining this!!!! I had this 23 years ago. Healed it but my right shoulder has been dropped (lower than the left shoulder) since. It just came back with a vengeance and feels like a horrible, pinched nerve OMG it hurts!!!
The unfortunate reality is that these don't heal quickly, but with time, most do significantly improve. Physiotherapy will not cure it or enhance the healing process but would still confer short and medium term benefits in terms of best utilising the other surrounding muscles. Wishing you all the very best with it! Simon
Hi, thanks for your question. To be clear that's not what I said at all. Physiotherapy is very important but it won't cure actual nerve lesions. That's for the nerve repair mechanisms to do. Physiotherapy is there to support healing by best utilising whats left and to prevent secondary damage by preventing stress on the other muscles. Hope that clarifies things and wishing you all the very best. Simon
Dr Simon Freilich Thanks a lot! I guess that means physiotherapy could be very efficient , if the winging is caused by bad posture etc and not nerve damage.
I have this really sharp pain when breathing and doing lifting around the back of the shoulder blade above and below, I had physio but nothing much happend, it's a month now and seems to be getting worse, the knots in my back are crazy, great video, really dove into it with depth n knowledge, must of been the gym when I trained shoulders few weeks back x
Hi, there's nerve damage related muscle weakness that leads to winging, and that is rare. There's also a different entity called scapular dyskinesia, where the scapular does wing but it's not from true muscle weakness, rather an imbalance and desychronisation in how the brain recruits the shoulder muscles to activate. It's not common but not rare either. Tends to affect gym bunnies, and you'll see a lot of YT content that probably relates to that. Bw Simon
This is an excellent video. I've had problems with my rhomboids for months and months after doingof the some pull ups. Initially I suspected a complete detachment of the rhomboids as I felt like I just couldn't "feel" my rhomboids and couldn't contract them. This spontaneously went away when I was doing some foam rolling and stretching one day which led me to believe it was a trapped nerve (literally went from lots of pain and dysfunction to no pain and dysfunction in a couple of minutes). A couple of weeks later I had a spasm and the all pain and dysfunction came back. I've since had an EMG done and it showed a problem at the rhomboid (but not the levator which shares the same nerve about 50% of the time). My doctor was stumped and doesn't seem to know what to do. I've had a thought since: My pec minors are incredibly tight and could be pulling my scapula up and forward via the connection to the coracoid; by proxy this would stretch and weaken the rhomboids quite a bit. Can a weakened muscle (like in the pec minor scenario) show a problem on an EMG or are problems on EMG strictly for muscle tears and nerve damage?
Thanks for the great questions and feedback. First;y, I'm impressed with your weight lifting - those weights look tremendously heavy. Which leads me on to saying that you may well be right about nerve pinching. A lot of the scapular winging videos on RUclips relate to bodybuilders and those doing extreme exercise. This can lead to both significant stress on the nerves and muscles, such as when I see you doing a 'clean and jerk' (hope that's the correct term) as well as imbalances when particular muscle groups are focused on for development. So there can be a combination of both acute and chronic injuries to both muscles and nerves from any and all these kinds of activities (not necessarily just from the pull ups you mentioned). EMG (whilst a great tool) can only pick up diseased muscle and even then only looks at certain fibre types. It wouldn't be able to determine whether a muscle is tight or over stretching. Good luck and best wishes! Simon
Thanks for the reply, doc! But I'm wondering - in terms of the EMG result - If an EMG shows a problem in a muscle it could be: Nerve Entrapment, Nerve Lesion or Muscle Tear?
Indeed! Basically, EMG of any 1 muscle can be one of 4 things: Normal, Neurogenic, Myopathic, Mixture of the two. To determine the cause, a combination of the clinical aspects and other muscle / nerve tests have to be combined. Very best wishes, Simon
I have the same problem with my rhomboids I couldn’t feel them and they don’t work at all . Including while I do barbell rows , pull-ups and even when doing a front raise my scapula either pops out causing abnormal scapular motion and don’t work at all . Did an MRI , no problem apart from supraspinatus tendinitis . Normal cervical scan with no radiculopathy . The doctor dosent seems to get what the problem is still I don’t feel my rhomboids and they don’t at all creating this muscular imbalance . My serrated have adequate strength so does my trapezius and lats. So how do I manage the problem . Time span has been more than a year . All imagings are Normal x rays , CT and MRI .
Man I’m devastated, trained Saturday night and woke up Sunday unable to activate my serratus! Been nearly two weeks of 0 Activation, the trap pain sucks, this injury sucks
Hi Zafar - there are two very distinct groups of 'wingers' to consider. There's the type that I'm primarily addressing here where there is actual nerve damage. Strengthening exercises won't actually fix that damage - nature will - depending on extent. But physio guidance (very specific to individual circumstances) will help improve strength in the residual muscle fibers and can help redistribute weight and movements through the surrounding muscles. There's another group - that relates more to the mechanics of the shoulder, and primarily seems to affect people who work out / gym users. The nerves (and muscle tissues) are healthy but due to a variety of other causes the shoulder becomes dyskinetic. Physio's are again the way forward but the specifics are again very individualised. I.d suggest you see one to get the right exercises. Bw Simon
One more question is scapula winging also able to occur without a nerve damaged like my scapula winging was so bad but as I stared to exercise my seratus anterior it got better and then I saw your vid and started doing exercises for all stabilizing muscles does that mean my nerve is not damaged btw my wing was sticking out like so much now its alot better but if you awnswer it want you to awnswer this is well my parents think my scapula winging will be fixed automatically because I'm 15 growing that's the cause and they also said it's caused by the way i sleep is that any way correct thank you.
Hello Dr Freilich! I have scapular winging with both scapulars, was born with it. I am currently seeing a neurologist but after various tests there is still no diagnosis. I will be in France May ‘23 and was hoping you would see me. Hope to hear from you!
Hi Scott, I'm not sure what to say, but some people are just born that way and I don't think the answer will be revealed by Neurophysiology tests. Bw Simon
Dr. Freilich, can you pls elaborate on 3:38 to 3:51 statement? I have chronic pain in rhomboid and shoulder after shoulder surgery 8 months ago. Thx for the informative video.
My heart sank when I learned that it may take one to two years to heal. I am now into my fifth week of pain on my right rhomboid area. I suspect it had to do with my recent pulling of heavy trolleys using my right arm. I am doing a couple of back rounding exercises daily now. Not sure if I should go to a doctor. I noted that the pain can also be felt somewhere at front right chest near the top. Can the back right shoulder pain give rise to pain at the front too?
@@auctionking4255 After suffering from the pain for two months, my friend dragged me to go see a GP. She didn't even bother to see or examine. Wanted to earn my money by asking me to do a blood test as part of getting old check up. Anyway, she prescribed me with two types of painkillers (non steroidal type) and a gel called fastnum. Also said no need to see a physiotherapist. It is now two and a half months. Medication has finished. I stopped the gel as the instructions said not to use for more than 10 days. I have been doing my stretching exercises which are mainly involving rounding the back kind of muscles and expanding the back kind of exercises. I have also went to the gym like once a week. I do very light weights with a big focus on triceps pull down the the upper back a bit rounded. So far my pain has gone from maybe an 8 to a four
Hi doctor, it seems like i have romboids or trapezius weakness.I tried some exercise from internet like scapular push ups but i felt like my scapula is moving to my shoulder and my scapula is rubing against my ribs.Thanks for this video.
Appreciate the video, I have been suffering with scapula winging but only slightly and all the other RUclips clips An google pages I looked at pointed more at the serratus anterior being weak instead of my rhomboids. This made so much more sense as I don’t have a huge winging unless I do a back pose then you can see my scapula shifting out and right. Thanks again now I know what muscle to focus on for my stretches An exercises!
Hi Dr. Freilich. How long does it take to completely heal winged scapula and can you recommend some exercises to lessen the time of fixing this winged scapula.
Hi Jhon, I can't answer either question. The first will depend on the cause, severity and time since onset and I can't do that online. The second is outside of my expertise as I am not a physiotherapist. Wishing you a speedy recovery, Simon.
In my case was the shoulder internal rotation that was inhibiting the serratus anterior. I'm doing PT for levator scapulae, pec minor, pec major and rotator cuff exercises and now it's going back to the rib cage.
I feel a sharp stinging pain on the bottom of my left shoulder blade. When I bend over, the pain activates. If I endure the pain, I eventually feel a popping sensation in that area. Is this scapular winging?
The video was great it perfectly represents my current problem. Was deadlifting and injured myself. The treatment length of time it may take is what’s scary. Is there any faster remedy/treatment or which do you consider the fasted way to regain balance?
Good morning dr. I have a scenario for you. The person early twenties, pushing a heavy object with his head a neck relaxed with arms slightly bent. Upon pushing this heavy object the right scapula Wing out in hyper-extended causing three distinct snaps that gave this person and incredible amount of pain. They could not lift or perform regular arm functions shoulder height and above and shoulder-width out. what could the long-term consequences be if not properly treated? Some of the symptoms is person has been experiencing in the decade since it occurred are, increase tension and inflammation throughout the muscles grouping around the scapula. Radiating up and down and out from the spine. Increasing during the day's work. When the injury occurred no movement from the shoulder width out or above shoulder height could be performed without extreme pain and discomfort. Which muscle groups could have caused the rubber band effect as a scapular hyper-extended?
Hi Lary, you or your friend is going to need to see an orthopaedic shoulder surgeon to get this type of advice, but decades long symptoms aren't going to self resolve. Bw Simon
Hey Doc, personal trainer here. My right scap flares a bit more than the left, and when I pull in with my serratus it moves outward. This, along with visibly greater hypertrophy of my left rhomboid, makes me believe the right rhomboid is weak. Big on bodybuilding so I could’ve done this with poor repetitive form. Thoughts?
Hello Dr. Simon, I'd like to ask, if can I be born without rhomboid major. I know, that I have rhomboid minor, I can active that and I feel it when I touch there by other hand. But under r. minor I can't touch any other muscle on medial border of the scapula. Also I can touch the other end of muscle on the spine at neck vertebrate but under that are no other tendons, where should be r. majors. When I cannot active rhomboids major I've got winged scapula mostly visible when I bend my body forward and I put my elbows out from body and try to put them higher - on level of rib cage. It makes me really hard to do that, because I do this movement mostly by trapezius and r. minor. And by the way I haven't any injury in those location neither the nerves, that are coneccted there. And I should write too I have this problem from always(by childhood). Thank you for any answer. Dan, 16 y.o.
Hi Dan, thanks for the really interesting question. Anything is possible when it comes to congenital absence of bones and muscles but it would also be important to know whether there are any bone abnormalities of the scapula as well. I haven't personally come across anything like this, and I suspect that it would need to be checked out by a local Orthopedic shoulder doctor. Bw and Happy New Year, Simon
Dan Jaluvka dan if you are concerned that you have a detached rhomboid, you need to research / contact Dr Ben Kibler at the lexington clinic in lexington KY, he invented the surgery to repair muscle detachment from the scapula and he can help you
Hello Doctor. May I trouble you for some advice please. Could a grade 3 subluxation of an AC joint cause a winged Scapula? Many thanks for your time. Regards, James
Hi James, a complex one to answer as it depends on what's being described as winging, and what else may have been damaged as part of the mechanism of injury. Youll have to enquire with your orthopaedic shoulder specialist. Wishing you a speedy recovery! Simon
If I have medial winging in one arm, is the only non-surgical treatment to strengthen the serratus anterior and stretch the pec minor? Also if I can completely raise the arm with winging and there's no pain, does that mean that there isn't any nerve damage and that it's just muscular?
@@asemyamak3984 Chill dude, its been a week haha, probably going to take 2 months, i would recommend training all parts illustrated in the video for best stabilization of the shoulder blade.
Appreciate you taking the time to make this. I have been in scapular/shoulder pain for years. 31yo white male. I have yet to have a doctor or physical therapist or chiropractor provide a long-term solution. I think I'll look into this nerve grafting thing at the end. Have any friends in Kansas you'd recommend?
I have a bulged disk at C6/7 and my right arm is very painful. About 3 days into having this issue I noticed my shoulder blade is now “Winging” quite dramatically. Could the compressed nerve be the cause?
Hi, I dont know and can't really give an opinion. Would suggest you see a local doctor asap for further investigation and treatment as there are a variety of causes that could include brachial neuritis. Bw Simon
I am suffering from winging scapula, from childhood now I am 20 now understand,,, because I work with left hand my right hand winging scapula the biggest thing is my turn Bangladesh. If there is a solution please give??
Hi Michael, that's a chat with your GP/Family doctor first. The questions to be addressed are how significant is it and does it affect your function. If yes, then a chat with orthopaedics and or physiotherapists. But realistically, nerve tests ?30-40 years later don't tend to be particularly helpful and surgical interventions are significant and have risks. Bw Simon
Thank you for very informative video. I have access to a boxing club. Would punching a punch bag or pads develop the serratus also? Or has to be specific exercises? Thanks again.
Hi, whilst I am not a physio and can't generally advise on specific exercises, if you have winging due to SA weakness, I doubt that boxing would be a good idea. The reason being that fully extending your arm at force into a bag would only lift the scapula even more off the ribs and stress the other muscles trying to keep it in place. It could perhaps tear what's left of the SA muscles too. But I do understand the rationale of the movement. Perhaps someone else with specific knowledge could comment below and I'd be happy to be corrected if I'm wrong? Bw Simon
@@DrSimonFreilich Im surprised holding the body in a certain position such as hunched over while sitting doesn't make one muscle stronger than the other or possibly one inactive. Anyway thanks for replying
Do you know ant exercise (without weight) that I can use to strengthen my trapezius muscle? If you do this would be VERY helpful and I would really appreciate it
Like when holding onto a pullup bar with straight arms try to bring Ur 2 shoulders as close together as possible , so in a way a pull up without use of lats
My shoulder blade hurts or I'm not sure if it is the shoulder blade but I feel pain near it and it hurts when i move my torso and my arm and sometimes the pain decreases and sometimes it increases plz read this and is there a way to relieve the pain
Hi Dr Freilich, I am from the UK, but live and work in Rotterdam. I have had scapular winging on my right hand side for 10 months now, possibly caused by open heart surgery I had. Is it possible to ask the medical profession for the kind of specific diagnosis you mentioned in your video, i.e. to specifically determine which nerve is responsible?
My shoulder blades never used to look like this, that was until almost ten years ago I worked in a meat packing warehouse. I was constantly lifting heavy weight all day. At the time, I noticed a burning pain in my shoulder blade area. Now my left shoulder blade sticks out like this, and I always have pain it that area, along with a stinging/burning pain. Any suggestions? I do have an appointment coming up with my MD in a couple weeks.
Thanks, to be honest, I really don't think it's a significant cause. When you consider the number of big muscles surrounding the scapula, especially at the lower portion. The tensile force required to pull the scapula up against their keeping it down, would be beyond the scope of comprehension, unless one had a very unusual exercise plan! I know there are quite a few other videos that promote that kind of theory but the physics doesn't add up. Unfortunately, winging is usually caused by a weakened muscle, with the remaining ones pulling the scapular in their direction, unopposed. Sometimes there are other mechanical issues, but not so common. Hope this helps and best wishes, Simon.
It does. I have shoulder issues, rounded shoulders along with cracking going on at the bottom of my ribs in the back area. Plus, my quadratus lumborum muscles are very tight as well. Thinking this may all come down to my serratus muscles being weak. All of this is surrounded by a decent amount of superficial muscle mass, I've been training for about 7 years now. Those problems arrived about 3 years ago. If you have any other thought, let me know. Thank you for your reply Simon!
Thank you for this video. I have been dealing with this symptomatically for more than 20 years. I am trying PT again and finally understand that, while there is likely damage to my long thoracic nerve, PT is not looking to fix my LTN but trying to do what we can to stabilize my shoulder blade, reduce pain and improve function. I have "failed" PT multiiple times because I didn't understand their approach and would get frustrated when increased pain caused me to miss work. This time we are going to go very slow and having a clearer understand of what we are trying to accomplish (I wish I would have seen your video earlie!) will help me dig deeper and focus on the long term goal. It may or may not work - but I am going to try! One question - how do you determine what muscle is weak? My shoulder blade is hiked up (my levator is working overtime) and pulled out. We are working on my serratus and it feels like that muscle has not been used much in years. But that doesn't seem to fit with how my shoulder blade is sitting. It should be pulled in toward the spine if the serratus was weak? I am confused and hoping you can explain. Thank you.
Anytime you are working the serratus you must focus on the pec minor aswell as it has an almost identical function and if your serratus is weak your pec minor will be working hard to compensate and as such the higher resting tone of your pec minor will result in a downward roation of the scapula
Hi Simon, I have this condition. I believe from parsonage Turner syndrome. I am struggling to get anywhere with the nhs in terms of fixing my problem. Could you give me some advice on how to get it sorted. I also have a raised diaphragm which can be caused by phrenic nerve damage, I believe the 2 conditions are linked. Are there any specialist I can get a consultation with privately?
Hi Marc, yes phrenic nerve involvement can definitely be part of Parsonage Turner. If you're willing to come to London then Prof Mike Polkey is probably the best person to see, particularly because of the diaphragm involvement (he's an international expert). He can bring in other specialists too, as necessary /required. Bw Simon
Will massaging the scapula and sorrounding muscles help? I have seen some videos that instruct not to get massage as it relaxes the muscles and to treat winging we actually need to stiffen the muscles. Is that true ?
Hello doctor I got a winged scapula at the time I reached maturity stage I inherited it. my dad also had such problem.is it possible if I practice some exercise for unwinging scapula it works. thanks
Hi dr simon thank you for your video i have found it very informative. i have had winged scapula for about two years now, well it is two years since i noticed the appearance of it. i felt my shoulder to be weak but did not have any unbearable pain until i crashed my car in November. I suffered whiplash from the crash and after a clear mri and xray of my neck i was advised to do physio therapy, which i did. The Pain seemed to be travelling from my nape of neck right down along my shoulder blade tingling in my fingers and arm . My physio also performed electro acupuncture on the area . Since then i am having worse pain and spasms and the pain is in my rib cage scapula and shoulder and tingling sensations and weakness in my hand my physio is not happy with my progress and has suggested further investigation and maybe surgery. I should mention I am a professional guitarist and singer . I stopped playing the guitar to rest these last while but now finding singing terribly Uncomfortable as i cant seem to breathe deep and expand my rib cage . my winging is quite severe and prominent and i have very very prominent ribs. is rib pain common with winged scapula ? i am currently waiting to be seen by orthopedics as i have never had an mri of the thoracic spine. Thank you for your time
Hi Stephen, sorry for the delay in getting back to you. I don't really know much about electro-acupuncture so it's difficult for me to comment on that. In terms of rib cage pain - I've come across quite a few patients with fairly diffuse discomfort in the region. It's quite logical given the extensive muscle attachments to the ribs that can be affected either directly or indirectly with winged scapulae. Good luck with the Orthopaedics. Bw Simon.
Sir my right arm lift more then lrft and its ancomfertable for me my both shoulder are rounded but right is too far also scapula ringing can u plzz tell me how too fixx it in easy way
Dr, this is marvelous. This will help in my recuperation, thank you so much. I must ask, though: Occassionally, the pinkie from my right side will hurt when I hold it at shoulder level, palm facing up and right arm extended to the right (at should level). I feel pain in my elbow pit, more specifically on a tendon (?) connected to my pinkie. The pain extends all the way to behing my right ear, goign through my shoulder, around my right scapula, rising along the neck (I guess the trapesiuz following allong... I must've had really bad posture). Is this a dirrect consequence, or a different issue? I had acute, unilateral reactive tendinitis at 17, so that must have affected me someway(yes, on my right side).
Well explained And Very informative Sir. If patient present after Cervical Biopsy with Shoulder pain and Sensory loss above Shoulder and weakness of Shoulder ER and Abduction plus Scapular Winging what could be the cause. What to order in Electro physiology Testing? Thank you.
If you have scapular winging, does it usually constantly stay out or can you push I️t out? I’m just a kid and only can push it out. It would be really helpful if you can reply to this comment.
Swiss Reign Hi, I'm not sure what you mean by 'pushing it out' Scapular winging is unusual in kids and if you haven't already seen a doctor locally to look at it, I can only suggest that you do. Bw Simon
I have long thoracic nerve damage will I be able to heal it quick with exercise or I have to wait for nerve to heal which will take 2 years which I don't want.
Hi, I'm not sure. Perhaps at an extreme of it with tendon rupture or if the pain is so severe that there is functional impairment, but not generally. Bw Simon
Sir, I'm suffering from pseud scapula winging (left side) .It is noticed after gym workout for 2 months. After noticing the winging I stopped gym workouts. Consulted an ortho, but he suggested ncv and emg..... He said my serratus anterior may be weak. He also suggested to consult a neuro surgeon. After consultation he told there is no muscle weakness. There is only a small winging.... But when I do some job, means something like lifting or even pushups I am feeling pain.... So what should I do...... If possible can you give ur wtsupp num.... Or any contact detailssss
Thanks Syeda for all your lovely comments. As with any operation there are potential risks and complications as a result of Anaesthesia and the Operation itself. Specific to this operation are the following reported complications: Pneumothorax, Haemothorax, Pleural effusions, Reduced range of movement in the shoulder, Failure of fixation and Frozen shoulder. There are quite different reports of the successes and failures of this type of surgery (in relatively small case series) which is why I would always be cautious about pursuing it unless patients were particularly troubled by their symptoms. Best wishes Simon
hello sir this is your best ever video which shows your hard work very informative very short and sweet the explanation is awesome.thank you very much the almighty bless you a lot.
Sir I met with an accident 5 weeks ago. I had acromioclavicular sublexion and scapula fracture. I have recovered and gained full motion of arm. But doctor told me not to lift weight for life and also I am unfit for army. Please help sir. I am devastated.
Hi, its complex in kids as sometimes the scapulae can appear to be winged but it may not be pathological. So if you're concerned then you'll have to have your child assessed locally. Bw Simon
Hi Dr. Freilich! Really like this video! The Improper position of scapular caused my neck pain for years. How can I know if I injured the long thoracic nerve? Thanks!
Well, the best medicine, is where the nerve heals itself and this depends on which nerve has been affected, what mechanism has affected it and how badly it has been damaged. This is primarily a question of time and whilst it comes at no direct cost, physiotherapy will almost certainly be necessary to prevent further damage, as I've explained in other comments below. Other surgical treatments are possible and depend again on exactly what and where the problem(s) are / failure of conservative treatment and various feasibility issues. So all in all, not an easy question to answer and will depend entirely on the context. Hope this helps and best wishes!
hello dr simon.i have winging sqapula and im from israel:)my dr said that from he nows that nerve cant get better i wand to ask if that nerve can heal?i have that problem 3 years and i can see a big progres but its still there...thanks a lot
Hi Livna, Shalom! I don't know the exact cause or details of why your scapular is winging, but if it is due to a nerve problem and it hasn't healed by this time point (3 years) then your doctor is sadly correct and it won't heal by itself. Physiotherapy would still help you use and develop the affected muscles as much as possible and rest the unaffected muscles from over-straining. This is probably why you are feeling some improvement. There are some surgical options depending on the cause and how much it is bothering you. Wishing you a 'refuah sheleimoh', Bw Simon
Yo this guy is the best doctor out there. Knows everything. He wasn't even reading a script
Thank you for not just stating "do these 3 exercises and you will be fine" as many others do. They often assume you have a weak serratus, whilst you clearly show that there can be multiple causes (and the animations make it easy to spot yours).
I can’t built a nice back and traps with these stupid shoulder blades😖
Same bro same
At least you can still hack and slash, Jason.
Same here. If you have found a solution, pls let us know. 🙏
Best video ever on winging and I have seen many. Thank you!!!
Sir, a brilliant video, very informative, superb. Perhaps you could consider using a clip of a real human to demonstrate the different aspects of winging as this would really contectualise your excellent video; just a thought.
Shalom.
Thanks so much! I'd really like to show real life examples which is far more informative and interesting. However, here in the UK it's very difficult to adequately consent patients and meet various regulatory requirements for these types of videos, so I just avoid it altogether. Bw Simon
@@DrSimonFreilichHello Dr. By any chance do you diagnose people with scapular winging by just looking at his picture? I am curious to know the condition of my brother since no local doctors around could actually identify his condition. And I do think that it might be scapular winging. Thanks and I hope you recognize my question. 💗
Thanks for the question. Unfortunately I can't give you specific exercises as, being on the Medical side of health care, it's not something I have expertise on. In general though, in this scenario, it's about strengthening compensatory movements and muscles and simultaneously not overusing them either, which is quite a challenging balance act. Bw Simon
Dr can i continue my upper body workout with problem ,, beside workout i will fixe my problem !!
Well said, who would you recommend to assist in getting back in balance?
Are you saying it may never return back to normal?
This is indeed, wonderful information. Dr, I’ve had this pain for 15 years now and my frustration has begun to turn into depression. I’ve tried every stretch, every exercise, every medication including opiates, witch make you feel good, but do nothing to stop the pain. I’m a roofer by trade and it would be very difficult to step away from working long enough to let it try and heal. I’ve always assumed that by this point so many years later, healing isn’t something that’s even possible. I pretty much try to overcome the pain by simply focusing on ignoring it. But as I said, it’s getting harder to deal with mentally. Every minute of every day I live with words “it hurts”. Thanks for posting the info ! .......sending love from Memphis Tennessee USA
My goodness that does not seem good for you.
I have been very disappointed as the strong tramadol that I have for my chronic lower back problem do nothing at all to take away the pain for my winged scapula.
Have you managed to find any relief as yet.?
Don't let it hurt too much. Go see a lawyer and apply for disability.
Try to find a good PT if you can, but if you can’t, there are great exercise experts and PTs on RUclips. Look at squat university, saturnomovement, or fitnessfaqs.
The three most important scapular stabilizers: 0:36
Serratus anterior (long thoracic nerve)
Trapezius (spinal accessory nerve)
Rhomboids (dorsal scapular nerve)
STR
If one muscle becomes weak due to nerve injury, the opposite muscles will contract to compensate that.
Different rotational patterns:
*Weak serratus* 1:34
•Traction against the chest wall (becomes obvious at rest).
•The rhomboids and trapezius pull the scapula inwards.
•The trapezius pulls the shoulder blade upwards.
•In general terms, the whole bone (scapula) will move towards the midline and upwards (when stretching the arm forward, the winging becomes very evident).
*Weak trapezius* 2:04
•The scapula drops downwards.
•The winging is not very evident at rest.
•The strong serratus pulls the scapula outwards and the rhomboids will rotate the bottom part of the scapula inwards (best appreciated when looking at the upper pole of the trapezius, which rotates outwards and downwards and magnifies with arm abduction. 2:11
•Winging may be reduced in forward flexion, pulling the serratus towards the chest wall. 2:27
*Weak rhomboids* 2:35
•The serratus pulls the scapula outwards and around the chest on opposed.
•The trapezius will pull and rotate the scapula outwards.
•The winging can be accentuated by drawing the shoulder blades in or by pushing the elbows backwards against an external force (asking a person to hold your elbows from your back and push against their hands). 2:54
I just confirmed I have rhomboid weakness on my left side. 💀
(read on reverse) !kcul nmad, uoy kcuF
TY. This was incredibly helpful in the search for a diagnosis for my ancient injury and the battle it has been to still need an MRI on this area of my left scapula. I have had a few muscle tears in this region on my left side, once on my right side but the significant damage that has been there for 20 years is on the left.
I have had serious muscle tears and rehabbed them before, and this feels like when it recurs a rib is flopping around which is why I have long suspected a significant serratus tear and just as likely, detachment.
I don't know what to do. My doctor told me 10 years ago that my scapular winging would heal by itself. Well, that hasn't happened. I still have it. My right side is the issue. My right trap & neck are sore. I hope there is something I can do. It definitely wings out.
Almost fell asleep but great video I learnt a lot
I fixed my with single arm cable pull down, I added to my back workout and did it once a week, it took maybe 3-4 months to fix it 🤗
What is a cable pull down?
@@twincherry4958 search in youtube lmao
Are you saying you fixed your winging?
Thank you for explaining this!!!! I had this 23 years ago. Healed it but my right shoulder has been dropped (lower than the left shoulder) since. It just came back with a vengeance and feels like a horrible, pinched nerve OMG it hurts!!!
Your videos are invaluable!! Thank you from my heart for this source of insight!
The unfortunate reality is that these don't heal quickly, but with time, most do significantly improve. Physiotherapy will not cure it or enhance the healing process but would still confer short and medium term benefits in terms of best utilising the other surrounding muscles. Wishing you all the very best with it! Simon
Dr Simon Freilich it is sad to hear to hear that because this is my profession , and my life doctors here are not doing anything :(
Dr Simon Freilich Hi! I do not understand. Do you mean physiotherapy won't help at all with winged shoulders?
Hi, thanks for your question. To be clear that's not what I said at all. Physiotherapy is very important but it won't cure actual nerve lesions. That's for the nerve repair mechanisms to do.
Physiotherapy is there to support healing by best utilising whats left and to prevent secondary damage by preventing stress on the other muscles.
Hope that clarifies things and wishing you all the very best. Simon
Dr Simon Freilich Thanks a lot! I guess that means physiotherapy could be very efficient , if the winging is caused by bad posture etc and not nerve damage.
Indeed! Bw Simon
I have this really sharp pain when breathing and doing lifting around the back of the shoulder blade above and below, I had physio but nothing much happend, it's a month now and seems to be getting worse, the knots in my back are crazy, great video, really dove into it with depth n knowledge, must of been the gym when I trained shoulders few weeks back x
Make sure you always warm up rotator cuffs before shoulder workouts! helped me
4:26 is scapular winging rare? I feel like I know many people who have it
Hi, there's nerve damage related muscle weakness that leads to winging, and that is rare. There's also a different entity called scapular dyskinesia, where the scapular does wing but it's not from true muscle weakness, rather an imbalance and desychronisation in how the brain recruits the shoulder muscles to activate. It's not common but not rare either. Tends to affect gym bunnies, and you'll see a lot of YT content that probably relates to that. Bw Simon
This is an excellent video. I've had problems with my rhomboids for months and months after doingof the some pull ups. Initially I suspected a complete detachment of the rhomboids as I felt like I just couldn't "feel" my rhomboids and couldn't contract them. This spontaneously went away when I was doing some foam rolling and stretching one day which led me to believe it was a trapped nerve (literally went from lots of pain and dysfunction to no pain and dysfunction in a couple of minutes). A couple of weeks later I had a spasm and the all pain and dysfunction came back.
I've since had an EMG done and it showed a problem at the rhomboid (but not the levator which shares the same nerve about 50% of the time). My doctor was stumped and doesn't seem to know what to do. I've had a thought since: My pec minors are incredibly tight and could be pulling my scapula up and forward via the connection to the coracoid; by proxy this would stretch and weaken the rhomboids quite a bit. Can a weakened muscle (like in the pec minor scenario) show a problem on an EMG or are problems on EMG strictly for muscle tears and nerve damage?
Thanks for the great questions and feedback. First;y, I'm impressed with your weight lifting - those weights look tremendously heavy. Which leads me on to saying that you may well be right about nerve pinching. A lot of the scapular winging videos on RUclips relate to bodybuilders and those doing extreme exercise. This can lead to both significant stress on the nerves and muscles, such as when I see you doing a 'clean and jerk' (hope that's the correct term) as well as imbalances when particular muscle groups are focused on for development. So there can be a combination of both acute and chronic injuries to both muscles and nerves from any and all these kinds of activities (not necessarily just from the pull ups you mentioned).
EMG (whilst a great tool) can only pick up diseased muscle and even then only looks at certain fibre types. It wouldn't be able to determine whether a muscle is tight or over stretching. Good luck and best wishes! Simon
Thanks for the reply, doc! But I'm wondering - in terms of the EMG result - If an EMG shows a problem in a muscle it could be: Nerve Entrapment, Nerve Lesion or Muscle Tear?
Indeed! Basically, EMG of any 1 muscle can be one of 4 things: Normal, Neurogenic, Myopathic, Mixture of the two. To determine the cause, a combination of the clinical aspects and other muscle / nerve tests have to be combined. Very best wishes, Simon
I have the same problem with my rhomboids I couldn’t feel them and they don’t work at all . Including while I do barbell rows , pull-ups and even when doing a front raise my scapula either pops out causing abnormal scapular motion and don’t work at all . Did an MRI , no problem apart from supraspinatus tendinitis . Normal cervical scan with no radiculopathy . The doctor dosent seems to get what the problem is still I don’t feel my rhomboids and they don’t at all creating this muscular imbalance . My serrated have adequate strength so does my trapezius and lats. So how do I manage the problem . Time span has been more than a year . All imagings are Normal x rays , CT and MRI .
@@bibeksunar5237what did you do to work on activating those romboids?
Man I’m devastated, trained Saturday night and woke up Sunday unable to activate my serratus! Been nearly two weeks of 0
Activation, the trap pain sucks, this injury sucks
Is it fine to do strengthening exercises for every muscle you outlined so it fixes what ever is damaged please awnswer specifically Thank you
Hi Zafar - there are two very distinct groups of 'wingers' to consider. There's the type that I'm primarily addressing here where there is actual nerve damage. Strengthening exercises won't actually fix that damage - nature will - depending on extent. But physio guidance (very specific to individual circumstances) will help improve strength in the residual muscle fibers and can help redistribute weight and movements through the surrounding muscles. There's another group - that relates more to the mechanics of the shoulder, and primarily seems to affect people who work out / gym users. The nerves (and muscle tissues) are healthy but due to a variety of other causes the shoulder becomes dyskinetic. Physio's are again the way forward but the specifics are again very individualised. I.d suggest you see one to get the right exercises. Bw Simon
One more question is scapula winging also able to occur without a nerve damaged like my scapula winging was so bad but as I stared to exercise my seratus anterior it got better and then I saw your vid and started doing exercises for all stabilizing muscles does that mean my nerve is not damaged btw my wing was sticking out like so much now its alot better but if you awnswer it want you to awnswer this is well my parents think my scapula winging will be fixed automatically because I'm 15 growing that's the cause and they also said it's caused by the way i sleep is that any way correct thank you.
You're parents likely to be right! Sometimes kids do have a natural prominence that you'll hopefully grow out of
Hello Dr Freilich! I have scapular winging with both scapulars, was born with it. I am currently seeing a neurologist but after various tests there is still no diagnosis. I will be in France May ‘23 and was hoping you would see me. Hope to hear from you!
Hi Scott, I'm not sure what to say, but some people are just born that way and I don't think the answer will be revealed by Neurophysiology tests. Bw Simon
Thank you great information and very helpful when explaining it to my patients who are often young and impatient with stabilization exercises
Can you tell what should be strengthened or stretched
Dr. Freilich, can you pls elaborate on 3:38 to 3:51 statement? I have chronic pain in rhomboid and shoulder after shoulder surgery 8 months ago. Thx for the informative video.
I have a weak rhomboid, no traumatic injury. am actively trying to strengthen it but it keeps going back to where I stared :(
My heart sank when I learned that it may take one to two years to heal. I am now into my fifth week of pain on my right rhomboid area. I suspect it had to do with my recent pulling of heavy trolleys using my right arm. I am doing a couple of back rounding exercises daily now. Not sure if I should go to a doctor.
I noted that the pain can also be felt somewhere at front right chest near the top. Can the back right shoulder pain give rise to pain at the front too?
My god.....no My heart sank aswell
It’s a very long time for healing I wonder if steroids would help speed the healing?
@@auctionking4255 After suffering from the pain for two months, my friend dragged me to go see a GP. She didn't even bother to see or examine. Wanted to earn my money by asking me to do a blood test as part of getting old check up. Anyway, she prescribed me with two types of painkillers (non steroidal type) and a gel called fastnum. Also said no need to see a physiotherapist. It is now two and a half months. Medication has finished. I stopped the gel as the instructions said not to use for more than 10 days. I have been doing my stretching exercises which are mainly involving rounding the back kind of muscles and expanding the back kind of exercises. I have also went to the gym like once a week. I do very light weights with a big focus on triceps pull down the the upper back a bit rounded. So far my pain has gone from maybe an 8 to a four
Hi doctor, it seems like i have romboids or trapezius weakness.I tried some exercise from internet like scapular push ups but i felt like my scapula is moving to my shoulder and my scapula is rubing against my ribs.Thanks for this video.
WHERE DO I FIND A DR. WHO SPECIALIZES IN THIS??
Physical Therapist in a orthopedic setting
Appreciate the video, I have been suffering with scapula winging but only slightly and all the other RUclips clips An google pages I looked at pointed more at the serratus anterior being weak instead of my rhomboids. This made so much more sense as I don’t have a huge winging unless I do a back pose then you can see my scapula shifting out and right. Thanks again now I know what muscle to focus on for my stretches An exercises!
Hi Dr. Freilich. How long does it take to completely heal winged scapula and can you recommend some exercises to lessen the time of fixing this winged scapula.
Hi Jhon, I can't answer either question. The first will depend on the cause, severity and time since onset and I can't do that online. The second is outside of my expertise as I am not a physiotherapist. Wishing you a speedy recovery, Simon.
In my case was the shoulder internal rotation that was inhibiting the serratus anterior.
I'm doing PT for levator scapulae, pec minor, pec major and rotator cuff exercises and now it's going back to the rib cage.
Thank you again
I love the video, but please make a part 2 with a real human being demonstrating, it would make it easier to understand. Thank you!
I feel a sharp stinging pain on the bottom of my left shoulder blade. When I bend over, the pain activates. If I endure the pain, I eventually feel a popping sensation in that area. Is this scapular winging?
I have the same problem
Amazing video!!! Wondering if steroids would helping in the healing process? Two years seems like forever when dealing with this discomfort/pain???
A couple months wil fix you brother, no need for steroids
@@momolacoste874 have you any experience with fixing this?
WTF?!
The video was great it perfectly represents my current problem. Was deadlifting and injured myself.
The treatment length of time it may take is what’s scary. Is there any faster remedy/treatment or which do you consider the fasted way to regain balance?
Hi, unfortunately nothing specific: eat healthy, avoid toxins (alcohol and smoking) and maintain a healthy lifestyle. Bw for your recovery, Simon
The seratus anterior inserts to the the costal aspect of the medial border of the scapula right?
Why is it said lateral in this video?
Thank you for the correction. Bw Simon
@@DrSimonFreilich oh no problem 😄
Good morning dr. I have a scenario for you.
The person early twenties, pushing a heavy object with his head a neck relaxed with arms slightly bent.
Upon pushing this heavy object the right scapula Wing out in hyper-extended causing three distinct snaps that gave this person and incredible amount of pain. They could not lift or perform regular arm functions shoulder height and above and shoulder-width out. what could the long-term consequences be if not properly treated? Some of the symptoms is person has been experiencing in the decade since it occurred are, increase tension and inflammation throughout the muscles grouping around the scapula. Radiating up and down and out from the spine. Increasing during the day's work. When the injury occurred no movement from the shoulder width out or above shoulder height could be performed without extreme pain and discomfort. Which muscle groups could have caused the rubber band effect as a scapular hyper-extended?
Hi Lary, you or your friend is going to need to see an orthopaedic shoulder surgeon to get this type of advice, but decades long symptoms aren't going to self resolve. Bw Simon
Is there a NCS for long thoracic
It's possible but not routine. EMG assessment is the standard examination. Bw Simon
I have this. The only way I was told to fix mine was to do surgery. Since there is absolutely no way to fix it by doing exercises.
Did you do the surgery?
@@ashramdhan1582 no i haven't. I have had other surgeries come up and now im in college.
@@hospitalqueen4047 you have eds right?
Hey Doc, personal trainer here. My right scap flares a bit more than the left, and when I pull in with my serratus it moves outward. This, along with visibly greater hypertrophy of my left rhomboid, makes me believe the right rhomboid is weak. Big on bodybuilding so I could’ve done this with poor repetitive form. Thoughts?
Ur mom
Hello Dr. Simon, I'd like to ask, if can I be born without rhomboid major. I know, that I have rhomboid minor, I can active that and I feel it when I touch there by other hand. But under r. minor I can't touch any other muscle on medial border of the scapula. Also I can touch the other end of muscle on the spine at neck vertebrate but under that are no other tendons, where should be r. majors. When I cannot active rhomboids major I've got winged scapula mostly visible when I bend my body forward and I put my elbows out from body and try to put them higher - on level of rib cage. It makes me really hard to do that, because I do this movement mostly by trapezius and r. minor. And by the way I haven't any injury in those location neither the nerves, that are coneccted there. And I should write too I have this problem from always(by childhood). Thank you for any answer. Dan, 16 y.o.
Hi Dan, thanks for the really interesting question. Anything is possible when it comes to congenital absence of bones and muscles but it would also be important to know whether there are any bone abnormalities of the scapula as well. I haven't personally come across anything like this, and I suspect that it would need to be checked out by a local Orthopedic shoulder doctor. Bw and Happy New Year, Simon
Dan Jaluvka dan if you are concerned that you have a detached rhomboid, you need to research / contact Dr Ben Kibler at the lexington clinic in lexington KY, he invented the surgery to repair muscle detachment from the scapula and he can help you
Hello Doctor. May I trouble you for some advice please. Could a grade 3 subluxation of an AC joint cause a winged Scapula? Many thanks for your time. Regards, James
Hi James, a complex one to answer as it depends on what's being described as winging, and what else may have been damaged as part of the mechanism of injury. Youll have to enquire with your orthopaedic shoulder specialist. Wishing you a speedy recovery! Simon
If I have medial winging in one arm, is the only non-surgical treatment to strengthen the serratus anterior and stretch the pec minor?
Also if I can completely raise the arm with winging and there's no pain, does that mean that there isn't any nerve damage and that it's just muscular?
Hi, it's almost impossible to answer either question! You'll have to see someone to get those answers. Bw Simon
Gotta work on my trapezius, thanks for the detailed explanation.
How is it now?
@@asemyamak3984 Chill dude, its been a week haha, probably going to take 2 months, i would recommend training all parts illustrated in the video for best stabilization of the shoulder blade.
Marius o_o oh a week and no progress? Sorry I’m just tryna figure how long it would take to fix mine I have similar problem
@合Mwalkerr Sorry man, i havent been consistant at all xD
@@Marius553what about now lol
Appreciate you taking the time to make this. I have been in scapular/shoulder pain for years. 31yo white male. I have yet to have a doctor or physical therapist or chiropractor provide a long-term solution. I think I'll look into this nerve grafting thing at the end. Have any friends in Kansas you'd recommend?
Hi Brett, I don't know anyone in Kansas, but wish you well! Bw Simon
I have a bulged disk at C6/7 and my right arm is very painful. About 3 days into having this issue I noticed my shoulder blade is now “Winging” quite dramatically. Could the compressed nerve be the cause?
Hi, I dont know and can't really give an opinion. Would suggest you see a local doctor asap for further investigation and treatment as there are a variety of causes that could include brachial neuritis. Bw Simon
I am suffering from winging scapula, from childhood now I am 20 now understand,,, because I work with left hand my right hand winging scapula the biggest thing is my turn Bangladesh.
If there is a solution please give??
I have had a winged scapula since I have been a child, should I request a nerve test?
Hi Michael, that's a chat with your GP/Family doctor first. The questions to be addressed are how significant is it and does it affect your function. If yes, then a chat with orthopaedics and or physiotherapists. But realistically, nerve tests ?30-40 years later don't tend to be particularly helpful and surgical interventions are significant and have risks. Bw Simon
Thank you for very informative video. I have access to a boxing club. Would punching a punch bag or pads develop the serratus also? Or has to be specific exercises? Thanks again.
Hi, whilst I am not a physio and can't generally advise on specific exercises, if you have winging due to SA weakness, I doubt that boxing would be a good idea. The reason being that fully extending your arm at force into a bag would only lift the scapula even more off the ribs and stress the other muscles trying to keep it in place. It could perhaps tear what's left of the SA muscles too. But I do understand the rationale of the movement. Perhaps someone else with specific knowledge could comment below and I'd be happy to be corrected if I'm wrong? Bw Simon
Landmine press develop SA providing protraction and upward rotation of scapula
If the scapular winging is not painful, should one still seek treatment?
Depends if it's bothering you, if it's getting worse or if there's a question about causation or prognosis. Bw Simon
Many thanks @@DrSimonFreilich! It is on a 17 year old. It doesn't hurt.
Is poor posture a cause. I never had an injury but I do have rounded shoulders
No, bw Simon
@@DrSimonFreilich Im surprised holding the body in a certain position such as hunched over while sitting doesn't make one muscle stronger than the other or possibly one inactive. Anyway thanks for replying
Do you know ant exercise (without weight) that I can use to strengthen my trapezius muscle? If you do this would be VERY helpful and I would really appreciate it
Hi, exercise info isn't really my thing, but it sounds like a visit to a physio could be helpful. Bw Siimon
Hang on something and do in a way a pull up just pulling Ur shoulder back
Like when holding onto a pullup bar with straight arms try to bring Ur 2 shoulders as close together as possible , so in a way a pull up without use of lats
@@hithere1036 Ok thx
@@hithere1036 Ok thx!! (Sorry for the late response. I didn't get the notification)
My shoulder blade hurts or I'm not sure if it is the shoulder blade but I feel pain near it and it hurts when i move my torso and my arm and sometimes the pain decreases and sometimes it increases plz read this and is there a way to relieve the pain
What is the solution ?
Any exercise ?
depends on your condition
Hi Dr Freilich, I am from the UK, but live and work in Rotterdam. I have had scapular winging on my right hand side for 10 months now, possibly caused by open heart surgery I had. Is it possible to ask the medical profession for the kind of specific diagnosis you mentioned in your video, i.e. to specifically determine which nerve is responsible?
Sure, ask for Neurophysiology testing. Bw Simon
My shoulder blades never used to look like this, that was until almost ten years ago I worked in a meat packing warehouse. I was constantly lifting heavy weight all day. At the time, I noticed a burning pain in my shoulder blade area. Now my left shoulder blade sticks out like this, and I always have pain it that area, along with a stinging/burning pain. Any suggestions? I do have an appointment coming up with my MD in a couple weeks.
I can't answer, but a great idea to see your doctor. bw Simon
Does winged scapula decrease height or affect body growth?
Hello simon, what is your take on the levator scapulae muscle getting tight?
Thanks, to be honest, I really don't think it's a significant cause. When you consider the number of big muscles surrounding the scapula, especially at the lower portion. The tensile force required to pull the scapula up against their keeping it down, would be beyond the scope of comprehension, unless one had a very unusual exercise plan! I know there are quite a few other videos that promote that kind of theory but the physics doesn't add up. Unfortunately, winging is usually caused by a weakened muscle, with the remaining ones pulling the scapular in their direction, unopposed. Sometimes there are other mechanical issues, but not so common. Hope this helps and best wishes, Simon.
It does. I have shoulder issues, rounded shoulders along with cracking going on at the bottom of my ribs in the back area. Plus, my quadratus lumborum muscles are very tight as well. Thinking this may all come down to my serratus muscles being weak. All of this is surrounded by a decent amount of superficial muscle mass, I've been training for about 7 years now. Those problems arrived about 3 years ago. If you have any other thought, let me know. Thank you for your reply Simon!
Thank you for this video. I have been dealing with this symptomatically for more than 20 years. I am trying PT again and finally understand that, while there is likely damage to my long thoracic nerve, PT is not looking to fix my LTN but trying to do what we can to stabilize my shoulder blade, reduce pain and improve function. I have "failed" PT multiiple times because I didn't understand their approach and would get frustrated when increased pain caused me to miss work. This time we are going to go very slow and having a clearer understand of what we are trying to accomplish (I wish I would have seen your video earlie!) will help me dig deeper and focus on the long term goal. It may or may not work - but I am going to try! One question - how do you determine what muscle is weak? My shoulder blade is hiked up (my levator is working overtime) and pulled out. We are working on my serratus and it feels like that muscle has not been used much in years. But that doesn't seem to fit with how my shoulder blade is sitting. It should be pulled in toward the spine if the serratus was weak? I am confused and hoping you can explain. Thank you.
Anytime you are working the serratus you must focus on the pec minor aswell as it has an almost identical function and if your serratus is weak your pec minor will be working hard to compensate and as such the higher resting tone of your pec minor will result in a downward roation of the scapula
Hi Simon, I have this condition. I believe from parsonage Turner syndrome.
I am struggling to get anywhere with the nhs in terms of fixing my problem. Could you give me some advice on how to get it sorted. I also have a raised diaphragm which can be caused by phrenic nerve damage, I believe the 2 conditions are linked. Are there any specialist I can get a consultation with privately?
Hi Marc, yes phrenic nerve involvement can definitely be part of Parsonage Turner. If you're willing to come to London then Prof Mike Polkey is probably the best person to see, particularly because of the diaphragm involvement (he's an international expert). He can bring in other specialists too, as necessary /required. Bw Simon
@@DrSimonFreilich thanks for the reply. Yes I would definitely be prepared to come to London.
Do you have any contact details?
Hello, can a Scoliosis results in Scapular Winging?
Hi, a very interesting question and yes it certainly can be associated with scoliosis for quite a number of reasons. Bw Simon
Am suffering from this one please tell me any suggestion
Will massaging the scapula and sorrounding muscles help?
I have seen some videos that instruct not to get massage as it relaxes the muscles and to treat winging we actually need to stiffen the muscles. Is that true ?
No, sadly it's not true. Bw Simon
@@DrSimonFreilich Thanks for your reply. This will help :)
Hello doctor I got a winged scapula at the time I reached maturity stage I inherited it. my dad also had such problem.is it possible if I practice some exercise for unwinging scapula it works. thanks
Hi dr simon thank you for your video i have found it very informative. i have had winged scapula for about two years now, well it is two years since i noticed the appearance of it. i felt my shoulder to be weak but did not have any unbearable pain until i crashed my car in November. I suffered whiplash from the crash and after a clear mri and xray of my neck i was advised to do physio therapy, which i did. The Pain seemed to be travelling from my nape of neck right down along my shoulder blade tingling in my fingers and arm . My physio also performed electro acupuncture on the area . Since then i am having worse pain and spasms and the pain is in my rib cage scapula and shoulder and tingling sensations and weakness in my hand my physio is not happy with my progress and has suggested further investigation and maybe surgery. I should mention I am a professional guitarist and singer . I stopped playing the guitar to rest these last while but now finding singing terribly Uncomfortable as i cant seem to breathe deep and expand my rib cage . my winging is quite severe and prominent and i have very very prominent ribs. is rib pain common with winged scapula ? i am currently waiting to be seen by orthopedics as i have never had an mri of the thoracic spine. Thank you for your time
Hi Stephen, sorry for the delay in getting back to you. I don't really know much about electro-acupuncture so it's difficult for me to comment on that. In terms of rib cage pain - I've come across quite a few patients with fairly diffuse discomfort in the region. It's quite logical given the extensive muscle attachments to the ribs that can be affected either directly or indirectly with winged scapulae. Good luck with the Orthopaedics. Bw Simon.
Sir my right arm lift more then lrft and its ancomfertable for me my both shoulder are rounded but right is too far also scapula ringing can u plzz tell me how too fixx it in easy way
Dr, this is marvelous. This will help in my recuperation, thank you so much.
I must ask, though: Occassionally, the pinkie from my right side will hurt when I hold it at shoulder level, palm facing up and right arm extended to the right (at should level). I feel pain in my elbow pit, more specifically on a tendon (?) connected to my pinkie.
The pain extends all the way to behing my right ear, goign through my shoulder, around my right scapula, rising along the neck (I guess the trapesiuz following allong... I must've had really bad posture). Is this a dirrect consequence, or a different issue? I had acute, unilateral reactive tendinitis at 17, so that must have affected me someway(yes, on my right side).
No idea! Best wishes though, Simon
@@DrSimonFreilich Thank you, nonetheless. This video gives me a good idea on how to research on that.
Can you apply for disability when having a winged scapula ?
Well explained And Very informative Sir.
If patient present after Cervical Biopsy with Shoulder pain and Sensory loss above Shoulder and weakness of Shoulder ER and Abduction plus Scapular Winging what could be the cause.
What to order in Electro physiology Testing?
Thank you.
The primary concern would be the Spinal Accessory Nerve to the Trapezius which can be damaged during Neck Biopsies bw Simon
@@DrSimonFreilich Thank you sir.
Thank you this was really informative without any kind of nonsense.
Incrediblely simple yet diligent & comprehensive video. 🙏🏻
Sir,
Please mention the role of levetor scapula and scalene muscles in role of wiinging
This is my problem, scalenes & levator
can you tell about the physiotherapy treatment
If you have scapular winging, does it usually constantly stay out or can you push I️t out? I’m just a kid and only can push it out. It would be really helpful if you can reply to this comment.
Swiss Reign
Hi, I'm not sure what you mean by 'pushing it out' Scapular winging is unusual in kids and if you haven't already seen a doctor locally to look at it, I can only suggest that you do. Bw Simon
No you have to push it out
Sir i have a birth injury where i had scapula winging, is it curable?
Not curable, but there might be surgical options. Bw Simon
I have long thoracic nerve damage will I be able to heal it quick with exercise or I have to wait for nerve to heal which will take 2 years which I don't want.
Devlife fun what side affects do you have?
Luis Suarez left side
Can supraspinatus tendonitis lead to winging of scapula?
Hi, I'm not sure. Perhaps at an extreme of it with tendon rupture or if the pain is so severe that there is functional impairment, but not generally. Bw Simon
I have both🥲
Sir, I'm suffering from pseud scapula winging (left side) .It is noticed after gym workout for 2 months. After noticing the winging I stopped gym workouts. Consulted an ortho, but he suggested ncv and emg..... He said my serratus anterior may be weak. He also suggested to consult a neuro surgeon. After consultation he told there is no muscle weakness. There is only a small winging.... But when I do some job, means something like lifting or even pushups I am feeling pain.... So what should I do...... If possible can you give ur wtsupp num.... Or any contact detailssss
sir what are the complication a subject may face after scapulo thoracic fusion?
Thanks Syeda for all your lovely comments.
As with any operation there are potential risks and complications as a result of Anaesthesia and the Operation itself. Specific to this operation are the following reported complications: Pneumothorax, Haemothorax, Pleural effusions, Reduced range of movement in the shoulder, Failure of fixation and Frozen shoulder. There are quite different reports of the successes and failures of this type of surgery (in relatively small case series) which is why I would always be cautious about pursuing it unless patients were particularly troubled by their symptoms.
Best wishes
Simon
hello sir this is your best ever video which shows your hard work very informative very short and sweet the explanation is awesome.thank you very much the almighty bless you a lot.
Great video and execution
Hi sir i have sholder pain mostly if i do work i think so scapular winging problem what do you think sir please reply me ?
If i workout and make my trapesius and romboids steonger can i fix it or?
Did you figure it out?
lol did u even watch the video
No, you have to work the mobility of the muscles not the strenght.
@@5driedgrams you dropped a gem and nobody is paying atention, thank you brother
@@dios319 thank you, mate
I have muscle knot bony like part over the superior angle scapula area I noticed winging too
Is it possible to be born with scapular winging? Or is it just from injuries?
Yes and there are a variety of causes. Bw Simon
@@DrSimonFreilich Thank you!
Sir
I met with an accident 5 weeks ago. I had acromioclavicular sublexion and scapula fracture. I have recovered and gained full motion of arm.
But doctor told me not to lift weight for life and also I am unfit for army.
Please help sir. I am devastated.
Hi Kamal, I can't help you with this but wishing you a speedy recovery, Bw Simon
Remember brother when life hits you hard you hit harder and keep pushing
Get a degree and try to become a general in the army or non fitness related role, you can still serve
are these treatment expensive?
i need ur help sir my winging scapola with shulder bande
Can i refer you to a new directory for chiropractors to add your video? Can we also send you the link by email?
I smoked a cart and started to cough and it started to hurt and every sense it’s been hurting under my shoulder blade !!!!!
Ye kaise thik hota hai
Is it rare for a child to have scapula winging? Also, is nerve surgery mandatory?
Hi, its complex in kids as sometimes the scapulae can appear to be winged but it may not be pathological. So if you're concerned then you'll have to have your child assessed locally. Bw Simon
Sir am also suffering from scapular winging is there any treatment and exercise sir...........
Have you found any way of helping this please let me know because I have a severe case of scapular winging
Hi Dr. Freilich! Really like this video! The Improper position of scapular caused my neck pain for years. How can I know if I injured the long thoracic nerve? Thanks!
Suggest that you see an orthopaedic shoulder specialist. Bw Simon
Thanks a lot doctor really helped me fixing my upper back :x
How to fix what excise I do tell me please
how much it takes to fix it ??
Well, the best medicine, is where the nerve heals itself and this depends on which nerve has been affected, what mechanism has affected it and how badly it has been damaged. This is primarily a question of time and whilst it comes at no direct cost, physiotherapy will almost certainly be necessary to prevent further damage, as I've explained in other comments below. Other surgical treatments are possible and depend again on exactly what and where the problem(s) are / failure of conservative treatment and various feasibility issues. So all in all, not an easy question to answer and will depend entirely on the context. Hope this helps and best wishes!
I didn't understand a word you said man
hello dr simon.i have winging sqapula and im from israel:)my dr said that from he nows that nerve cant get better i wand to ask if that nerve can heal?i have that problem 3 years and i can see a big progres but its still there...thanks a lot
Hi Livna, Shalom! I don't know the exact cause or details of why your scapular is winging, but if it is due to a nerve problem and it hasn't healed by this time point (3 years) then your doctor is sadly correct and it won't heal by itself. Physiotherapy would still help you use and develop the affected muscles as much as possible and rest the unaffected muscles from over-straining. This is probably why you are feeling some improvement. There are some surgical options depending on the cause and how much it is bothering you. Wishing you a 'refuah sheleimoh', Bw Simon
thank you very much!there is a way that i can maybe send you video of my back before and after working on that problem for your opinion?
I disagree. Only mentioning nerve damage as a cause of muscle imbalance (therefore causing scapula winging) is simply incorrect.
Thank you for this video - very informative.
Thank you extremely helpful