The functional role of the shoulder is twofold. First, the shoulder creates a sphere about which the hand is placed in space. Second, the shoulder provides a stable fulcrum enabling the arm and hand to work. The glenohumeral joint and scapulothoracic articulation work in concert to achieve these two shoulder functions. Scapulothoracic motion accounts for approximately one-third of shoulder range of motion. Disorders affecting the muscles that attach to the scapula and coordinate scapulothoracic motion or injury to the nerves that innervate these muscles can result in scapulothoracic winging and dysfunction. Scapulothoracic dysfunction can manifest as periscapular pain; cosmetic asymmetry; and diminished shoulder motion, strength, and endurance. Surgery may be warranted in patients with diminished shoulder function resulting from periscapular muscle dysfunction. If the periscapular muscle dysfunction is the result of an isolated muscle dysfunction, such as a long thoracic nerve palsy resulting in a dysfunctional serratus anterior and medial scapular winging, a tendon transfer may be beneficial to restore proper scapulothoracic function. However, if scapulothoracic dysfunction is caused by multiple periscapular muscle dysfunctions or function is not restored with tendon transfer, a scapulothoracic fusion (STF) should be considered to improve shoulder function, reduce periscapular pain, and enhance cosmesis.