“Scapular winging could be mistaken for a tumor, or vice versa,” says John-Paul H. Rue, MD. This is precisely what you were hoping NOT to hear: a cancer can be mistaken for a benign winging of the scapula bone.

Dr. Rue is an orthopedic sports medicine surgeon with Orthopedics and Joint Replacement at Mercy Medical Center in Baltimore, MD.

Not all tumors involving the scapula are malignant.

“A common benign tumor of the scapula is an osteochondroma,” says Dr. Rue. This means an overgrowth of the cartilage where it attaches to the bone.

An osteochondroma, however, can transform into cancer. What doctors look out for as a red flag for this is a cartilaginous cap on the tumor that exceeds two cm in thickness.

A younger person with an osteochondroma tumor is more likely to be misdiagnosed as having a winged scapula than is a middle aged patient, because this condition is more common in people 10 to 30.

An osteochondroma can cause scapular winging – but there are only a few cases of this described in the medical literature (Journal of Medical Case Reports 2012).

Dr. Rue continues, “This is a benign tumor which typically presents on the side of the scapula facing the body and can cause snapping or popping as it rubs against the chest wall.” Internal rotation and abduction (raising arm at the side, as in a dumbbell “lateral lift”) can bring on this snapping.

Cancerous Tumors on the Scapula
“Other tumors include chondrosarcoma, Ewing’s sarcoma, multiple myeloma and lymphoma,” says Dr. Rue.

Chondrosarcoma. Not only is this cancer extremely rare (400-600 cases per year in the U.S.), but only about seven percent of these tumors end up on the scapula. This means around 42 new cases per year affecting the scapula.

Ewing’s sarcoma. This tumor is exceedingly rare too. In general, Ewing’s sarcoma comprises four to 10 percent of ALL bone cancers, and affects the long bones and pelvis most of the time.

This cancer is “rarely seen before the age of 5 years and after the age of 30 years,” says the APSP Journal of Case Reports.

For 2016, only 3,300 new cases of ALL bone and joint cancer were projected (National Cancer Institute Surveillance, Epidemiology, and End Results Program).

Dr. Rue explains, “If there is an abnormal growth on the scapula, it’s important to have this evaluated by your physician. With some basic exam techniques, he or she can determine if it is scapular winging or something abnormal on the scapula itself. Radiographs and possible CT scan or MRI or bone scan may be needed as well.”

Scapular winging is not uncommon. If you suspect winging you should see an orthopedic physician.

Dr. Rue specializes in prevention and treatment of sports and exercise injuries. His primary focuses are knee, shoulder and elbow injuries including ACL and cartilage injuries, rotator cuff injuries and overuse tendonitis.
Sources:
ncbi.nlm.nih.gov/pmc/articles/PMC3546017/
sarcomahelp.org/chondrosarcoma.html
ncbi.nlm.nih.gov/pmc/articles/PMC3418025/
seer.cancer.gov/statfacts/html/bones.html