Scapular winging: causes, symptoms, and treatment options

Your shoulder blades play an important role in helping you move, lift, and reach with confidence. If you've noticed that one shoulder blade sticks out more than the other, a condition known as scapular winging, it may catch your attention, but it's often something that can improve with the right approach. In many cases, targeted exercises and physical therapy can help restore strength, improve movement, and support a return to the activities you enjoy.

“Scapular winging may look concerning, but you can improve it with simple strategies, like physical therapy,” says Krista Asprec, PT, DPT, a physical therapist at Hinge Health.

Scapular winging doesn’t necessarily indicate a serious problem. Sometimes it isn’t even painful. But it can affect how your shoulder moves, making activities like lifting, pushing, pulling, or reaching overhead feel harder than usual.

“When your shoulder blade isn’t moving well, it can irritate other parts of your shoulder or arm because they’re compensating for the instability,” says Dr. Asprec.

With the right treatment approach, your shoulder blade can often return to a more supported position. Strengthening the muscles around your scapula can also support your overall shoulder health and help prevent other issues, such as rotator cuff irritation, shoulder impingement, and frozen shoulder.

Read on to learn what scapular winging is, what causes it, and how to fix it with physical therapy and targeted exercises recommended by Hinge Health physical therapists.

What is scapular winging?

Scapular winging is a condition where your shoulder blade, or scapula, sticks out from your back instead of lying flat against your ribcage. “It’s called winging because it looks like a bird’s wing on your back,” says Dr. Asprec.

The winged appearance is often most noticeable when you push against something, such as a wall, or when you reach your arm overhead or behind your body. A wall push-up test is commonly used to help identify scapular winging.

Scapular winging is a type of scapular dyskinesis, which is just a broader term for changes in shoulder blade movement. It usually happens when the muscles that stabilize your shoulder blade become weak, irritated, or stop working efficiently — often due to nerve involvement or muscle coordination issues.

This is usually a functional movement issue, not a sign that your shoulder blade is “broken.” With the right exercises and support, scapular winging can often improve.

Types of scapular winging

There are two main types of scapular winging: medial and lateral. Understanding which type you have can help guide the right treatment approach.

• Medial scapular winging. This is when the inner border of the shoulder blade, closest to your spine, sticks out. It’s usually related to weakness in the serratus anterior, a muscle that helps hold your shoulder blade flat against your ribcage. Think of it like a support strap that keeps the shoulder blade close to your back. When that support isn’t working as well, the inner edge of the shoulder blade can lift away, creating the winged appearance. This is the more common type of scapular winging.

• Lateral scapular winging. This is when the outer portion of the shoulder blade, closer to your arm, protrudes. It’s typically related to weakness in the trapezius muscle, which helps position and guide your shoulder blade as you move your arm. Think of it like part of the shoulder’s steering system. When that support isn't working as well, the outer portion of the shoulder blade can begin to drift outward, creating a winged appearance.

A physical therapist (PT) can help determine which type you have and recommend exercises that target the right muscles.

Causes of scapular winging

Scapular winging can happen when something disrupts the normal strength, coordination, or nerve signals that help your shoulder blade move smoothly. Sometimes the exact cause isn’t clear, but treatment can still be very effective. Common scapular winging causes include:

• Nerve injury or dysfunction. Nerves help control the muscles that stabilize your shoulder blade. Injury or irritation to the long thoracic nerve or spinal accessory nerve can affect how those muscles work. Nerve impingement, or when tight muscles compress against the nerve, can also contribute to irritation. 

• Direct trauma. A fall, sports injury, car accident, or blow to the shoulder or upper back can affect the muscles or nerves around the scapula.

• Repetitive overhead activities. Sports like swimming, baseball, or volleyball — or jobs that require frequent overhead reaching — can strain shoulder blade muscles beyond their current capacity.

• Other shoulder issues. Conditions such as rotator cuff injuries or frozen shoulder can change how your shoulder moves, which may place extra stress on the muscles around your scapula.

• Post-surgical complications. Some procedures, such as lymph node removal or mastectomy, can affect nerve function around the shoulder blade.

• Muscle imbalances. Weakness, tightness, or poor coordination in the muscles that stabilize your shoulder blade can contribute to winging.

Symptoms of scapular winging

Scapular winging symptoms vary depending on the cause, severity, and which muscles are involved. Some people notice a visible change but have little to no pain, while others experience shoulder discomfort or weakness.

Common symptoms include:

• Visible protrusion of the shoulder blade, especially when pushing against something

• Difficulty or weakness when lifting the arm overhead

• Shoulder pain, especially with overhead activities

• Clicking or popping with arm movement

• Trouble with pushing movements, such as push-ups or opening a heavy door

• A feeling of shoulder instability or that your shoulder blade isn’t “sitting right”

• Reduced range of motion

• Pain or discomfort when lying on the affected side

How movement can help scapular winging

Scapular winging often responds well to physical therapy focused on strengthening and retraining the muscles that stabilize your shoulder blade. “You need movement — not rest — to engage the muscles, which helps ease pain, improve range of motion, and aid healing,” says Dr. Asprec.

The goal is to help your shoulder blade muscles work together again. Targeted exercises can improve muscle activation, shoulder blade control, strength, and positioning over time. This movement-based approach gives you an active role in recovery instead of waiting for symptoms to improve on their own.

A physical therapist can assess which muscles need support, identify movement patterns that may be contributing to symptoms, and create a progressive exercise plan that meets your body where it is.

Consistent practice of these shoulder exercises can help retrain your shoulder blade muscles to work together effectively. Most people see gradual improvement over several months with dedicated exercise therapy.

The information contained in these videos is intended to be used for educational purposes only and does not constitute medical advice or treatment for any specific condition. Hinge Health is not your healthcare provider and is not responsible for any injury sustained or exacerbated by your use of or participation in these exercises. Please consult with your healthcare provider with any questions you may have about your medical condition or treatment.

Treatments for scapular winging

Most cases of scapular winging can be fixed with simple at-home treatments, including physical therapy, targeted exercises, and activity modification. Here are common scapular winging treatments.

• Try physical therapy and targeted exercises. Targeted exercises can help strengthen the muscles around your shoulder blades, improving shoulder stability and function. You can do exercise therapy at home or work with a physical therapist who can guide you through movements tailored to your needs. You can see a physical therapist in person or use a program like Hinge Health, where you may access a PT via telehealth/video visit.

• Activity modification. Movement is important, but you may need to temporarily adjust activities that aggravate symptoms, especially repetitive overhead movements. The goal is to keep moving within a comfortable range and find your movement sweet spot, or the point where you feel challenged without straining.

• Try over-the-counter (OTC) medication. Pain relievers such as ibuprofen (Advil, Motrin), naproxen (Aleve), and acetaminophen (Tylenol) can help ease pain so you can do your targeted exercises and stay active when you have shoulder pain. Other options are topical NSAIDs or pain relief creams. If you have a medical condition or take other medications, check in with your provider to make sure these OTC options are ‌safe to take.

• Nerve recovery time. If nerve injury is involved, some natural healing may happen over six to 24 months alongside exercise therapy. “Using the muscles around the injury helps stimulate the nerve, aiding in healing,” says Dr. Asprec.

• Consider lifestyle modifications. Factors like sleep, stress, nutrition, and certain activities can all play a role in how you feel. In fact, many people are surprised to learn that pain isn’t just about what’s happening physically — your daily habits and overall well-being can have a real impact, too. Staying curious about how your routines affect your muscles and joints can help you identify where small changes might help reduce pain. For example, you might notice your pain is less noticeable on low-stress days.

• Consider complementary treatments. Talk to your provider if you’re interested in trying alternative treatments for shoulder relief, such as massage, acupuncture, or chiropractic care.

• Ask about TENS therapy. TENS, or transcutaneous electrical nerve stimulation, uses gentle pulses to quiet your pain response and help reduce pain from scapular winging. One option is the wearable device Enso, available through Hinge Health. It’s small, wireless, and portable.

• Surgical options. In rare cases, severe nerve injuries may require surgery, such as nerve or muscle transfer. This is usually only considered if there’s no improvement after one to two years of consistent physical therapy.

How long does it take to fix scapular winging?

There’s no one set timeline for healing scapular winging. It depends on what’s causing it, how long you’ve had symptoms, and how consistently you’re able to do your exercises. Many people start to notice improvements in how their shoulder feels and moves within a few weeks of regular exercise therapy, but fuller changes in strength and control often take several months.

If your scapular winging is mainly due to muscle weakness, stiffness, or changes in how your shoulder blade muscles are working together, a tailored exercise program is usually very effective. A physical therapist can help you gradually build strength and control in the muscles around your shoulder blade and upper back, while also working on posture, mobility, and day-to-day activity modifications. Staying active and doing your exercises regularly is one of the most important parts of recovery.

In some cases, a nerve that helps control the shoulder blade muscles is irritated or injured. Nerves tend to heal slowly, and some natural recovery can happen over about six to 24 months. While this is happening, you don’t have to just wait it out. A physical therapist can show you specific exercises to keep your shoulder blade and upper back muscles strong and flexible. These exercises help other muscles support your shoulder blade, improve how your shoulder moves, and may support nerve recovery over time.

Tips to manage scapular winging

Managing scapular winging successfully involves regular exercise, smart activity adjustments, and patience with the recovery process.

• Be consistent. “Exercise is the go-to treatment for scapular winging, but you need to stick with it to get results,” says Dr. Asprec. Small, regular efforts often matter more than occasional intense workouts.

• Progress slowly. Start with gentle movements and gradually add more challenging strengthening exercises as your shoulder adapts.

• Stay active. Modify certain activities so they don’t aggravate symptoms, but don’t eliminate movement. “Inactivity can make the joint stiff and may lead to other problems like frozen shoulder,” says Dr. Asprec.

• Listen to your body. “Don’t force anything that doesn’t feel comfortable,” says Dr. Asprec. “Listen to your body and move within your comfort zone. But don’t rest it completely, either.” A physical therapist can help you find that balance.

• Track your progress. Notice small wins, such as lifting your arm higher, pushing with less discomfort, or feeling more control around your shoulder blade. These changes can help you stay motivated during a longer recovery.

• Be patient. “It takes time, especially to notice changes in appearance,” says Dr. Asprec. “This can be frustrating, but it will improve with consistency and effort.”

When to see a doctor

Scapular winging often improves with physical therapy and targeted exercises. But if you have sudden, severe winging after an injury, rapidly worsening symptoms, or no improvement after several months of consistent exercise therapy, see a healthcare provider. It’s also a good idea to get care if you have:

• Severe pain that limits daily activities

• Inability to lift your arm

• Numbness, tingling, or visible muscle loss

• Sudden arm weakness

• Winging that developed suddenly after trauma or surgery

• Concerns about whether your exercise program is right for your specific situation

PT tip: Think big picture

The work you do for scapular winging can support more than shoulder blade positioning. “Strengthening your shoulder blade muscles can improve your posture, help with neck and upper back pain, and prevent rotator cuff issues,” says Dr. Asprec. “It builds a foundation for overall shoulder health and good exercise and movement habits.”

How Hinge Health can help you

If you have joint or muscle pain that makes it hard to move, you can get the relief you’ve been looking for with Hinge Health’s online exercise therapy program.

The best part: You don’t have to leave your home because our program is digital. That means you can easily get the care you need through our app when and where it works for you.

Through our program, you’ll have access to therapeutic exercises and stretches for your condition. Additionally, you’ll have a personal care team to guide, support, and tailor our program to you.

See if you qualify for Hinge Health and confirm free coverage through your employer or benefit plan here.

This article and its contents are provided for educational and informational purposes only and do not constitute medical advice or professional services specific to you or your medical condition.

References

1. Martin, R. M., & Fish, D. E. (2007). Scapular winging: anatomical review, diagnosis, and treatments. Current Reviews in Musculoskeletal Medicine, 1(1), 1–11. doi:10.1007/s12178-007-9000-5 

2. Park, S. B., & Ramage, J. L. (2020). Winging of the Scapula. PubMed; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK541005/ 

3. Geurkink, T. H., Hamez Gacaferi, Marang-van, P. J., Jan.W. Schoones, de, H., Jochem Nagels, & G.H.H, R. (2023). Treatment of neurogenic scapular winging: a systematic review on outcomes after nonsurgical management and tendon transfer surgery. Journal of Shoulder and Elbow Surgery, 32(2), e35–e47. doi:10.1016/j.jse.2022.09.009

4. Park, S. B., & Ramage, J. L. (2020). Winging of the Scapula. PubMed; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK541005/

5. Srikumaran, U., Wells, J. H., Freehill, M. T., Tan, E. W., Higgins, L. D., & Warner, J. J. P. (2014). Scapular Winging: A Great Masquerader of Shoulder Disorders. Journal of Bone and Joint Surgery, 96(14), e122. doi:10.2106/jbjs.m.01031