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Weird Anatomy of the Shoulder Blades


#1

Hi friends,

This is a strange query. Last night I was working out with my gf and we were doing push-ups.

She can only do them with her hands out wider than her shoulders and not any closer. When she attempts to bring her hands in closer to shoulder width, her shoulder blades get closer to each other as she declines, and physically stops her from doing a push-up.

Is this an anatomical dysfunction or she is not doing something properly??

nb: She used to be a highly competitive swimmer and has crazy shoulder flexibility.

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#2

Hello, i’m guessing she might have a weak serratus muscle, although i am not sure, it might be worth checking out.


#3

[quote]Odin338 wrote:
Hello, i’m guessing she might have a weak serratus muscle, although i am not sure, it might be worth checking out.[/quote]
Thanks mate.

I did some extra research and looks like you are right. Is this the same as “winged scapula’s”?

Does anyone have any advice on the prognosis and treatment of such condition?

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#4

Google for: Musings on scapular winging: Anatomy (muscular and nerve), causes, and exercise considerations

She could indeed have a winged scapula, you can test this if you put her arm behind her back (internally rotated), and make her touch the lower trapezius with her thumb (as high as possible).

If this is the case, make her stop doing any exercises that downwardly rotate the scapula. Some exercises she should do are: Internal rotations (for the subscapularis, which probably is weak too), and front squat shrugs (for the serratus and upper trapezius).

Good luck, mate.


#5

If she does have scapular winging, the entire shoulder blade will lift off of the rib cage. It is pretty obvious if this is the case (you can google images of a winged scapula and clearly see all borders). Often times, the winging will occur with overhead movements as well. As previously mentioned, this is typically a product of a weak serratus anterior muscle.

This could be from a number of reasons which range from poor recruitment all the way to long thoracic nerve injury. Scapulothoracic musculature (low trap, mid trap, upper trap, rhomboid, lats) and serratus anterior strengthening exercises would be performed in therapy to correct a winged scapula. Good luck.

DPT


#6

Thanks guys.

I haven’t had much time to look into things and work out a “rehab” plan.

The other day I watched her back while she did push-ups, and the 2 shoulder blades pretty much almost cross over each other.

Very bizarre.

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#7

[quote]mattf3213 wrote:
If she does have scapular winging, the entire shoulder blade will lift off of the rib cage. It is pretty obvious if this is the case (you can google images of a winged scapula and clearly see all borders). Often times, the winging will occur with overhead movements as well. As previously mentioned, this is typically a product of a weak serratus anterior muscle.

This could be from a number of reasons which range from poor recruitment all the way to long thoracic nerve injury. Scapulothoracic musculature (low trap, mid trap, upper trap, rhomboid, lats) and serratus anterior strengthening exercises would be performed in therapy to correct a winged scapula. Good luck.

DPT[/quote]

Hey Matt, i personally wouldn’t recommend strengthening the downward rotators (low trap, mid trap, rhomboids, lats), since this would only make this Tug of war game worse.


#8

[quote]Odin338 wrote:

[quote]mattf3213 wrote:
If she does have scapular winging, the entire shoulder blade will lift off of the rib cage. It is pretty obvious if this is the case (you can google images of a winged scapula and clearly see all borders). Often times, the winging will occur with overhead movements as well. As previously mentioned, this is typically a product of a weak serratus anterior muscle.

This could be from a number of reasons which range from poor recruitment all the way to long thoracic nerve injury. Scapulothoracic musculature (low trap, mid trap, upper trap, rhomboid, lats) and serratus anterior strengthening exercises would be performed in therapy to correct a winged scapula. Good luck.

DPT[/quote]

Hey Matt, i personally wouldn’t recommend strengthening the downward rotators (low trap, mid trap, rhomboids, lats), since this would only make this Tug of war game worse. [/quote]

Odin, the middle and lower trapezius actually are upward rotators but also contribute to adduction and depression of the scapula. The thought process for all-around scapular stabilizer strengthening is to maintain the orientation of the scapula on the rib cage since, most often times, the serratus anterior isn’t functioning properly in a person with scapular winging and one of the functions of the serratus is protracting and stabilizing the scapula in addition to upward rotation. It is the premise of proximal stability of the scapula before distal mobility of the humerus. Of course when you strengthen all these muscles, you will end up strengthening some downward rotators (lats, upper traps, rhomboids). However, overall scapular stabilization over-rules the evils of strengthening the downward rotators since those patients with true winging scapulas as a result of long thoracic nerve damage are advised to avoid overhead movements, if possible.


#9

[quote]mattf3213 wrote:

[quote]Odin338 wrote:

[quote]mattf3213 wrote:
If she does have scapular winging, the entire shoulder blade will lift off of the rib cage. It is pretty obvious if this is the case (you can google images of a winged scapula and clearly see all borders). Often times, the winging will occur with overhead movements as well. As previously mentioned, this is typically a product of a weak serratus anterior muscle.

This could be from a number of reasons which range from poor recruitment all the way to long thoracic nerve injury. Scapulothoracic musculature (low trap, mid trap, upper trap, rhomboid, lats) and serratus anterior strengthening exercises would be performed in therapy to correct a winged scapula. Good luck.

DPT[/quote]

Hey Matt, i personally wouldn’t recommend strengthening the downward rotators (low trap, mid trap, rhomboids, lats), since this would only make this Tug of war game worse. [/quote]

Odin, the middle and lower trapezius actually are upward rotators but also contribute to adduction and depression of the scapula. The thought process for all-around scapular stabilizer strengthening is to maintain the orientation of the scapula on the rib cage since, most often times, the serratus anterior isn’t functioning properly in a person with scapular winging and one of the functions of the serratus is protracting and stabilizing the scapula in addition to upward rotation. It is the premise of proximal stability of the scapula before distal mobility of the humerus. Of course when you strengthen all these muscles, you will end up strengthening some downward rotators (lats, upper traps, rhomboids). However, overall scapular stabilization over-rules the evils of strengthening the downward rotators since those patients with true winging scapulas as a result of long thoracic nerve damage are advised to avoid overhead movements, if possible.
[/quote]

So in layman’s terms, what exercises should she be doing and what should she be avoiding??

My knowledge of the anatomy of the shoulders and back is not that flash.

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#10

[quote]mattf3213 wrote:

[quote]Odin338 wrote:

[quote]mattf3213 wrote:
If she does have scapular winging, the entire shoulder blade will lift off of the rib cage. It is pretty obvious if this is the case (you can google images of a winged scapula and clearly see all borders). Often times, the winging will occur with overhead movements as well. As previously mentioned, this is typically a product of a weak serratus anterior muscle.

This could be from a number of reasons which range from poor recruitment all the way to long thoracic nerve injury. Scapulothoracic musculature (low trap, mid trap, upper trap, rhomboid, lats) and serratus anterior strengthening exercises would be performed in therapy to correct a winged scapula. Good luck.

DPT[/quote]

Hey Matt, i personally wouldn’t recommend strengthening the downward rotators (low trap, mid trap, rhomboids, lats), since this would only make this Tug of war game worse. [/quote]

Odin, the middle and lower trapezius actually are upward rotators but also contribute to adduction and depression of the scapula. The thought process for all-around scapular stabilizer strengthening is to maintain the orientation of the scapula on the rib cage since, most often times, the serratus anterior isn’t functioning properly in a person with scapular winging and one of the functions of the serratus is protracting and stabilizing the scapula in addition to upward rotation. It is the premise of proximal stability of the scapula before distal mobility of the humerus. Of course when you strengthen all these muscles, you will end up strengthening some downward rotators (lats, upper traps, rhomboids). However, overall scapular stabilization over-rules the evils of strengthening the downward rotators since those patients with true winging scapulas as a result of long thoracic nerve damage are advised to avoid overhead movements, if possible.
[/quote]

Someone else is recommending scapular upward rotation!

I could weep.


#11

[quote]mattf3213 wrote:

[quote]Odin338 wrote:

[quote]mattf3213 wrote:
If she does have scapular winging, the entire shoulder blade will lift off of the rib cage. It is pretty obvious if this is the case (you can google images of a winged scapula and clearly see all borders). Often times, the winging will occur with overhead movements as well. As previously mentioned, this is typically a product of a weak serratus anterior muscle.

This could be from a number of reasons which range from poor recruitment all the way to long thoracic nerve injury. Scapulothoracic musculature (low trap, mid trap, upper trap, rhomboid, lats) and serratus anterior strengthening exercises would be performed in therapy to correct a winged scapula. Good luck.

DPT[/quote]

Hey Matt, i personally wouldn’t recommend strengthening the downward rotators (low trap, mid trap, rhomboids, lats), since this would only make this Tug of war game worse. [/quote]

Odin, the middle and lower trapezius actually are upward rotators but also contribute to adduction and depression of the scapula. The thought process for all-around scapular stabilizer strengthening is to maintain the orientation of the scapula on the rib cage since, most often times, the serratus anterior isn’t functioning properly in a person with scapular winging and one of the functions of the serratus is protracting and stabilizing the scapula in addition to upward rotation. It is the premise of proximal stability of the scapula before distal mobility of the humerus. Of course when you strengthen all these muscles, you will end up strengthening some downward rotators (lats, upper traps, rhomboids). However, overall scapular stabilization over-rules the evils of strengthening the downward rotators since those patients with true winging scapulas as a result of long thoracic nerve damage are advised to avoid overhead movements, if possible.
[/quote]

You are right that overall scapular stabilization may be the best, and i agree that the lower and middle traps are also important in upward rotation, however i personally would first like to see that some of these aren’t already overdeveloped, since i’ve come across overdeveloped rhomboids, lower, and middle trapezius before in relation to the serratus and upper trapezius.

Upward rotation can be trained without overhead movements.

See: https://www.T-Nation.com/training/one-shrug-to-rule-them-all


#12

[quote]Odin338 wrote:

[quote]mattf3213 wrote:

[quote]Odin338 wrote:

[quote]mattf3213 wrote:
If she does have scapular winging, the entire shoulder blade will lift off of the rib cage. It is pretty obvious if this is the case (you can google images of a winged scapula and clearly see all borders). Often times, the winging will occur with overhead movements as well. As previously mentioned, this is typically a product of a weak serratus anterior muscle.

This could be from a number of reasons which range from poor recruitment all the way to long thoracic nerve injury. Scapulothoracic musculature (low trap, mid trap, upper trap, rhomboid, lats) and serratus anterior strengthening exercises would be performed in therapy to correct a winged scapula. Good luck.

DPT[/quote]

Hey Matt, i personally wouldn’t recommend strengthening the downward rotators (low trap, mid trap, rhomboids, lats), since this would only make this Tug of war game worse. [/quote]

Odin, the middle and lower trapezius actually are upward rotators but also contribute to adduction and depression of the scapula. The thought process for all-around scapular stabilizer strengthening is to maintain the orientation of the scapula on the rib cage since, most often times, the serratus anterior isn’t functioning properly in a person with scapular winging and one of the functions of the serratus is protracting and stabilizing the scapula in addition to upward rotation. It is the premise of proximal stability of the scapula before distal mobility of the humerus. Of course when you strengthen all these muscles, you will end up strengthening some downward rotators (lats, upper traps, rhomboids). However, overall scapular stabilization over-rules the evils of strengthening the downward rotators since those patients with true winging scapulas as a result of long thoracic nerve damage are advised to avoid overhead movements, if possible.
[/quote]

You are right that overall scapular stabilization may be the best, and i agree that the lower and middle traps are also important in upward rotation, however i personally would first like to see that some of these aren’t already overdeveloped, since i’ve come across overdeveloped rhomboids, lower, and middle trapezius before in relation to the serratus and upper trapezius.

Upward rotation can be trained without overhead movements.

See: https://www.T-Nation.com/training/one-shrug-to-rule-them-all[/quote]

Thank you for the repost of that article. Good read!


#13

Hey Matt, what would you do if targeting the serratus isn’t working well, because other dominant muscles take over, like when doing push up plus and the pectoralis major takes over to much?


#14

Odin,

My go-to serratus anterior exercise is the wall slide with neutral humeral position (pinky side of hands/forearms on wall). It allows for serratus activation by having them slide their hands/forearms up the wall by replicating shoulder flexion while also taking away the weight of the arms since they are resting on the wall. By taking away the weight of the arms, it can focus more on the serratus. At the top of the motion, you will feel a large stretch of the lats/pecs and the stretch will be even more with a large inhale at the top of the motion.

To amplify this exercise, you can hold a band in your hands and isometrically pulling the band apart. By pulling the band apart, you are activating the humeral lateral rotators ie mainly infraspinatus.

Another option is the serratus punch using a cable machine. The position is at 90 degrees shoulder flexion. Hold the handle at the end of the cable so that the resistance is pulling posterior and then punch the arm forward. It’s a very small motion since the rest of the body should stay stationary.

The push-up plus, which you mentioned earlier, is another good one however I feel it is the most difficult for precision because it does activate the pecs. A modification that can be made is to do them against the wall and not in the plank position.

If you have any others that you use, I’d be glad to know them!


#15

Matt,

Thanks for the advice, you are dropping some good ideas.

I’ve also been using a serratus bench press, however this also sometimes seems to get taken over too well by the pecs. Something else i have been using is basically an anterior shoulder raise using a small weight, and a neutral grip, which seems to hit the full trapezius muscle and serratus pretty well.

I find the serratus to be one of those muscles that is quite hard to hit, when you can’t really go overhead much, so i’m always searching for new better ways to hit that muscle.