A winged shoulder blade (scapular winging) is when the shoulder blade sticks out from the back instead of lying flat against the ribs, most visibly when you push against a wall or lift the arm. It has two broad causes. The more common one is weakness or poor control of the muscles around the blade, which usually improves over 6 to 12 weeks of strengthening. The other is injury to a nerve that powers those muscles. Nerve recovery is slower, often 6 to 24 months.
The shoulder blade has no joint holding it to the ribs. Muscles hold it in place. Two matter most for winging: the serratus anterior, which wraps around the side of the ribs and holds the blade flat, and the trapezius, which runs from the neck and spine across the top and middle of the back. If either is weak or loses its nerve supply, the blade lifts away from the chest wall.
Winging is often painless at first. People notice it in a mirror, or someone else points it out. Others feel a dull ache around the blade, tiredness when the arm is raised, or trouble reaching overhead.
Key takeaways
- What it is: the shoulder blade lifting away from the ribs, most visible when pushing or lifting the arm.
- Muscle-related winging: the more common type, from weakness or poor control, usually improving over 6 to 12 weeks of strengthening.
- Long thoracic nerve: injury weakens the serratus anterior, so the inner edge of the blade sticks out.
- Spinal accessory nerve: injury weakens the trapezius, so the shoulder droops and the blade shifts outward.
- Nerve recovery: usually slow, often 6 to 24 months, and some people do not recover fully.
Where are you right now?
- You have just noticed it: read “Muscle or nerve?” below, then the safety sections near the end.
- Months in and not changing: go to “If it isn’t going to plan”. A nerve cause often needs a nerve test to confirm it.
- After surgery to the neck, armpit or chest: winging that appears after surgery needs review with your surgeon or doctor soon, as some nerve problems are best treated early.
- Getting back to work or sport: the “When can I…” table covers overhead work, lifting and sport.
Muscle or nerve?
- Muscle weakness or poor control: mild winging that varies with fatigue, often on both sides, with good strength overall. Common after long periods of reduced activity, in people with a stiff upper back, or alongside shoulder pain such as impingement.
- Long thoracic nerve injury (serratus anterior): the inner edge and lower tip of the blade stick out, clearest when pushing against a wall. Lifting the arm forward and overhead is weak. Causes include heavy straps or backpacks pressing on the shoulder, repeated overhead effort, a blow to the side of the chest, surgery in the armpit or side of the chest, and inflammation of the nerves around the shoulder (neuralgic amyotrophy, also called Parsonage-Turner syndrome).
- Spinal accessory nerve injury (trapezius): the shoulder sits lower, the blade shifts outward, and lifting the arm out to the side is weak. Shrugging may be weak too. This nerve runs close to the skin in the side of the neck, so it can be injured during neck surgery or lymph node biopsy, or by a blow to the neck.
- Dorsal scapular nerve (rhomboids): a rarer cause of mild winging, often with an ache along the inner edge of the blade.
A nerve conduction study and needle test of the muscle (electromyography, or EMG) can confirm which nerve is involved and how much. These tests are usually most informative from about 3 to 4 weeks after the problem starts.
Month by month
This timeline is for nerve-related winging that is being managed without surgery. Muscle-related winging usually improves within the first 3 months.
- Months 0 to 3: the aim is to protect the affected muscle from overstretch and keep the shoulder moving. Avoid heavy overhead loads and straps on that shoulder. Strengthening of the surrounding muscles usually starts gently. Neuralgic amyotrophy often begins with severe pain for days to weeks before the weakness shows.
- Months 3 to 6: early signs of nerve recovery may appear, such as a flicker of strength or less winging when pushing. Many people see little change yet, which is common.
- Months 6 to 12: many long thoracic nerve injuries show clear improvement in this window. Strengthening progresses as the muscle responds.
- Months 12 to 24: recovery can continue. If there is little change by around 12 to 24 months, surgical options such as nerve or muscle transfer may be discussed with a surgeon.
Nerves recover on their own slow clock. Measure progress in months, not weeks.
Where else this could be coming from
- Shoulder pain causing poor blade control: rotator cuff problems or impingement can change how the blade moves, producing mild winging that settles as the shoulder improves.
- Pinched nerve in the neck: a nerve root in the lower neck can weaken shoulder and blade muscles, usually with neck pain and arm symptoms.
- Snapping shoulder blade: grinding or clunking under the blade, without true winging.
- A rib or spine shape difference: scoliosis or a rib shape difference can make one blade look more prominent at rest, without weakness.
- Muscle conditions: rarely, winging on both sides with weakness in other muscles comes from an inherited muscle condition, such as facioscapulohumeral muscular dystrophy.
Is this normal?
- Both my shoulder blades stick out a little: mild, even prominence of both blades is common, especially in slim people and children, and is usually not a nerve problem.
- It does not hurt, it just looks odd: winging is often painless. It is still worth an assessment if it is new or on one side only.
- Nothing has changed in three months: common with nerve injury. Nerves regrow slowly, and visible change often comes after month 6.
- My shoulder aches after a day of using the arm: common. Other muscles are working harder to make up for the weak one.
If it isn’t going to plan
It is month four. You have been doing push-ups against the wall to “fix your posture”, and the blade still lifts away every time. Hanging a shirt on the top rail of the closet leaves the shoulder aching. The thought in your head is that you just need to work the shoulder harder.
When a nerve is injured, the muscle it powers cannot respond to training until the nerve recovers. Pushing it hard can overstretch it and tire the muscles compensating for it. What usually helps is protecting the weak muscle, keeping the shoulder moving, and strengthening the muscles that still work, then building the affected muscle as its nerve returns.
If winging has not improved after about 6 to 12 weeks of exercise, get assessed by a doctor or physical therapist. Questions worth asking:
- Is my winging from muscle weakness or a nerve injury?
- Should I have a nerve conduction study or EMG, and when?
- Which movements should I avoid while the nerve recovers?
- At what point would a surgical opinion be worth having?
When can I…
| Activity | Typical range |
|---|---|
| Sleep on that side | Usually possible throughout, if comfortable |
| Drive | Usually possible throughout, if you can steer and reach the controls safely |
| Reach overhead | Muscle-related: often easier within 6 to 12 weeks; nerve-related: often limited for 6 to 12 months or more |
| Lift | Light loads close to the body throughout; heavy or overhead lifting usually waits for strength to return |
| Desk work | Usually possible throughout, with the arm supported |
| Manual work or sport | Overhead, pushing and throwing activities often limited for months with a nerve injury |
If you have had surgery, your surgeon’s protocol comes first.
Call your local emergency number or go to the emergency department if
- Stroke signs: sudden arm weakness with face droop, slurred speech or confusion.
- Major injury: severe pain or deformity around the shoulder or collarbone after a fall or collision.
- Chest symptoms: shoulder or upper back pain with chest pain, breathlessness or sweating.
See a doctor today if
- After surgery: new winging, shoulder droop or weakness after surgery or a biopsy in the neck, armpit or chest.
- Severe pain then weakness: intense shoulder pain for days, followed by new weakness or winging.
- Spreading weakness: weakness in other parts of the arm, or in both arms.
Get it checked soon if
- New winging on one side: visible winging that was not there before.
- Overhead weakness: trouble lifting the arm above shoulder height.
- No change: winging has not improved after 6 to 12 weeks of exercise.
- Muscle wasting: a visible hollow above or around the shoulder blade.
More on this area: upper and mid back conditions.
A winged shoulder blade from weak muscles often improves within weeks, and one from an injured nerve needs months of patient, protected work.
Written by Louise Yow, Neck & Shoulder Physio.