Winging of the scapula due to long thoracic nerve palsy is a common diagnosis and should be treated as a significant functional problem. It must be recognized that scapular winging is not simply an aesthetic issue; the compensatory muscular activity required to improve shoulder stability is associated with secondary pain and spasm due to muscle imbalances and tendonitis around the shoulder joint. Other described resultant anomalies include adhesive capsulitis, subacromial impingement and brachial plexus radiculitis.

The physical examination forms an important basis for management and evaluation. The physical examination typically reveals medial deviation of the inferior angle of the scapula and prominent winging of the medial border of the scapula with backward pressure on the shoulder as in pushing off a wall. Superior elevation of the scapula is also noted. Overhead movements of the arm and shoulder cause significant discomfort and feelings of shoulder instability; many patients are unable to flex or abduct the shoulder beyond 90 degrees (shoulder level).