The athletic trainer and the patient devised a plan that 
included rehabilitation and limited practice to 
manage the patient’s pain. The patient had some pain 
relief while adhering to the plan, so participation in 
competition was allowed. During the uneven bars 
warmup at the first competition of the season, the 
gymnast had another dislocation episode and follow-
ing, the patient was not able to participate in competi-
tion. It was at this time the patient and the athletic 
trainer decided the patient should be referred to the 
team physician for diagnostic imaging.
The patient saw the team physician and in their 
clinical evaluation, it was noted that the severe 
scapulothoracic dysfunction was affecting function of 
the entire shoulder girdle with activities of daily 
living. The team physician ordered an MRI to deter-
mine presence of labral abnormality and an EMG 
was also ordered to evaluate neurologic causes of 
winging. While awaiting the MRI, the patient was 
allowed to participate in sport to tolerance and 
continue with rehabilitation. The EMG was negative. 
The MRI (Figure 3) demonstrated evidence of both 
anterior and posterior labral tearing. The patient 
demonstrated no improvement in daily symptoms or 
scapular winging with continued physical therapy. A 
diagnostic intra-articular injection was performed 
which allowed the patient to demonstrate improved 
motion and above shoulder elevation.  Based on this 
information, it was proposed that the patient was 
suffering from multidirectional instability and labral 
tearing, with her scapular winging occurring as a 
secondary or compensatory process. As such, the 
patient underwent surgery, and a circumferential 
labral repair was performed. After surgery, the 
patient was in a sling for 6 weeks and then could 
begin light range of motion exercises. Once light 
range of motion was started, the patient was in the 
sling for another month and then started light rehabil-
itation with the surgeon. Eight months post-operation 
is when the patient was able to begin strengthening 
exercises. The patient decided to not return to sport 
due to the complicated nature of her case and 
surgery. Even though  she did not return to 
FIGURE 1: Static image demonstrating medial scapular winging of the 
left shoulder
FIGURE 2: Left shoulder elevation (winging)
Right shoulder elevation (no winging)
19

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