Tweetorial. 1/🧵. Scapular winging.
A young man with shoulder pain after a road traffic accident. His back looks like this
A young man with shoulder pain after a road traffic accident. His back looks like this
Step 1. Is the scapula medially or laterally displaced? In this case both appear laterally displaced from the midline. Medial displacement is due to Serratus palsy, lateral is due to either Trapezius (mostly) or Rhomboid (rarely) weakness.
Trapezius weakness is also associated with arm abduction weakness⬇️
If the serratus was weak, this movement would have popped the scapula out
Pushing back with the hands on the hips can worsen the winging with rhomboids weakness⬇️which we suspected, in addition. However rhomboid EMG was normal bilaterally
We discovered serendipitously that 'Chest dips' which work the triceps, pectoralis major, Serrati and the Trapezius, nicely brought out these Scapulae➡️accentuated by the Trapezius palsy
This vid demonstrates all the movements. Final diagnosis➡️Bilateral trapezius palsy with lateral scapular displacement.
If you need a Mnemonic its TRAWL - Trapezius & Rhomboid Are Winged Laterally , SWIM - Serratus Winging Is Medially
For those who need it simplified even more. Check out these pics which demonstrate the scapular displacement from the midline⬇️
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