Medial scapular winging is most commonly caused by an injury to the long thoracic nerve. However, there are cases, such as the one attached below, in which scapular winging may be caused by dysfunction of the serratus anterior muscle even in the absence of frank palsy. In many cases surgical treatment is not necessary. Chronic shoulder pain may ultimately result in the need for tendon transfer surgery to stabilize the scapula during forward elevation of the shoulder, and do address painful impingement of the rotator cuff that results because of the abnormal scapular kinemtics.

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