• Milger P Plaza Meza, Theodorakys Marín Fermín, and Nicola Maffulli.
• Department of General Surgery, Hospital Universitario Periférico de Coche, Av. Intercomunal de El Valle con Calle Zea, 1090 Caracas, Venezuela.
• Br. Med. Bull. 2021 Dec 16; 140 (1): 23-35.

BackgroundWinged scapula (WS) is a critical complication of axillary surgery in patients treated for breast cancer, and is associated with pain, impairment of the upper extremity's function and poor performance in daily activities.Sources Of DataA systematic review and meta-analysis were performed following the PRISMA guidelines. Two independent reviewers searched PubMed, Embase and Virtual Health Library databases from January 1, 2000 to December 1, 2020. Clinical studies evaluating the diagnosis and epidemiology of WS among breast cancer surgery (BCS) patients were included.Areas Of AgreementThe diagnosis of WS relies almost entirely on physical assessment. Studies have suggested a high variability in the report of the incidence of WS given the subjectivity of its diagnosis, and the different criteria used during clinical assessment.Areas Of ControversyThe diagnosis of WS in BCS patients remains a challenge given the lack of standardized diagnostic protocols. Physical examination cannot rely on one manoeuvre only, as it may overlook patients with subtle injuries or overweight and contributing to the underreporting of its incidence.Growing PointsBCS patients undergoing axillary lymph node dissection experience a significantly higher incidence of WS than those undergoing sentinel lymph node dissection. The global incidence of WS after BCS is 16.79%. Additionally, the anterior flexion test and the push-up test are the most commonly performed diagnostic manoeuvers.Areas Timely For Developing ResearchFurther studies should aim for objective diagnostic tests, especially when the condition is not evident.© The Author(s) 2021. Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

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