If she does have scapular winging, the entire shoulder blade will lift off of the rib cage. It is pretty obvious if this is the case (you can google images of a winged scapula and clearly see all borders). Often times, the winging will occur with overhead movements as well. As previously mentioned, this is typically a product of a weak serratus anterior muscle.
This could be from a number of reasons which range from poor recruitment all the way to long thoracic nerve injury. Scapulothoracic musculature (low trap, mid trap, upper trap, rhomboid, lats) and serratus anterior strengthening exercises would be performed in therapy to correct a winged scapula. Good luck.
Hey Matt, i personally wouldn’t recommend strengthening the downward rotators (low trap, mid trap, rhomboids, lats), since this would only make this Tug of war game worse. [/quote]
Odin, the middle and lower trapezius actually are upward rotators but also contribute to adduction and depression of the scapula. The thought process for all-around scapular stabilizer strengthening is to maintain the orientation of the scapula on the rib cage since, most often times, the serratus anterior isn’t functioning properly in a person with scapular winging and one of the functions of the serratus is protracting and stabilizing the scapula in addition to upward rotation. It is the premise of proximal stability of the scapula before distal mobility of the humerus. Of course when you strengthen all these muscles, you will end up strengthening some downward rotators (lats, upper traps, rhomboids). However, overall scapular stabilization over-rules the evils of strengthening the downward rotators since those patients with true winging scapulas as a result of long thoracic nerve damage are advised to avoid overhead movements, if possible.
You are right that overall scapular stabilization may be the best, and i agree that the lower and middle traps are also important in upward rotation, however i personally would first like to see that some of these aren’t already overdeveloped, since i’ve come across overdeveloped rhomboids, lower, and middle trapezius before in relation to the serratus and upper trapezius.
Upward rotation can be trained without overhead movements.
Thank you for the repost of that article. Good read!