Research Review - Winging Scapulae Rehabilitation





Scapular winging is a condition that leads to limited functional activity of the upper extremity.


It is the result of numerous causes, including traumatic, iatrogenic, and idiopathic processes that most often result in nerve injury and paralysis of either the serratus anterior, trapezius, or rhomboid muscles


Diagnosis is made through visible inspection of the scapula, with serratus anterior paralysis resulting in medial winging of the scapula.


This is in contrast to the lateral winging generated by trapezius and rhomboid paralysis.


Majority cases of serratus anterior paralysis spontaneously resolve within 24 months


Conservative treatment of trapezius paralysis is less effective.


To allow time for spontaneous recovery, a 6–24 month course of conservative treatment is often recommended, after which if there is no recovery, patients become candidates for surgical intervention


Intervention should involve increasing the capacity by loading the tissue correctly


Various exercises can achieve this through core stability, increasing strength, function, and mobility.


Core Exercises

Juri Deadbugs


- On your back, palms overhead and pressing into a wall behind you

- Push your back flat into the ground and maintain neutral spine

- Progress to leg lifts, ipsilateral and contralateral, and heel tapping


Rolling patterns three month prone to high oblique sit


- On your back in a deadbug position, left arm against the around, right left crosses body to stabilize

- Press up onto your left forearm, maintain neutral spine

- Press up on right foot to stress the oblique sling of left shoulder to right hip


Strength and Coordination

Push lift and spread


- Using a foam roller at shoulder height against the wall

- Rolling the foam roller from your elbow toward your hands

- Lifting your arms overhead and maintaining contact with the wall

- Focus on pushing upward, lifting overhead and SPREADING your arms apart.


Kettle bell figure 8’s


- Laying on your back, packed shoulder, start static then process to dynamic figure 8 patterning

- To stress grip strength complete the pattern with the kettle bell bottom up


Dynamic


Progressive Angular Isometric Loading and Regressive Angular Isometric Loading

- Through the whole range of motion within the shoulder

- Maintain neutral shoulder and core control

- Concentrate on concentric and eccentric phases


References


https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2684151/

https://www.ncbi.nlm.nih.gov/pubmed/24618724


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