Athletic Thoracic Outlet syndrome/scapular winging/ shoulder impingement
 

Hi guys,

I'm new here, never started a thread before, but I'm looking for some guidance. Okay here goes, so 3 years ago after starting university I developed this horrible ache in my shoulder, I had a single strap bag that I would carry all my books in and would constantly sit at my desk hunched over to study. I also was doing a rigorous weight training program with no real guidance (I was 18 and didn't know it was possible to be hurt). The combination of these things are what I believe pushed me into this situation. Over the last three years I have had highs and lows ranging from absolutely crippled to just a slight itch/pain in my left shoulder.

My symptoms are (both arms but way worse in left):

-dull aching pain in my left shoulder that has made me strongly consider cutting off my arm
-pins and needles only while sleeping in some positions
-terrible pulling feeling from my neck, through my shoulders, under my bicep, and into my fingers whenever I hold my arm out at my sides (adduction)
-Scapular winging or S.I.C.K scapula which can be determined by its resting position or prominence of the inside edge of the scapula sticking out both at rest and with movement. (As diagnosed by PT and orthopedic surgeon)
- severe scapular depression
- popping clunking and crunching from my shoulders, neck, and scapula

As far as tests go I have had
-neck MRI (normal)
-nerve conduction study at rest (normal)
- shoulder MRI of only the left side (tendonosis of the supraspinatus, mild inflammation of the subacromial bursa, and labral cysts associated with a small labral tear. These symptoms are commonly found in those with shoulder impingement syndrome)


Okay so my question is this:

Could my scapular winginging be the cause of all this? Or is it a symptom of a problem in my neck or something (i question this because my neck MRI was normal). Has anybody else had similar discomfort coupled with scapular winging? How about shoulder impingement, could that be caused by winging? If so what are some things I can do to help this? I already do upward rotation shrugs to improve my depressed scaps and wall slides for my serratus To improve scap position. What else can I do? Am I attacking this the right way? If you guys direct me toward articles and other threads I would really appreciate it, I would also love to hear your stories. I sometimes forget what its like to feel completely normal, there are good days and bad days. I appreciate any input you guys, thanks.

I am not a medical professional so I can't give you much specific advice, but I can relate a bit of my story. Sadly, your story and mine have some common threads, but since you are younger you may be in a better position to get well.

I am 29, with a wide array of upper body problems including thoracic outlet syndrome, cubital tunnel syndrome (probably related), pain in my neck and scapula, and intermittent pain in my lower back and right glute. But the problems started when I was 17 and doing a lot of, wait for it, weightlifting without a proper instructor.

Like I said I'm not a professional, so I only feel comfortable giving general advice. How is your flexibility? How is your muscle balance? Posture? Do you breathe correctly (into your diaphragm instead of into your chest)? Have you seen a skilled physical therapist or other professional bodyworker who could assess some of these things? If you haven't, I recommend it. I also recommend sticking with it until you find someone who is highly skilled, analytical, and willing to listen. I had a lot of early diagnoses when I was your age that basically went like this: "You have tendinitis, you're young, it will clear up." It only got worse. Had I seen the right people 8 or 9 years ago, I might be in much better shape now.

Check out our sticky threads too -
at the upper portion on this link- green circle Icons with arrow on them-
http://neurotalk.psychcentral.com/forum24.html

Have you looked into shoulder nerve injuries? I think, for example, the long thoracic nerve supplies the serratus anterior muscle. When this doesn't function properly, it can cause winging of the scapula.

As mentioned above, I'm not a doctor. There are probably lots of conditions that can cause your symptoms (the more I read, the more possibilities!) Have you seen an orthopedic doctor who specializes in the shoulder?

Hey! Welcome to the crappy club that apparently doesn't exist.
Your dull ache, desire to lop off your ow arm for escape, and neck pulling sounds Real familiar to me. And forgetting what it was like to be human once.
I hope you find help soon, but just steel up to do a lot of self advocating, and convincing doctors that it actually Does friggin hurt. There are surprisingly few docs that are familiar with winged scapula outside of text books.

I have a very similar issue, a totally debilitating TOS that began after dislocating my arm and developing a really intense winged scaupla. I could hold oranges under the damn thing if I could control the muscles around it. It looked like a shark fin. It could have also been my unguided weight training, extensive backpacking, carrying kayaks on my shoulder, working as a jeweler, or stage tech where I would hold about 100 lbs over my head for a few hours. Hard to tell, and it's taken me 2 years of no longer being able to do daily care to begin convincing doctors it's real. SICK scapula diagnoses, chronic dislocation, TOS, and it spread to my left arm about a year in my desperate pleas for help. I just had capsular plication surgery to make my shoulder stop popping out and winging, but the PT to regain my range of motion further irritated my nerve issues, and now it's Winging again! AH!

Did any direct trauma or dislocation precede this?
What sort of shoulder MRI did you get? (No contrast or arthogram?)
What was tested on your EMG?
Where is/what do you mean by scapular depression?(The depression sounds worrisome as possible wasting. As crappy as that is, it Will give doc a definite thing to trace back to the source of the issue)
What sort of doctors have you seen thus far?
Do you have pain and cramping under your arm? Around your scapula? Between both scapulas?

Now.. It's totally possible that the winged scapula itself is contributing to the issue, especially if it's winging medial and turning upward, your shoulder rolling forward. This could your clavicle to narrow and compress your brachial plexus on your first rib (that's my deal). It does kind of put things in this crappy cycle where you can't control the muscles to pull back your shoulder, so it rolls forward compressing the space and aggrevating you scalenes, which irritates the nerves that allow you to pull back your shoulder.
However, it may not be the root of your issue. If it's been going on so long you may have developed other compressions or muscle hypertrophy in your neck. For me, all the the PTs I saw to try and get my scap to sit down made the issues with scalenes WAY worse.

My research material on this subject has become quite extensive in my years of trying to find some answers, but I'll dig up some of the most relevant ones for you soon.
Try to stick to scholarly articles if you can (google scholar is a gem) and check out Long Thoracic Nerve Injury and Quadrilateral Space Syndrome. Look in to your impingment theory as well (although it would likely be the impingment, which caused the winging, which made the symptoms more severe)

I have a few posts floating around on here about my battle with winged scapula hell, and Please feel free to hit me up with any questions or if you want to vent.

Good advice there. I'd look in to this one more thoroughly. I have similar sx but my nerve conduction/ emg test were normal. Eleven years later neurosurgeon requested they were redone before putting in a spinal cord neurostimulator. Of course, they found long thoracic nerve palsy and chronic dennervation of anterior serratus muscle! Apparently, it's commonly overlooked as they do not test far enough down the nerve tree. Too late for me to look at any remedial surgery, though may have been from the start as likely mechanism was traction.Good luck, booklover

Hi!!!

Yes I did have an injury that sent me into this situation. I dislocated my shoulder multiple (like 20) times over the 6 years that I played linebacker when I was younger. I never had problems until I decided to finally go for the surgery and have my labrum repaired. After that surgery my good arm developed the dull ache of death and I haven't been able to shake it for 3 years. Like what the hell?

My shouder MRI was no contrast. I'm pretty sure that all of the issues in my shoulder that were found by my MRI are what cause the eternal dull ache.

My EMG tests were done to test "nerve conduction and velocity"

The scapular depression was something a random physiotherapist mentioned months ago. He said that my upper trap was likely extremely weak and strengthening it should alleviate my symptoms. I did, and still do upward shrugs to isolate my upper traps and they have helped a lot. Not even close to fixing the problem, but helped.

I have seen 3 massage therapists, 2 chiropractors, 3 general physicians, 4 physiotherapists, 2 ortho surgeons, and a neurologist.

Overall my pain is a consistent 3/10, I have not had less than a 3/10 since I was 17 years old. Sometimes the dull ache can decide to go nuts and get to a 5 or 6/10. I get sharp pains between my shoulder blades sometimes and my shoulders, neck, and scapulas all crack and pop and clunk. I hope its my winged scapula causing all this, that would mean that there is still a chance to have a normal fun life, I mean Jesus can't a guy just go lift weights with his friends? Also yes, the dull ache sometimes sits in my armpit and just drives me insane. I would say of all the different forms of discomfort that come with this injury, the dull ache is the king.

Thanks so much for contributing your experience to the thread. We will figure this out and hopefully one day have no need to even be on these forums.

Oh wow. So there is nothing for you to work towards as far as improving symptoms? I wasn't aware that nerve injuries were so permanent. So let's say, in the event that I do have an injury to the long thoracic nerve, would my only option be surgery? I absolutely HATE surgery. everything about it. Electing to have surgery on my shoulder is what put me into this situation in the first place.

Im responding to everyone by pressing reply on each post but it isn't posting? Am I doing this wrong?

Welcome to NeuroTalk!

You're doing just fine!
Sometimes there can be a short delay.

I'm not a good person to ask about surgery of LTN as in Melbourne Australia when I injured the LTN 20yrs ago-there wasn't the expertise here to even get any advice it's so rare. My understanding is surgery would only help for impingement/ obstruction.

My focus has been on functional restoration through clinical pilates, neurophysio /bobath technique, occupational therapy etc. Still pain remains a major issue for me and poor use of arm in raised position. However, I have hardly any winging after all my hard work and it makes a big difference to function at waist level. Don't be disheartened, my anatomy made me susceptible to developing bilateral TOS over time so your situation may have a much more optimistic outlook. booklover

Okay good!!

What about your anatomy made you susceptible? Do you have that rib? Im glad to hear that you are improving your situation. Do you feel that its possible in your future to retun to 100% normal function?

This is upsetting. So you just learned to live with it? Do you feel like it limits what you do day to day? Has anyone on earth actually had TOS/shoulder impingbment type stuff and been cured? If this thing is for life I wont be able to handle it as I get older

Apparently I had an extra cervical disc (a long Neck) and developed fibrous bands on either side to support it which squashed my arteries and nerves. No I have a lot of permanent damage done before the decompression, which is one of the risks of long term compression of sensitive structures. That is, they don't fully recover once you release the pressure. Besides, I had the traction damage as well. The most recovery usually occurs in the first year or so following surgery...I can't really comment further on alternative to surgical options as an active strategy as i only put it off because of risk to right arm as I only had partial use of left...booklover

Hi Booklover, I seem to have injured my LTN in a fall from a bike several years back and have been working on reactivating my right serratus. I can feel a muscle contracting beneath my armpit even if i move my right arm up. Does that mean I can rehab the muscle? Any idea of teh time I'd take and the specific exercises and other muscles to focus on along with it?Also what wre your symptoms. Mine are bilateral TOS, right is (i think) due to serratus issue. Left is due to injured longus colli which is not stabilizing my cervical spine. I have constant pain in my right shoulder/neck area, I think overstressed levator and upper trap and also a supraspinatus injury probably.

That's wild! It's kind of nice, but also a real bummer to hear from someone else who developed this madness through chronic dislocation. Despite what I've read in medical literature, talking to doctor's you would think it's about as common as people being bitten by werewolves.

I'm glad you got the labrum work done. MRI with contract (arthogram) was something I was going to suggest to test for an overlooked labrum injury, which is a not uncommon cause of this kind of pain and dysfunction.
Did the issues develop while healing from the surgery? Laymens guess from a fellow bum arm, however you were holding your arm pre-surgery plus while weakened after surgery could have put a lot of strain on your neck, levator scapulae, etc, pinching/irritating the nerves.

I know my winging scapula started to develop from the dislocation stretching and pulling on my long thoracic nerve, coupled with holding my arm up protectively and using my neck muscles to lift it instead of my back.
(It popped out multiple times a day for almost 2 years and got so bad I would dislocate it trying to get dressed or scrubbing myself in the shower.
It got Gross! One PT dry heaved when trying to do the maneuver to pop it back in and my arm just fell in to place and popped out the back with no resistance. Sounded like putting a truck in to gear, Hahaha!)
When I finally got surgery, capsular plication, to cinch that sucker back in there my nerve problems got WORSE because my neck was again forced to do all the work, and my arm was pulled forward by the sling. 2 year of holding it up with my neck and I couldn't let it go slack in the brace.
The doc even anchored my shoulder capsule to my scapula to stop the winging.. but the body finds a way and the shark fin is back.

If you can find someone to do it, it may be worth trying to get the EMG again. Did they just test your arm, or did they put the needles in your ribs and upper back as well? It took a literal yelling argument with one of my Dr's to even get them to test the long thoracic nerve, which is a hard one to accurately test. Even if they do, most EMG's seem to just test for "ON" or "OFF" and not measure any level of dysfunction in between. Which, as you seem to be experiencing, leaves a lot of room for issues. There's a lot of people on here who mention multiple failed EMG's, only to have them re-done years later and show major issues that were missed and Could have been fixed if only someone looked a littler harder.

Keep an eye on that shoulder dent. Especially if you PT mentioned it could be from a weak upper trap. That would be a major contributing factor you the pain in between your shoulder blades, meaning your rhomboids are working double due to the weakness of your upper trap. I'm fighting this same battle in PT now. It's hard to get the balance back if your nerves aren't sending a strong signal to the muscles in that area, and hard for the PT to tell when you're compensating with rhomboids or using your trap.
And that dull, tennis ball like ache in the arm pit my PT says is my serratus anterior muscle basically endlessly spasming. If you still see you PT, maybe they can help focus on that muscle to get you some relief.

I hope you keep pushing to get someone to take this jazz seriously! It helps a lot to go in to the Dr's ready to guide them in a new direction, rather than letting them guess and send you through another round of unhelpful PT.

Here's a few more articles for your perusal:
[Edit- ugh, it won't let me submit links yet]


Also, getting TMJ treatment with a special TENS unit (delivered some other kind of shock than the usual) from my desist has helped A LOT, although the relief if temporary, it calmed my cramping shoulder down.

Snapple, would you have an idea about my question above?

Yeah I havent met anyone who has developed this from shoulder instability so I feel pretty unique. I would rather dislpcate my shoulder every day for the rest of my life than have 10 more minutes of nerve stuff though.

And YES how did you know? Half way through shoulder recovery all of these symptoms started popping up.

About my EMG my experience was ********. Pardon my language. The 80 year old neurologist just could not take me seriously. At the time I was 18 and running track, she looked me up and down and saw a healthy teenager who was whining about nothing. She did the tests on two of my fingers on each side then sent me on my way. When I brought up the long thoracic nerve/scapular winging she said thats a disorder that only occurs in older women with hunched posture. So yeah Id like to go back but how? Every doctor says its already been done theres no point in doing it again. And the wait for the first appointment with a neurologist was around 8 months.. Im done waiting for months-years for appts and having people tell me im 20 and should stop complaining.

i want so bad for this to just be serratus anterior weakness so I can strengthen it and start rock climbing again. Also because the outcomes for surgery are so poor that there is no point in even getting one in my opinion.

Whats ypur activity level like? How do you stay in shape? How do you sleep? Do you think its possible for you to reach 100% recovery? What exercises are you currently doing to ward off symptoms?

I basically jut run about 80 miles a week and do core every other day to stay in good enough shape. I find the days where I work out and do core I feel the best and I get the worse symptoms when I hang out on campus and study all day.

Thanks so much for the message. I really appreciate talking to anybody who even remotely understands what its like.

Im curious about this too. If my LTN is compressed or injured could I just get the muscle firing and heal it that way?

Akash- This is a tough question! I wish I had a time line or a definite idea of an end point for you, I'm still hacking out this jungle myself.

My PT seems to be of the mind that the constant cramping sort of thing, while crappy, Can have its benefits in that your muscle isn't atrophying even though it's hard to control. There is still Some signal getting through to it. I guess it really depends on how damaged you LTN is, and how long ago the injury was. There are surgeries where docs transfer the thoracodorsal nerve to the serratus anterior to make it work again, but that's usually done when it's palsied.
When that muscles Does start freaking out, especially if you had a traumatic injury associated with it, it throws your body in to this weird hell cycle. LTN injury causes scapular winging and trouble holding the shoulder up> shoulder rolls forward compressing brachial plexus and straining compensating neck muscles> narrowed brachial plexus/over worked neck compresses and irritates the nerves that hold your shoulder up. Rinse, repeat, lay on the floor in pain.
With your other familiar symptoms though, it's probably a good idea to pursue docs or PT focusing on a brachial plexus injury or compression, even an atypical TOS presentation (I'm going through this battle right now). The LTN goes through the scalenus medius and hypertrophy or spasming really irritates it. Especially if your neck stabilizers are injured, making it very likely you've developed a kyphotic posture or are just over working your scalenes to make up for it. A lot of the TOS treatment deal with mainly the Anterior scalene which, in my experience, does jack all for helping the LTN symptoms.
My serratus freaks out whenever I try and lift my arm, and my PT helped confirm that this was from my initial guarding behavior of the injured arm and without the resistence and pull of my serratus anterior my levator scapulae and neck muscles were doing all the lifting for me. They're just not built for that kinda work!

Def go see somebody, someone who specializes in posture physical therapy if possible too. Most PT's will put you through the paces of strengthening your rhomboids and upper traps to make up for your wacky serratus anterior, which may work for you if you haven't tried it. Lots of core strengthening and mid back exercises as well.
All the winged scapula specific work in my case wound up only further irritating the neck and shoulder support muscles causing a lot more dysfunction, but the core work did make it so I have Amazing abs for a shut in, Hahaha. Still, everyone on here has such a unique injury and background, just cause something fails for one person doesn't mean it won't be the key to relief for another. Try to keep zen about it though and be pushy with your PT if it's not working.

jzp119- (Forgive the long reply, I've been stuck in bed all day with the demon arm and am a little vocal on the ordeal.)

Kind of, sort of, maybe with the LTN. Like I mentioned, it's variable depending on your specific injury, anatomy, and duration. It could work! Most docs aren't used to dealing with LTN injury, even less accustomed to LTN injury without palsy. A stretch injury is too often approached as either it gets better through PT strengthening the supporting shoulder muscles, or you wait until there's some major measurable damage and deal with that. This is only commentary through experience and research however, while the reality of dealing with it is Immensely dependent on your doc's experience and interest. The board still won't let me post links, but I'd be glad to PM you and Akash, or anyone, some medical articles.

The appreciation goes both ways. It's a weird relief to just hear of someone outside of a dated medical publication who can confirm that yeah, this happens.

And right to the guts with your climbing worries! I was still free climbing and rigging about 6 months in to my injury (bad plan), and the betrayal of not being able to trust my grip, or Thinking of life where I'm just.. Done. Purgatory. I mention this to every doc. It's apparently important to set a standard of the activity level you want to return to when dealing with an injury only 80yo hunchbacks get, and like you am tired of being passed off and told to limp it.

I think your docs and my docs hang out at the same country club together.
WTF!? Even with a history or dislocation?! That's just.. ugh.. I'm sorry dude. You got hosed.
With this last experience it, logically, shouldn't be too hard to convince an orthopedic doc or a neurologist to send you back for another EMG. (I've been through 3, in varying levels in apathy and disinterest, and every one said THEY were doing it the way it should have been done while testing totally different things.) However, the situation unfortunately is rarely based on logic, more so on your insurance or age or interest of the doc. You always have the option of not mentioning or excluding the results of your last test to the next doc. You could remind them how operator specific EMG results are. If focusing on the scapula is going nowhere (mine didn't) ask about your neck, brachial plexus, scar tissue, etc. Try some lidocaine injections, acupuncture, all that jazz, which you shouldn't need an EMG for that kind of post traumatic pain treatment. If you're at a 3/10, that's pretty awesome all considering, and you may find a lot of success there.

And I feel ya man, it takes forever to get in with someone. Followed by the soul crushing moment of being brushed off. I'm at 46 docs now, the first 34 of which were a constant loop of people collecting my office visit fee and immediately telling me I was someone else's problem. I've had docs blow me off without even examining me (kept a tally first 34 docs, sometimes 2 at a time, only 12 were willing to touch my shoulder), send in their secretaries instead, one dude said my dislocation was purposeful and I was looking for attention, another one literally threw his pen and said "We're done here!" when I argued against his treatment plan of resting my 2yo injury. One trip to the ER after a Really bad PT left me unable to breathe, the doc told me that sometimes his arm hurts too and it's not that big of a deal. It took a year and a half to find someone who agreed that my constantly dislocating arm was gross, a problem, and probably also very painful. About half of that was waiting. You'll be told you're drug seeking, complaining, making it up, etc, but ya gotta get your life back somehow. I was 28 when I got hurt, and still had all my muscle mass the 1st year or so, and got the same blow off of too young, too healthy. Who knows what the cut off point is of "old enough to hurt". Now I'm withered husk I get accused of drug seeking, even though I refuse pain rx. Don't let someone's professional problems keep you from having an arm.

Try not to be too hard on the surgery too. The most vocal people are the ones it didn't help, but a lot of them are not at your activity level, or motivation, or health. People who it helps just.. don't need to talk about it anymore. A lot of people on here have mentioned how important it is to find the Right surgeon too, and it makes sense, as nerve injury after shoulder trauma is apparently at the same reporting rate as being abducted by aliens. Famous athletes, pitchers, rowers, etc get that jazz all the time and go back to doing what they do. I have one friend who was back to body building the week after surgery. Still, I've also had docs tell me I'll Never go back to sports and climbing, or lifting heavy things is not something little girls like myself should be doing, and why would I ever kayak again after what I've been through? (One doc suggested I'd be much happier sewing and I wouldn't have to do so much physical labor if I just found a husband. Super!) It's a gamble but you'll know when they stakes are high enough.

As for activity level, you're on a whole different planet than me currently! Keep doing what you're doing, as it may have a lot to do with keeping your pain level down. Take note of your positions and posture while studying, it may be a bigger deal than before. I do think it's possible to fully recover. More reasonable to Mostly recover. PT seems to agree despite my bug-sprayed-with-raid lifestyle. I crushed my hand in a work accident like 9 years ago and was supposed to lose 2 of my fingers, but I got that back to full function through stubbornness. What's an arm?
Sleep is near impossible (note the post time) as no matter how I position myself, I can't seem to find a way to calm my arm or relax my neck. The current best is on my good side my with the bad arm propped parallel to my chest, neck slack, or with my bad side slightly propped on a pillow allowing my scapula to fall in to place and my levator to relax. Previously I could only sleep on my chest with a pillow pushing my shoulder in to place, so try this too.
I hope you don't have the same affliction, but based on your asking, seriously get someone to look in to your neck muscles/brachial plexus. There's symptoms and then there's SYMPTOMS, and serratus anterior, LTN, shouldn't be keeping you up consistently. That points to issues further up the nerve network.
My current activity level is similar to that of Howard Hughes, where I'm confined to the house and bed most of the time. I lived full time on the road, and about a year in I had to leave my job, my house, everything and have my Mom come pick me up from half way across the country because I couldn't consistently do daily tasks. About 6 months ago I stopped being able to drive at all and loading the dishwasher is akin to fingernail torture. Before that I was doing acrobatics, construction, stage work, kayaking, rucking, rigging and lifting even with the bum arm, I think that's what helped stave it off for so long. I ran a Lot up until recently. It helped distract my neck and shoulders from cramping, and when that started to fail I switched to barefoot which worked Amazingly for a while. After shoulder surgery the bouncing weight of my arm became too much.
Now I'm on old lady level. I do a lot of meditating, modified yoga, biofeedback, and low impact resistance work for my core, shoulders, and neck. I have PT 3x a week, and If I'm feeling wild I walk my dog. I used a rake the other day and my family prepped for me to be totally incapacitated for the following week. It's. Maddening. I'm clearly not in a place to give solid advice on how to keep the symptoms at bay, but the best I can offer is keep your activity level high and keep limber while still being patient with your mortal body. Coming to a full halt is going to make recovery a lot harder whatever path you wind up going down.

Yes please send articles!

Purgatory is the perfect word for it. Just done. I know exactly what you mean. I feel like Ive just lost the last 3 years without doing the stuff I really like doing. Doctors dont really seem to care though? Like as long as we can painlessly lay in bed and eat cheetohs were healthy enough for them. Its brutal, I just want to climb stuff and lift things for once.

The idea of getting another EMG makes my skin crawl. Just thinking about it in terms of wait times til I even get scheduled for an EMG, then the doctors follow up, would take 10-14 months alone. I likely wont be feeling better, like back to normal better, for a very long time. Sigh.

What bothers me the most is that its always "youre young it'll heal" but when I imevitably have the exact same symptoms in 30 years they'll say "youre 50! Thats what happens when your 50!"

Im sorry about your healthcare experience. The whole thing is BS. Like wtf? There are people that smoke, eat bad food, never exercise, do drugs, drink excessively and they get amazing health care to improve their quality of life. But active people under the age of thirty have their nerves being compressed and we can get help???? I swear to god in a hundred years they will look back on the treatment that TOSers got and shake their heads. Seriously, rest it? My entire life is "resting it".


A real medical doctor suggested that, because you're female, you should not do anything active? Holy ****, Its like if the 1950s could manifest as one single person, it would be that doctor. I hope he crashes his porsche.

And the surgery can be successful. But there are literally thousands of posts on here about it making people worse, and not a single success story of return to competetive sport or real athletics/fitness. I would think if they were out there, at least one success story would be on one of these forums just to say, hey im better, I know I would. Most docs tell me that regardless of whats wrong, having a problem for 3 years will have irreversible side effects. But wait.. You had a friend who.. Actually got better.. Like real weight lifting bodybuilding? Completely back to normal??? I need to know more about her situation. Did she have the one where just the vein is pinched? Those people seem to have better outcomes. This is one of the best things ive heard in a long time. I was under the impression that this was a death sentence.


And im so sorry about losing so much because of this, i completely understand how you feel. It's extremely hard to handle. developing nerve atuff as an athlete/heavy worker is almost worse than if you were a non athlete. In your case you had so much more to lose compared to the average hunchback computer desk folks. This is one of my biggest pet peeves as well with explaining this disorder to people. Like im interested in RETURN TO PREVIOUS ACTIVITY, not being pain free so long as I NEVER use my arms. I feel so much empathy for you because I totally understand losing so much of your identity to this.


As far as sleeping goes, the only way I can sleep is if I do some combination of upper trap work, lower trap work, serratus work, roll my chest with a lacrosse ball, foam roll my upper back, and stretch everything as good as possible. I also HAVE TO sleep on hard floor on my back with almost no pillow. It sounds crappy but im used to it now and the floor helps my symptoms alot. I find that I feel amazing in the morning for about an hour then eventually my shoulders go to hell. I dont know what you've tried to improve sleep quality, but Doing some exercises and stretches and sleeping on hardwood on my back got me back to sleeping normally, its progress. Honestly my symptoms get brutal when I even lay on a bed or a couch for more than 20 minutes. Anything with cushion is a no go.


There has to be a way to reclaim previous quality of life. This cant just be it. Please PM me! I would love to talk back and forth. Its hard to read a long post and not forget to include something while replying. So forgive me if I did!

Also I wanted to ask. My Neck MRI came back normal is this unusual? Should I get a fancy brachial plexus MRI or something?? I dont know what tests are even left for me. Thanks for the advice!!!

The problem is the medial scalene has the LTN pass through it. I believe that's what caused the serratus dysfunction to begin with and then causes cramps later!! I massaged side of my neck heavily and lo and behold my serratus cramp reduced to literally little on raising my arms.

I dont have the serratus cramps.. Doesnt sound fun. Do you or does anybody else have a super tight nerve twingey feeling when you hold your arm straight out to your sides?????? I hate that so bad

I do - in my index and second finger.

It is extremely limiting, but I have not yet "learned" to live with it. That is, I have not given up on getting better. The pain problems have forced me to quit my career and go back to a lower paying job that is less physically stressful. They have also affected relationships and my ability to live where I want.

But complaints about all of that aside, I am still focusing on ways to cure, or at least reduce, my symptoms. I have been on a steep learning curve for the past year, as before that I thought I mostly had elbow problems.

I haven't come across people who are exactly cured, but I have come across people who have gotten their symptoms under control, corrected some of the underlying body problems, and are now living normal lives. Giving up is not going to help.

I'll be obsessed with fixing myself until I'm 100% pre injury level. I don't see myself giving up on getting back to completely normal. i like your attitude. I would definitely call mine managed so long as I stay in my boundaries ie) sleeping on the floor on my back, running as much as possible, no heavy upper body strength building, doing physio exercises every night forever. But in my opinion thats BS, we should be able to find a real solution that solves the problem, not just managing it. I mean christ most of us just had some bad posture for a while, we should be able to get back to normal.

That is an amazing post. So much of it applies to me that its freaking scary. The forward shoulder, the symptoms, the kyphotic posture, the neck and Upper Trap, Levator and Rhomboid pain.

I managed to reactivate my serratus this year. Some luck and manual mobilization from a PT of my thoracic spine.

However, your post brings up a very valuable point. You see massaging my medial scalene turns down the serratus cramps on occasion. So million dollar question, how does one "shut off" the medial scalene and how did it get facilitated to begin with?

In my case, there was a severe whiplash/muscle injury especially on the left side of my neck. Could the right side be compensating for the weak left side.

Would strengthening the deep cervical flexors, extensors and neck extensors help to make the medial scalene tone down, in turn letting the tensioned LTN ease up.

My biggest problem is I am in a place where TOS familiar PTs are next to impossible to find. The handful of PTs I have met who are empathetic are so overworked its next to impossible to get time with them. Others, can't help.

I am doing everything on my own, basically with the help of folks like you to provide tips.

Since serratus is already weak, the problem is that rhomboids are probably already strong and overdominant. Antagonists being strong would further weaken the serratus effect. Also, we want to improve our upward rotators. Rhomboids are downward rotators and adductors if I remember correctly.

My other idea is to strengthen the rotator cuff - infraspinatus, supra, teres minor and subscapularis. Guess being that it would take some of the load off the upper trap and levator.

My guess is that more upper trap and levator get overworked worse it is is for us, since they drag on the delicate cervical spine and irritate the structures all of which seem to have nerve endings.

On the other hand, I wonder if strenghtening the upper trap is required if the serratus continues to misfire and is weak.

One thing I have learnt (and I KEEP FORGETTING) is that i shouldnt read/sleep with my head propped up on a pillow, moment i do so my hands start burning up. I wonder whether that is because scalenes activate causing scapular instability or because the neck flexes forward too hard because deep flexors are weak compressing the cervical roots themselves.

I also have a disc bulge at C6-C7 but doctors tell me that is not the issue.

Please do send articles and any PT that has helped, protocol and the logic behind it, and most importantly what was your impression of what worked and what didn't!

That's how I am navigating.

I wonder though if we are not approaching this from the ground up, whereas we should be looking from the top down, ie the cervical area. The scalenes and the c-spine need to be switched off/fixed for the nerves downstream to do what they are meant to.

Do add me to the PMs!

Regarding doctors /medical professionals. Met all sorts. Including one quack who told me my symptoms were all in the head, was insulting and then said "TOS heals in a few months, nobody has it for more than 2 months". I kid you not. The quack is down the road from me and I have learned to be very polite and mostly keep my irritation in check. However, I finally snapped and told him he didn;t have a clue of what he was speaking and got up and left, as I was leaving he started panicking & told me I was obviously well read, bla bla and he did want to help bla bla. One thing I have realized, even the medical field has no shortage of buffoons and on top of it, many get arrogant. Some want to help but don't have enough knowledge or are out of date. Some are too busy to give you the time that is required. Some are just money minded. The knowledgeable practitioner who is in the field to help people is so overworked he can barely manage the time to see us.

Sorry for the delay in reply. I've been down with the demon arm again. I try not to post when I'm in so much pain or wallowing in crapulence, it's not productive for anyone, hahaha.

So first, the biznatch end-

Akash- horray!!! Some relief!!
And sweet corn casserole! Ya know, positive doctor TOS stories are fun days at the DMV. How can Al Roker poses a new mortal body with litter repercussions, and people who want to hold their heads upright lift their arms, and consistently take deep breaths are wasting valuable medical time?
It's not like this has been an identified condition before even anesthesia and hand washing were trendy or anything..
... If you cannot tell by my references I don't have tv or get out much anymore

Interestingly, none of my current docs will admit to this, and I don't have any document to verify she wasn't messing with me, bit a previous ortho once told me that the 90 maneuver , a typical diagnostic for anterior scalene compression, is sometimes relieving for middle and posterior, Scalenes , long as the elbows don't go over the shoulders.. Just interesting..

Anyhoo! I'm culling the data collection now. Please let me know if you have any interest or preference in research, as I have a hit of a collection after having to self advocate for so long.
It will take a bit for be get back to chair pose to send them out to you guy, but they not forgotten!
I have a science background as well and deal mostly in academic publications, but I can find you some other stuff as well if you prefer.

Also if you like can send you some links to some medial scalene self relief techniques that have been very effective for me.
There can be a very fine balance in the neck massage, although I hope you're nerves are not at this point. Sometimes it seems like once you find something that finally works and brigs relief it Turns on you after a few days!! Augh!! There is a science behind this tho.
Basically your nerve cells have something called an action potential, which is the ability of the nerves to get exited and send an impulse from one end to another. When a nerve is irritated (but not fully compressed or cut off, measurable on a emg a Lowered through No velocity) its action potential goes up so to speak. It takes Less stimuli to activate the nerve impulse. Whether it be cramp, or 'sleep' or twitch, or general freak out, it really takes very little to set it off. This is why muscle hyper trophy, scar tissue, fibrous bands, posture, surgical slings, and that goddam 1st rib cause so many issues in the Grand Central Station that is the brachial plexus.
And, for better or for worse, our brains are Very adaptive to certain stimuli, much like you don't feel the constant sensation of wearing your clothes. Our brains however are hard wired Not to shut off that blinking"problem" light. So what what suddenly distracts one day fails the next. Less becomes more.
Long winded, but I hope this helps you understand your tricky neck more.

And Yes! Compensation could be a huge issue! And yes! Strengthening your deep cervical flexors Could possibly take pressure off your Scalenes! This is a big favor is ergonomics and, posture adjustment, occupational therapy, all that jazz. The compensation likely extends past your neck, into your shoulders, mid back, hips, and even feet depending on on how long it's been. (Compensation for chronic creepy shoulder would up tilting my hips waaay to my right. Pt for that Didn't fix my shoulder or tos, but solved the killer migraines). Scalenes are meant to be stabilizing muscles, for jostling rocking, leaning, etc. They're your struts, but injuries and postures easily put them in control, and they are Full of nerves.
If you're already out of whack, than getting your neck back in to shape is something possibly best supervised. I've learned hard what feels "right" after a while is really screwy and it's good to have someone supervising.
Also, someone stopping you in those dark "I just want my head back" moments where you try to do All the exercises ever..

It is Amazingly hard to find a TOS pt. All of the people I have contacted in my long, drawn out saga promised to specialize in it but turned out to be utterly clueless upon signing the paperwork with them. There is the sticky post on here with the suggested PTs, but it is a little dated and a kind of insurance selective as I've found.
My current PT(#5) like yours, is totally baffled by the whole brachial plexus, tos, why you make faces when you lift your arms thing,, and suggested I contact my PCP about getting a second PT referral for someone certified through the postural institute http://www.npionline.org
People trolling the PT thread probably have some suggestions as well.
Also consider taking to a pain doc, physiatrist, etc about your continuing whiplash symptoms. This is a definite start point, and dx, which gives you a Lot more to work with than most! Those Scalenes can be shut off with medication such a gabapentin (ugh), Lyrica, topamex, or more than likely a trial injection of numbing agent followed by some Botox to shut the bad boy Down.

SOD, that makes two of us. I rarely if ever step out now for personal stuff. I didn't get all your references but I can google them up I guess. :)
I am based out of India where PT itself is a developing field and ortho docs decide everything and many as such don't develop diagnostics capability.

Thank you for your details. Do please send any references across - I am reading anything and everything and what you have is clearly sensible stuff.

1. I think I have some form of dystonia going on. On the left side, my deep cervical stabilizers are torn up, on the right side of the neck, weak. Scalenes overactive on both sides, right much more so. That spasm on both sides shut off LTN on right (causing TOS via scapular instability and not just scalene spasm). On left, it caused TOS via weak serratus and not completely switched off and general scapular instability + brachial nerve compression.
Blue hands and not just clawed ones mean vein compression either between clavicle and rib or Anterior scalene and SCm
Apparently, weakness on one side of neck makes other side flare up in hyper facilitation per weblinks to compensate.

2. My symptoms worsen when I flex my neck and my arms, upper traps all burn up when i flex my head down. I am wondering whether I have positional stenosis thanks to cervical cord compression as my disc bulge at C6-C7 acts up in flexion. MRI required but again, neck fusion surgery seems to be the answer and will only partly address my issues and not the scalenes. I am wondering whether this is the reason my upper traps spasm and not just the levator/rhomboid overwork due to a weak serratus.

My current method - I think - is to somehow activate my deep neck muscles and keep them up to switch off scalenes. Problem is neck flexion activates scalenes. I tried the Mc Kenzie neck retraction method, and oh boy, it helped my posterior neck symptoms but overactivated my front muscles, which coincidentally included those blasted scalenes and SCMs.

I did a lot of exercises to activate my serratus, and sometimes it works. But as long as the scalenes keep spasming, its a mugs game.

Please do send the medial scalene relief exercises or stretches. Thank you!!

Cripes!! I don't know why I keep writing novels as responses, it has apparently become compulsive, haha! Strangely therapeutic, and allows me to stretch my cramped nerd muscles. I hope these are helpful are at least entertaining.

Sorry for the continued delay on the medical texts. I have them bookmarked on my laptop, and a keyboard in a physical trail I can't even imagine taking on these past few days.

Akash- reread again at a more reasonable time of day, a little less exhausted, hahaha.
If you try out the posture work Def do it under the guidance of a pt especially if you have a cervical bulge, one better informed than your last batch. Although based out of India,I don't know which direction to send you in! I will trawl the net and see what I can find!
I'm really stunned that your disk bulge is being passed off as a non issue.
What?! Docs keep telling me my symptoms don't make sense/ they can't do anything Because I don't have a disk bulge! That's like.. Classic reason to have these kind of issues!
Time for a second opinion. Yeesh

Jzp119- which actually brings me to your MRI thing.
It's not that unusual and seems to be a pretty common story on here and with TOS. A lot of TOS diagnostic winds up being a process of elimination of more common pathologies, the top of the list being cervical radiculopathy and disk bulges. (Maybe more truthfully at the top of the list right under complaining too much and psychosomatic) Even the 'official' TOS/brachial plexus injury diagnostics are highly subjective in not only how they're preformed, but interpreted. This is especially true when the symptoms are largely neurogenic. Can't just take a swab and send it in to the lab.
A fancy brachial plexus imaging may have its place in your future, which push for an MRN which is going to look more at your nerve paths than soft tissue, but honestly unless the test shows a some Massive friggin train wreck of a result most docs don't seem to know what to do with this info.
I wound up pressuring a doctor into ordering an MRN for me because my symptoms were so Insane and no one seemed to have a guess and to what my next move should be. The results came up with nothing major, but noted irritation and issues along my C7, C8, and T1 root nerves (omg lower brachial plexus nerves controlling my arm scapula and serratus, wtfnoway!) They looked confused and affirmed that maybe there was a brachial plexus injury but they didn't know what to do.. Ugh! Sorry, tanget.
Point is, don't stress about more tests yet. Focus on finding help with symptom management. Finding out the "why" isn't necessarily the key to getting your life back and you may never have a satisfying answer of wtf is wrong with your should-scapul-neck.
With your pain level still manageable I would even stretch to say avoid allowing docs try and pass you off on the dead end of increasingly ridiculous tests, yet. At some point it become synonymous with "I don't know, go away". I know it seems like you've already tried a lot of things, but there's many different avenues of conservative treatments you could pursue. Injections, nerve meds, pain docs, etc. In the end medicine is still a Practice. Much like not every musician can make a song you like, not every doc has what it takes to deal with you. You've got a really solid chance a being taken seriously because of your history or trauma, and surgery. And although the pain is smearing Awful on every aspect of your life hasn't reached the everything is on fire point. It's harder to come back from burning wreckage. Consider your scheduling wait times in relative comparison to THIS. FOREVER. Makes 10-14 months seem like a burp. (Ps- 10-14 months?! Call someone else, they are trying to dissuade you from scheduling. ) pro tip- try to line up a couple at the same time, call and bother them every week and check for cancelations. Sometimes really works out time wise, and then you have a plan B when plan A turns out to be mystified by why your scapula levitates.

And damn, good call. Yea, my friend had a sudden onset blood clot style TOS from his body building and successful surgery. His neurogenic symptoms were minimal, but it didn't really go on long enough for him to explore the wide world of crap arm. He arm turned purple, hard surgery, bounced back fast.

Still. Remember, this surgery is a last resort. It wouldn't be suggested at All for anyone without a fairly significant success rate. No, not All surgeries work, but not All of these cases are caused by rib compression. Like I've word spewed, there's A Lot to this tiny space! A Lot that contributes to these issues. If your continuing symptoms Are caused largely by cervical or 1st rib compression, or associated scar tissue, anterior scalene compression, and lower brachial plexus fibrous bands, there is documented between a 50-80% success rate of full recovery after surgery. That's some damn good odds that look even better compared to the odds of laying on the floor in pain every day based on the last few years. As in 1/1, as in That, my friend, is the death sentence. If people can compete in the Olympic on metal spatulas for feet you can climb again as long as you can stop Hurting for a while.

And yea, some doctors truly DNGAF, or think you're lying, or a hysterical woman (maybe not in your case) but it's not the norm. Most just dunno. The complexity and subjectivity, as well as desire Not to be wrong and avoid liability pushes a lot of them when dealing with TOS brachial scapular weirdness to the realm of shrugging and making you someone else's problem rather than taking the responsibility of making the call themselves. It's the same reasoning behind the miraculous ability to help people much less healthy than yourself.

Think of it this way..
If you go to the mechanic and tell them your car is shaking like crazy, the steering is out of control and pulling all over the road, and it makes a terrible noise while driving.. That could really describe any number of things very clearly. If the mechanic takes a look at your car and you have a flat tire (ie- smoking, age, obesity, sedentary lifestyle, bad posture) the issue is probably the tire! Its smarter to try fixing that before ripping apart the transmission or the cv joints, and you'd be pretty cheesed if they did amassive overhaul first when you could have just swapped it for a spare in your driveway.
So if you brought your car in, mechanic said change your tire, again, which you Know is fine.. You'd go another mechanic, wouldn't you?

And I'm totally with you, squishy chairs, beds, pillows, or curved back chairs are Death!! I have a hard mattress which has kept me ok. Canvas military cots are also the best things ever.

Hey jzp119
We could be in a similar situation, however it's been 10 years I've been trying to fix this and finally now I'm gonna go all out to fix it. It may require me traveling to US from Australia as there doesn't seem to be a lot of experts here at all.

What set me off to get serious about this was reading about Baseball pitcher Chris Young and how he made a complete recovery from similar symptoms to mine. Link; tos.wustl.edu/en/Patient-Features/Chris-Youngs-Story

My case;
- 33 year old male
- Football, surfing and martial arts non-stop growing up
- Around 22 I hurt my shoulder lifting weights
- Diagnosed with torn rotator cuff (supraspinatus)
- Never really healed despite $$$ spent on PT etc.
- PT had me doing painful neck stretching causing pins and needles (This may be the source of my problem)
- Realized my scapular is winging and my shoulder is a few inches higher
- Winging seems to be Dorsal Scapular Nerve related (Rhomboids/Lev Scap) as my serratus seems ok and the winging itself is subtle
- EMG says everything normal except 'Borderline changes in Rhomboid/Levator Scap.'
- MRI etc. no problems found
- Neurologist baffled and wants to show me to his colleagues
- All up I've prob seen 20 doctors and PTs
- Kept training in the gym fpr last few years with progress being 3 steps forward 2 steps back. i.e. Make progress one week>symptoms flare up>I lose strength>start again>repeat
- Symptoms are; Dull ache, heavy arm, pins and needles in fingers, shoulder clicking, shoulder arm weakness
- I always get this burning in neck area and a strange burning/pulling feeling in my trap/neck when I sit at a computer


Had some frustrating days but I'm pretty confident I'll get it fixed. Basically now I'm ready to do whatever it takes to get it fixed, will pay anything to go overseas and get the surgery. Will try here first but it's not looking good so far. I will keep you/this thread updated, hopefully you can do the same.

This pic of a model illustrates one of my main problems, I have built my trap muscles up significantly but on the injured side there is a chunk missing (the bit up near the neck that runs at an angle). Possibly levator scapula.

Can someone post this I don't have enough posts
i.imgur(dot)com/JHV5wsH.jpg

Holy ..
This is what I just discovered my pain area is:
http://www.physio-pedia.com/File:Self_Exercise.png

Supraspinatus pain. It just won't go away.

And my symptoms to a T:
- I always get this burning in neck area and a strange burning/pulling feeling in my trap/neck when I sit at a computer

And:
- Symptoms are; Dull ache, heavy arm, pins and needles in fingers, shoulder clicking, shoulder arm weakness

I think I injured my Supraspinatus or the nerve itself when I fell with my arm outstretched.

Can you tell me some of the PT you did?

Before you move to the US, I'd suggest you seek out Lynn Watson, she is a PT with TOS experience from Australia with several papers to her credit.

Cant a rotator cuff surgery fix your issues -the pain at least?

Here is the pic you wished to reference:
http:// i.imgur.com/JHV5wsH.jpg