Tingling in scapula area & Is this thoracic outlet syndrome???
 

Hi All,
This is my first post, although I've happened upon this site many times while researching various solutions to my various ailments. So, hello all.

My most pressing issue has been tingling in the upper back area, near the right scapula, radiating from the T1 spinal process across my right upper back near the trapezius muscles. I've also been getting the sensation of numbness but not actual numbness near my middle back on my left side, in a band like section of the back. This has bothered me for the past year or longer. The neck issue came on gradually. At first it would happen a day here a day there, but for the past 4 months its basically been constant especially while sitting at a computer or any table. My girlfriend is a doctor and she says its probably a pinched nerve due to a forward neck posture while doing my job (strictly 100% computer work). In fact, I'm getting symptoms as I write. It's annoying but no pain at all, just tingling.

My primary care doc had an x-ray done and found very mild arthritis at C7/T1. so, there's at least a possible explanation for the symptoms, but of course, the doc doesn't provide a solution, just the results. Tells me to stretch the area!!! Not a very specific solution in my opinion. Orthopedist said that getting an MRI wouldn't really make sense. all it would tell me is that there's a pinched nerve and there's nothing you can do.

BUT, I want to find a solution nonetheless. Has anyone had such symptoms??? Can anyone offer advice on how I can fix this myself and/or who could help me??? Short of quitting my job and finding some non-computer related work, I don't know what else I can do to get a permanent fix.

Any advice would be greatly appreciated.
By the way, I'm a 36 year old male, 6'4", 220 pounds, active weightlifter, runner, and mountain climber, for what it's worth.

Thank you,
Joe

What I have found & learned over the years..

If you work at a desk you must work to negate the forward head/shoulder postures.

Do opposite postures often during the day.
Lay on the floor in the corpse pose - http://images.google.com/images?q=co...N&hl=en&tab=wi
as often as you can and for relaxation and use diaphragm breathing

possible hypertrophy of neck, back or ?? muscles?
Muscle imbalances pulling on the vertebra?

I would get a full evaluation with a expert PT or expert chiropractor to really find out how your spinal alignment is & they can do some tests to find out if it might be something spine related or soft tissue.

our useful sticky has even more saved info and videos therapy etc.-
http://neurotalk.psychcentral.com/thread84.html

Is this thoracic outlet syndrome???
 

Hi All,
For about a year now I've been experiencing the sensation of numbness and tingling on the left side of my middle back, which is confined to a section below my left scapula. I don't have actual numbness when I touch it, just the sensation of numbness, which in itself is annoying. There's no pain or weakness. I get the sensations when I bend over to do things like pick up objects, tie my shoes, and also when I'm lifting my arms in front of me and above my head. The symptoms are pretty much staying the same in severity, but in the last two days have becoming pretty much constant. I had gone mountain climbing over the past weekend and was carrying a 20 pound backpack for 7 hours on Monday. Maybe that aggravated the issue.

I had seen an orthopedic surgeon about 6 months ago and he declined to do anything for me saying that there's prety much nothing you can do when there's a thoracic nerve issue, and that surgery is only for those with extreme and constant pain. So I don't know whether its a bulged disc or just a nerve being pinched via another structure. Not sure if this is related but I've had a nasty habit of cracking my mid and upper back by bending to the left and right while seated or standing up. It feels good to relieve pressure but I'm worried that this isn't normal and that it might be causing the problem. But it's weird that my nerve issues didn't start until after 4 years of doing the cracking. I crack it all day because it feels good, but then the pressure rebuilds. I want to stop this habit.

Does this sound like thoracic outlet syndrome???

Does anyone else have experience with such symptoms? Do you think a chiropractor would help?

Thanks!

I merged your threads so replies would be in one place for you.

A surgeon mainly looks for surgical fixes, they don't specialize in soft tissue recovery.

Here are some subluxation charts/images - you can look at them to see what area they point to for your symptoms.
http://images.google.com/images?hl=e...=&aqi=&start=0

here's post that has our top 5 symptoms and another with a listing of all/ most of our symptoms -
http://neurotalk.psychcentral.com/post87845-18.html

It almost sounds like more of a T spine pinched nerve.

Do you have hand, arm, shoulder, upper back and neck pain along with the tingling?

here are the main medical sites with TOS info. It will help you to figure out if it is or not.

TOS info:
http://www.medifocushealth.com/RT017/index.php
http://www.nismat.org/ptcor/thoracic_outlet/
http://tos-syndrome.com/newpage12.htm
http://tos-syndrome.com
http://www.doctorellis.com

I think an adv PT or expert chiropractor would be of help .

Thank you Jo*mar....To answer your question I have absolutely no pain or weakness associated with the tingling. I'm glad that the only symptom I have is the tingling. In addition to sitting at a computer all day for work, I am a weightlifter, although I doubt my symptoms were from weightlifting because doing such an activity makes me feel better. I believe it has to do with sitting at a desk all day. To speak more to that point, I recently started working with a strength coach because I wanted to improve my lifting technique and to find ways to build more strength. When I had an initial consultation with him he noted a few problems. He said my shoulder girdle strength and flexibility was pathetic because I was sitting in a chair all day. He said if I didn't get that area up to par I could injury my shoulder doing certain lifts. So he's got me on a regimen to address the trapezius, rhomboids, rear deltoid, and triceps muscles. I'm hoping that greater strength in those areas will help to pull things back in line and reduce the tingling sensations, sort of counteracting the effects of a desk job. Another problem area he noted was that my hip flexors are tight because I can't squat down below parallel without bending way forward and losing balance.

Anyway, thanks for the links. I'll definitely be reseaching more about my issues. Also, I'm going to look into seeing a chiro. Pretty much can't get anywhere with my other docs.

Thanks again.

Based on where you are descringin the tingling, it could also be an impinged shoulder, especially where those backpack strips lay on your shoulder.

The suprascapular nerve could be impinged at the scaular notch. If it is it could be swollen and pressure from a backpack or mountain biking or even sleeping could aggravate. The fact that you describe relief when the pressure is relieved does sound like a pinched nerve.

Most orthos have a hard time finding this. They just dont ususally think to look at ths nerve first. Seek out a physiatrist and see if they can do an ultrasound of your shoulder. Believe it or not ultrasound is a new technology for the shoulder. MRI's cannot really catch a pinched nerve. Thats why they do a corresponding EMG which would show which nerve is potentially injured.

Welcome to NT

Sounds like you've got it going on, with the weightlifting and all.

Some thoughts for you.

I've recently moved a full-length dressing mirror at the side of my workstation. I call it the "posture police." :wink: I didn't know my head could advance that far from the axis of my neck.

I also used to use Kinesio tape often for my winged scapulas and back, neck, arms, thumbs, wrists. It's good stuff. It kind of retrains your muscles, ligaments and tendons and give you support too. If you try it, don't overstretch, as I found that caused muscle spasms.

Here is a link for that. It's used by a lot of athletes:

http://images.google.com/images?hl=e...Kinesio&aqi=g7

Keep in touch and let us know how you're progressing, what's helping, if anything.

Oh and depending on how long you might have been in the forward postures...

the muscles you named might have lowly stretched and the chest muscles have slowly shortened- so opening up those chest muscles will also help to re balance the shoulder girdle area.

Strengthening the back muscles alone won't do the trick, you must release/open the chest muscles also. The coach can probably verify/check to see if that applies or not.

Same age, body type and job: same problem
 

Joe,

I read this post and I have to say that I am shocked as to how similar my issue is to yours. I am a 38 yr old male, 6’4 235 lbs and I am a computer programmer. I have had a knot (trigger point) just above my left scapula that has been burning for over a year now. The tingling below the scapula is now constant whenever I am sitting.

I went to a rheumatologist, a neurosurgeon, MRI , xrays, nerve tests, etc. I have reversal of the lardosis of the cervical spine, spodilosys?, and disk degeneration pretty much in all the disks of the cervical spine.

I am completely functional and have no lose of motion or strength so both of the well known neurosurgeons in Miami say surgery is not advised. So I have been doing the PT to correct the forward head posture and my neck is much better but the shoulder issue is still bothering me. I am now taking Lyrica 150mg when the pain is unbearable.

It’s been a few months since you first posted, do you have an update?

Please free to contact me.
Raul

upper back tingling and numbness
 

Dear Joe,

The upper back, from the lower point of the scapuli, horizontally, all the way up to the crest of the shoulders and then down the upper chest to the axillary crease (where the arm pits start) and the arms and hands are innervated via the brachial plexus. The brachial plexus is a complex "bunch" of nerves deep within the shoulder. The brachial plexus gives off two nerves that go over the shoulder and they innervate the skin of the upper back and the muscles attached to the scapula. They are the dorsoscapular nerve and the suprascapular nerve. The "nerve pathway" goes from your upper back, via one of the two mentioned nerves, to the brachial plexus and then centripetally via the cervical nerve roots to the spinal cord and then up to your lateral brain, on the opposite side where your brain records various sensations of the skin.

Unfortunately, most physicians first think about the cervical spine as the source of such disturbances, but, you know, cervical spinal surgery rarely helps peoples neurological pain and tingling, etc. Just doesn't. No matter, surgeons keep on doing surgery: good income, I guess.

Usually, the brachial plexus is "where the problem lies". You can see if raising your arm, on the "bad side" up over your head, next to your ear, and hold it for a while. You can have someone stand behind you as you are sitting on a chair and "press down" hard on the peaks of your shoulders for a few minutes. You can "extend your arm at the shoulder" hard" and hold it for awhile. You can have someone put their hand up into the peak of your arm pit and press and hold it for awhile, you can have someone stand behind you as you are sitting on a chair and rotate your head "away" from the problematic shoulder, and hold firm for a bit. All those maneuvers mechanically stress the brachial plexus and often symptoms will develop and if they do it pin-points where the problem is located. If the tests or test is positive well then we can talk, if you want, about what is going on with the brachial plexus.

Neurological problems are probably some of the most difficult, for most physicians, to deal with. In the modern day, physicians want to use MRI's, CAT scans, x-rays, nerve conduction tests, etc., but not many physicians know neuroanatomy in an anatomically sure way. If you look in a medical book such as Harrison's Principles of Internal medicine, under Rheumatoid Arthritis, it will say something like: it is an autoimmune, systemic disease, that it features arthritis, vasculitis, and neuropathy. It features organ infarction, even myocardial infarction. It will say: sometimes the only symptoms that people have are neurological in nature. From my experience, often the only symptoms of rheumatoid disease that exist are of a neurological nature.
Have you ever had low back pain, for instance. Have you ever experienced your arm going to sleep at night if you lay on your shoulder, for instance. Those are various, common neurological keys to rheumatoid neuropathy. Most people and docs get mentally "tied up" with rheumatoid arthritis since arthritic knuckles "stick out" obviously, but it is a systemic disease process and so it has many other manifestations.

Drop a line.

Yours,


Norsk10

I have herniated disc in C5, C6 and always have tingling in my neck area especially when walking. Injections help a bit, but not for long.

A few words of advice from someone who's been there...
 

Hey Joe,

For what it's worth, I have neurogenic thoracic outlet syndrome, and I've had the exact same symptoms for quite some time (about 4-5 years). I'm 6 months post-op (bilateral first rib resection, bilateral anterior scalene resection, bilateral pectoralis minor resection), and I've had these symptoms both before and after surgery. It did get better right after surgery, but as scar tissue built up and I started using my arms again, the numbness and tingling in my upper back returned. In general, it's across my entire upper back, but is the worst between my shoulder blade and spine on both sides.

Many doctors/therapists will tell you it's muscle spasms, or unrelated to your other symptoms, or a myriad of other explanations. They are wrong. Many of these individuals, while they may be very intelligent or successful, do not have a good understanding of thoracic outlet syndrome, including what causes it, how it manifests itself, how to diagnose it, and how to treat it. The symptoms you're seeing are directly related to the nerve compression at or about the brachial plexus. Compression of the nerves and nerve roots can cause symptoms of pain and parasthesia (numbness and tingling) both locally and at other points on the body which those nerves [are supposed to] innervate.

If it's TOS, an MRI is pretty much worthless in this situation, unless you're looking for lesions on the nerves. A good place to start would be to get an EMG, and by someone who knows how to test using the medial antebrachial cutaneous (MAC) nerve, the most recent protocol for testing for TOS using an EMG. However, don't be disappointed if the EMG comes back normal - most doctors don't know how to correctly perform or interpret an EMG when specifically looking for TOS, and even if they do, TOS doesn't always show up conclusively in the EMG test results. I dunno where you live, but I would talk to a leading expert in the field, such as the guys over in Denver (Dr. Richard Sanders or Dr. Steve Annest). Good TOS-knowledgeable doctors are hard to find, simply because there aren't many, but those two are an example of the ones that do. *edit*

In terms of physically trying to find some relief from TOS, you have a few options, most notably:

1. Physical therapy to stretch out the muscles surrounding the plexus and the paths of the nerves that stem from it. This includes the teres major, teres minor, pectoralis minor, latissimus dorsi, and others in that general area. Doing so will give the nerves more room to move freely. There are some strengthening exercises you can also do for the trapezius/rhomboid muscles so that your body naturally holds itself in good posture (shoulders back, chest out, etc.), but you have to be extremely careful when it comes to strengthening - if you don't know exactly what a particular exercise involves (physiologically) and why it benefits someone with TOS, there is a very, very good chance you will do more harm than good. There are a lot of doctors and therapists out there advocating resistance bands and/or weight-training that requires use of the teres major/teres minor/pectoralis minor/etc., which is a terrible idea and one I can almost guarantee will do more harm than good.
2. Have the area surgically decompressed. This should be your last ditch effort unless you're at risk of losing life or limb, such as those with vascular/arterial TOS (which can cause blood clots, strokes, and/or pulmonary embolisms). Speaking from personal experience, it's a long, difficult, expensive, painful, and mentally trying recovery from neurogenic TOS surgery that usually requires a minimum of 3 months on short-term disability, and the success rates are not very good for non-vascular TOS: around 50% have a "successful" outcome (some benefit, even if only a little), and only a fraction of those have considerable improvement, despite what your surgeon may tell you. I really mean it when I say you should exhaust all possibilities before considering this.
3. Stop weight-lifting so that the muscles shrink and give the plexus area more space. Probably not what you want to hear as a weight-lifter, but it's up to you to gauge whether or not it's more important to you to be muscular or symptom-free. Sure, it's a crappy ultimatum, but I had to make the same call; I grudgingly gave up a lifelong obsession with music and guitars when it became too painful and costly (in terms of my health) to make music. I need to put food on the table and a roof over my head, and I can barely make it through the work day as it is.
4. Try your luck with prescription medicine. There are a bunch of meds that can help with this, ranging from painkillers (narcotics are unfortunately the only things that touch nerve pain) to those that target the nerves themselves (such as Lyrica, Neurontin, and Lidoderm patches). What works for any one individual is mostly a trial-and-error process.
5. Nerve blocks If you can find a TOS-knowledgeable physician, or at least someone familiar with thoracic surgery/physiology, you can try to get a nerve block for the ulnar, median, and/or radial nerves. Doing so can help you get some relief from the incessant pain and parasthesia.

Whatever you decide, make sure you do something before it gets too bad. If I had known several years ago what I know now about TOS, I could have given myself a much better chance at a favorable outcome. As cliche as it may sound, education is most certainly a big key to success here. I know more about TOS than I ever wanted to, but it's helping me mentally cope and physically participate in life (to some degree, anyways...) while dealing with this debilitating condition each day. It equips me with the knowledge to be my own healthcare advocate, and to allows me to better help my doctors so that they in turn can help me better. TOS sucks, but it doesn't have to rule every aspect of your life. Good luck!