scapular winging can help determine if it has been caused by muscular imbalances, or if it is a compen- satory mechanism to underlying instability. In gener- al, secondary scapular winging resolves after treat- ment of the primary condition.4 As such, determining the true nature of scapular winging is absolutely crucial to obtaining a good outcome. Successful treatment of circumferential labral tears relies heavily on interprofessional collaboration. Athletic trainers play a pivotal role in identifying persistent pain, instability, and abnormal movement patterns that may indicate underlying shoulder pathology. When conservative management, includ- ing rehabilitation, rest, and modality-based interven- tions, fails to yield improvements, referral to an orthopedic specialist is warranted. The diagnostic process may involve advanced imaging techniques such as MRI arthrography or CT scans, EMG, and surgical intervention if necessary. Postoperatively, physical therapists and athletic trainers work in tandem to restore range of motion, strength, and functional capacity, ensuring the athlete's safe return to sport. It is necessary to emphasize the importance of a cohesive team approach in managing complex shoulder injuries. A direct comparison of this case with the findings from Tokish et al. and Wall et al’s research, further illustrates the challenges associated with circumfer- ential labral tears. It was reported that among 41 patients who underwent circumferential labral repair, two experienced redislocation, and four had ongoing difficulties1. These findings highlight the potential for suboptimal outcomes even with surgical interven- tion. It was also found that while there were no significant differences in stability or function between circumferential and anterior-only repairs, 22% of patients in the circumferential repair group reported persistent pain, compared to 15% in the isolated anterior repair group.5 This suggests that while overall success rates are comparable, patients with circumferential tears may experience greater postoperative discomfort and a longer rehabilitation process. This case report underscores the challenges associat- ed with diagnosing and treating scapular winging in the setting of MDI and circumferential labral tears. The difficulty in recognition, combined with the potential for persistent postoperative symptoms, highlights the need for a multidisciplinary approach in managing these injuries. Understanding primary versus secondary causes of scapular winging can help choose the correct treatment pathway. Compari- sons with existing literature suggest that while surgical outcomes are generally favorable, patients with multidirectional instability may require longer rehabilitation and experience higher rates of residual pain. Moving forward, additional research, including larger case series and outcome studies, will be essen- tial in refining treatment protocols and improving the prognosis for athletes with this rare but significant shoulder injury. Clinical Summary This case highlights the diagnostic and treatment challenges associated with MDI and scapular wing- ing particularly in high-level athletes. Given the rarity of these injuries, the sports medicine team may be less familiar with their presentation, highlighting the critical need for increased awareness within the athletic training community. Athletic trainers play a fundamental role in recognizing persistent shoulder pain, instability, and compensatory movement patterns that may indicate underlying instability, and early identification of instability can help prevent progression of disease. The failure of conservative management should prompt further evaluation through advanced imaging and specialist referral. Additionally, rehabilitation professionals must be aware of the prolonged recovery timelines and the potential for incomplete return to function. Author information: Mercedes A. Himmons, PhD, LAT, ATC, CES, PES Email: himmonsm1@southernct.edu Anthony Eacuello, LAT, ATC Email: Eacuello707@outlook.co Eric Padegimas, MD Email: epadegimas@ct-ortho.com Jordan Gruskay, MD Email: jgruskay@ct-ortho.com 21
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