Some time ago, on the Victoria's Secret catwalk, the world's top supermodels, carrying beautiful "angel wings", walked through the long catwalk to show their beauty to the public.
In addition to the wings on the clothing decoration, they often have a pair of "wings" on their backs, just like the picture below. Many women who love beauty want to emulate it and give it a beautiful name - butterfly shoulder.
However, in medicine, the "butterfly shoulder", that is, the winged shoulder, is not a sign of health and may cause many problems in the body.
So, what are the causes of the winged shoulders and what kind of harm will be caused to the body. How should the evaluation, manual loosening and motor rehabilitation be carried out during the clinical treatment of the winged shoulder?
Take a look at our sharing today.
<h1>First, the definition and causes of the winged shoulder</h1>
First of all, let's see, what is a winged shoulder?
The "winged shoulder", also known as the "butterfly shoulder", is an abnormal scapula state.
Normal shoulder blades are pressed against the chest wall. The appearance of the very obvious lower angle of the shoulder blade is upturned, which is the so-called "wing-like shoulder".
So, what are the factors that can cause the winged shoulders?
Here, we mainly analyze it from the perspective of muscle imbalance.
I. Pterygium-like shoulder due to anterior serration injury
▼ Anatomy:
The anterior serratus arises from the outer side of the first to nine ribs. Stops in the inner lateral side of the scapula and in front of the lower corner.
The anterior serratus is innervated by the thoracic nerves of the brachial plexus, and a winged shoulder may occur if the brachial plexus is severely damaged.
II. Pterygium-like shoulders caused by weakness of trapezius and anterior serratus
The trapezius muscle starts from one-third of the upper neckline, the extraoccipital bulge of the neck ligament, the 7th cervical spinous process and all of the thoracic spinous process and supraspinous ligament, and ends at the shoulder peak and scapula at one-third of the outer third of the collarbone.
As the most dominant supracular scapular sylloscopic muscle, if the trapezius and anterior serratus muscles are weak, a state of subscapular schischil rotation will occur, and the lower shoulder blade angle will be closer to the spine.
III. Pterygium-like shoulder due to anterior serration injury
In the muscle chain, the rhomboid muscle interacts with the anterior serratus. When the rhomboid muscles are tense, the anterior serratus does not play an upper syringe, resulting in more angles of rotation under the scapula. Winged shoulders appear.
IV. Pterygic shoulders caused by pectoralis minor muscle tension
The pectoralis minor muscles start in front of the third to fifth ribs and end at the scapula beak process.
The pterygium-like shoulders caused by pectoral muscle tension are the most aesthetically affected. Tension in the pectoralis minor muscles causes the scapula to be in a state of forward extension, descent, and downward rotation, and the lateral view is manifested as a state of upturned lower corner of the shoulder blade.
<h1>Second, the harm of winged shoulders</h1>
In fact, in addition to affecting the appearance of the winged shoulders, it will also cause pain or lesions in the body. For example:
▼ If the anterior serratus injury is more severe, it will cause chest pain in the patient, and the pain will worsen during deep breathing (the anterior serratus is an auxiliary suction muscle), and the patient will feel pain in the ribs;
▼ In the superior crossed posture, the anterior serratus is prone to weakness, while the thoracic long nerve walking on the anterior serratus can cause fascial entrapment on the surface of the anterior serratus;
▼ After the occurrence of anterior servis muscle fascia syndrome, patients will reflect "shortness of breath" or inability to breathe deeply, and it is difficult to finish a sentence in one breath when speaking;
▼ When the shoulder blade is extended forward, the pain is aggravated. The scapula rhythm is easily disturbed by anterior serration injury.
▼ If the anterior serratus cannot stabilize the position of the scapula on the thoracic cage well, the scapula will move randomly, which can easily cause shoulder joint impact syndrome.
▼ The shortness and reduced function of the anterior serratus can easily strain the latissimus dorsi muscles overuse, and also overload the neck respiratory muscles such as the angle muscles and sternocleidomastoid muscles. Therefore, if the damage to the anterior serratus is not completely resolved, the patient's back pain problem cannot be completely resolved. Although anterior serratus injury also causes excessive contraction of the remaining cervical auxiliary respiratory muscles, respiratory compensation due to diaphragm injury is more common.
<h1>Third, the evaluation steps of the winged shoulder</h1>
So, how should we evaluate the winged shoulders?
Step 1 Posture assessment
The normal subscapular angle is close to the chest wall, and the upturned subscapular angle of the shoulder in visual examination is a manifestation of the winged shoulder.
Step 2 Palpation assessment
Assess the position of the scapula from the distance between the lower shoulder blade angle and the chest wall. The normal scapula is a straight line between the upper corner of the shoulder blade and the lower corner of the shoulder blade, the upper corner is on the outside of the inner lower corner, and the distance from the lower shoulder blade angle to the spine is 4 fingers.
The subject stands upright, and the tester is detected by manual palpation. Observe the spatial position of the lower shoulder blade angle and the upper shoulder blade angle, which should normally be vertical, and the lower shoulder blade angle is slightly lateral in the upper shoulder blade.
Step 3 Action Mode Evaluation
Clinically, many musculoskeletal pain cannot be assessed by testing muscle strength, but the degree to which the muscles are activated in the completion of the action pattern can be assessed by the action pattern.
Here we introduce the "push-up action evaluation mode" for everyone:
The patient is in a prone position with his legs straight and prepared for push-ups. Observe the presence of winged shoulder blades during slow push-up movements.
△ Photo taken in the Xth session of the Neck and Shoulder Training Course near Perfect Ridge, Instructor: Zhai Tianjun
<h1>Fourth, the manual treatment and rehabilitation training of the winged shoulder</h1>
So, what should we do with the winged shoulders caused by muscle imbalances?
▼ Winged shoulders caused by diamond muscle tension and anterior serratus weakness
For anterior serration muscle weakness due to tight diamond muscles, the rhomboid muscles should be loosened before excessive to strengthen the anterior serration muscles. The specific operations are:
The patient is in a prone position. The therapist stands next to the patient's head, facing the patient's back. Place your fingertips on the medial border of the shoulder blade and point to the outside. With the other hand, lift the patient's shoulder at the plenumulum joint while inserting the finger under the shoulder blade. Relax sequentially along the inner edge.
▼ Pterygic shoulders caused by pectoralis minor muscle tension
For scapula upturned when the pectoralis minor muscles are tense, the pectoralis minor muscles can be released by hand to quickly improve symptoms.
At the same time, it can also be combined with motor rehabilitation to achieve the purpose of improving the winged shoulders:
▼ Rehabilitation Training 1:
The patient is lying on the side, and the therapist bends the patient's shoulder front to 90 degrees with one hand and places the other hand on the lateral edge of the shoulder blade. Ask the patient to straighten their arms and try to extend forward all the time. People with poor muscle strength do not need to exert force in the shoulder blades.
△ Action guidance: Chiropractic near perfect exercise rehabilitation division - Zhai Tianjun
▼ Rehabilitation Training 2:
Stand up straight, push the ball on the front side with the hand bent forward 100 degrees (arm straight)
▼ Rehabilitation Training 3:
Choose an item that is level with your waist and push your hand straight forward. Be careful not to bend your forearms during the motion.
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