Is pushing the wall, the best known method for scapular winging, really the best? A Comparative analysis of various methods in neuromuscular disorders.

INTRODUCTION: 'Pushing the wall' has found acceptance in medical teachings. Other methods of scapular winging are less known. Comparative evaluation of the five available methods has not been undertaken. This study focuses on evaluation of the available methods in groups of neuromuscular disorders to select the most sensitive method and to characterize patterns of scapular winging. A survey of methods practiced by clinicians also forms a part of the study.

MATERIALS AND METHODS: Prospective study. Part A: questionnaire based survey of clinicians to explore the preferred method of examination for scapular winging. Part B: comparative analysis of five methods of scapular winging in four categories of neuromuscular disorders [facioscapulohumeral muscular dystrophy (FSHD), limb girdle muscular dystrophy, dystrophinopathies and neurogenic disorders].

RESULTS AND CONCLUSIONS: Forward lowering of arms was the most sensitive method [100%]. The use of this method in clinical teachings and routine bedside examination should be promoted. Pushing the wall was the most popular method, but was fourth in the sensitivity [60.41%]. Arm maneuvers can bring out winging, when it is not apparent at rest. FSHD patients had a unique combination of winging at rest, persistence of winging throughout the range of motion and elevation of scapulae.