winged scapula and a host of other problems
 

Hi everyone,

I'm posting this in the TOS thread because it seems like a lot of the winged scapula threads are here (I've searched them and read through them), even tho I don't have TOS (although I've had symptoms that were very similar to TOS).

I'm 21 and have been injured for over 2 years now. My 'injury' wasn't really an injury per se; I was an elite olympic-style weightlifter and woke up one morning in 2009 after a really great meet and realized my right upper back (between the medial border of my scapula), rotator cuff, lower neck (like C6 and C7) as well as my bicep and tricep were in complete spasms. Looking back at a photo of me taken a few weeks after the 'morning after' my scapula were noticeably medially winging (not dramatic, but noticeable) when they had lied flat before the injury.

2 years later, the scapula are still like that (no amount of serratus or lower trap work has changed it), and my pain and discomfort is unbearable, with spasming on BOTH sides now (the worst spasming is still in between the medial border and the spine, as well as the superior angle of the scapula and in the insertion point of levator on the skull, and the greater tubercle area on the posterior side of my shoulder (although everywhere from about T12 up through my neck experiences various degrees of spasm and pain).

I have no life anymore, can't do household chores, let alone be an athlete, and am at the end of my rope. I've seen and done about every kind of therapy that exists, and still no change (minor change with a chiropractor who adjusted my first rib and occiput, and that alleviated some of my TOS symptoms). I was wondering if anyone could shed any light on this? I heard about long thoracic nerve palsy and am curious, but don't feel like my winging looks to be at the level of most patients who have LTN palsy.

Here is a picture of my back for reference, as well as more detailed symptoms below (for those of you who make it that far). Thanks in advance.

Current symptoms
• Body is twisted (per current physical therapist) ie rotated pelvis, shoulders etc
• Pain at C1 on L and R
• Scapular winging (hasn’t improved even with enormous amount of strengthening exercises)
• Terrible trigger point superior angle of scapula
• Knots in upper back and in between shoulder blades (been present since injury in 2009)
• Trigger points in rotator cuff muscles, and shoulder girdle muscles in general
• First rib pain
• Pain on R side of spinous processes of cervical spine and thoracic
• Can’t raise arm laterally or else feels like my fingers are going to rip (this is rectified when serratus is ‘adjusted’) => mostly just right
• Pain/tenderness at base of skull (posterior)
• TMJ
• Constant need to crack my shoulder blades (do this by violently retracting one shoulder blade); both sides
• Subscapularis pain/tightness on right side
• Grinding/clicking of collarbone when I move my arm behind me along sagittal plane (right side)
• Grinding at T1
• Weakness in right hand and lack of strength in arm (used to do planks, arm would fatigue and shake)
• Trigger point on one of ribs (serratus? Intercostals?)
• Tightness/cramping/tenderness in right forearm (slightly on left)
• Extreme lack of mobility – cannot extend my fingers when arms are abducted
• The things that always aggravates this condition are 1) sitting in a slouched position (in a chair – I always have to sit either straight up or put a pillow that aligns my head); any kind of lifting or overhead movement of arms (even putting dishes away)
• Other things that aggravate: carrying a backpack on my shoulders (even one that has nothing in it), overhead movements, any weight bearing activities on my arm;
• RELATION TO PELVIS/HIP ISSUE????????? FEET????!!!! (arch on left foot = awful)

winging scapular
 

Did you ever give the nerve involved a chance to rest and heal before launching what sounds like a vigorous rehab program centered on strengthening the muscles in proximity to the shoulder blade?

Sorta at the beginning, but not really. I'm trying to remember. I had no idea what was wrong, so I blindly did everything my doctor told me. Which was pointless. He then told me I could keep exercising and lifting.

So in short, I guess not, because I was told that nothing was wrong. I've used my arm extensively throughout the 2 years because no one told me not to. So now I'm really confused.

your back looks like a more muscular version of mine, i can relate to most of what youre saying. i dont get spasms anymroe but its because i avoid doing ANYTHING. i can't sit and watch tv.

i have this too. my right shoulder is way more winged and i hear my collar bone go thud, ribs thud, shoulders i don't even move but if i do it cracks like crazy.

i agree it sounds like your muscles and nervous system hate your guts. do you have any strength in your lower body? my hips are very hypermobile, my ribs are twisted and i know it aggravates things, my thoracic spine is completely HYPOmobile. i would work on getting rid of the trigger points and focus on breathing, strengthening your lower body/core muscles if they are weak and thoracic mobility. don't try to fight it, don't reach for things, i used to try to and it really messes you up.


i'm only now doing the most basic strengthening, isometric type exercises and i've been in pt since march!

my lower body used to be very strong, I was a competitive weightlifter before this happened. my hips are crooked, but are much better now (I don't get low back pain that much anymore after seeing a postural specialist).

Do they have any idea what has caused this for you? I can't live the rest of my life like this.

i never really got a clear diagnosis. my pt said RSD which i completely disagree with!!

http://en.wikipedia.org/wiki/Ehlers%...anlos_syndrome
i do have this, you probably don't

it led to me hurting my brachial plexus in minor incidents (walking dogs, playing a wii etc) so many times i lost count coupled with improper stretching of my neck and a SEVERE magnesium deficiency which i am still recovering from.

is your thoracic spine relatively mobile? mine is very very tight.

i have hope though, there was a girl i befriended on the internet who did stabilize her shoulders with physical therapy, hers were way worse than mine. otherwise i mightve given up. the pt she used was vojta (sp) therapy.

You mentioned that now the opposite side is involved. That's to be expected: above all, the body wants balance. So, hypertension on one side of the body will eventually create hypertension on the opposite side. I take it that you are seeing a massage therapist as well as a physical therapist?

Hard to make a diagnosis from a photo. But to me it appears likely that your subscapularis contains very active trigger points. Not only will they refer pain to seemingly unrelated areas of the back, but the chronic contraction at the lateral border is pulling the scapula forward, creating hypertonicity in the rhomboids and probably in the posterior superior serratus. Regardless of the etiology, it's a virtual certainty that you now have active trigger points all over your back...in supraspinatus, subscapularis, teres minor, posterior serratus superior and inferior, anterior serratus, infraspinatus, the rhomboids, the traps, and in the TOS group (i.e., all three scalenes, pec minor and perhaps even in the coracobrachialis).

Richard D may have surmised the original source of your problem. Exalted by your great performance in the meet, you went to bed still excited, tense, and slept very soundly. Do you perhaps sleep predominantly on the problem side, perhaps with that arm extended forward? If so you could have unintentionally limited blood flow to the area when it needed it most. Then when you awakened, tight and experiencing the burning pain that sometimes results from neuromuscular compression during deep sleep, you logically performed your stretching routine, and inadvertently made it worse.

If you aren't seeing a massage therapist certified in neuromuscular therapy and myofascial release, my advice is to do so ASAP.

Hi,

So sorry you're having these problems.

You describe it all too well.

Sometime etiology may not be as important as a fix or workaround.

for my winged scapulas, I've had many, many hours of therapy, myofascial release, aqua therapy, stretches, yoga, 2 lbs bumbells, Kinesio taping (trememdous helper for winged scapulas) , stallette ganglion injections into my scalenes, trying to stabilize scalenes to help everything - didn't do the trick - also had botox to scalenes - helped just don't last.

Lidoderm 5% patches.

BackMagic spine alignment board.

Miracle Ball Set. and oversized tennis balls, mostly for lower back and thoracic spine, but will put in between scapulas.

I also used a Theracane for my scapulas and related muscle spasms.

e-stim during PT sessions. Moist heat.

Stretches after a shower. Lying on my back with a rolled towel longways up and down my spine. I would stretch my arms out and SLOWLY raise them to center and SLOWLY lower them.

I have also used LED and infra red light therapy pads to my scapulas. They helped tremendously.

Of late, I have found that keeping my arms, shoulders, scalenes and scapulas fleece warm cuts down on my pain tremendously.

Don't know if any of these might help, but just some things to share that have helped me.

Oh, also a hairdryer on a stand is a must.

Would be glad to explain or share any details you may need to understand what I've written here.

I hope you find some peace with your situation.

great tips! i forgot about k-tape i need to do that again

Any progress?
 

Hey rizzo02481 - did you ever solve the mystery injury? I'm currently suffering from a similar issue:

- winging scapula
- Constant trap pain and swelling

etc
etc

Dan

I must've been half asleep when I sent that previous post - it's terrible!

I've also been going through the exact problems - did you find the root of the cause? I have a winging scapula and the 2nd is now beginning to give me issues. I've had it noticeably for 2 years now and undergone physio/rehab to strengthen the lower traps and activate the serratus - of course nothing's work.

I've been given the run around by a hatfull of docs, physios and specialists.

However, none of them had pinpointed the cause. I have rotated hips, which COULD be the cause, but all the docs dismiss this as tripe.

My symptoms are:

- Overactive trap due to tilting/winging scapula
- numbness in ear, cheek, arm and hand - possible trapped ulnar
- Extremely tight neck and soreness
- Impinged shoulder
- Weakness in arm
- Spasms in both arms

I'd be interested to know if rizzo02481 made any progress.

Thanks,

Dan

Did you try loosening pec minor before strengthening your back?

If you don't, the tug of war between anterior and posterior muscles will continue.

I'd also look into Foundation Training. I'm convinced that a lot of lower body muscle imbalance contributes to upper body issues first. The lower back, glutes, and hamstrings need to be working together so the upper body can be straightened out.

KY

Thanks for your reply.

I've tried that in the past but due to the rotation of the shoulder his has causing a pinching of a nerve within and is unbearable.

I've also used a hockey ball to massage the pec. Is this enough alone?

My left scap has started to wing now. Is this the natural journey?

I'll research the foundation training.

Thanks.

A hockey ball should be enough.

Try doing it a few times per day for a week.

Which way is your shoulder not rotating?

It's rotating anteriorly. I've tried attaching images but I haven't submitted 10 posts yet.

The left is now following suit. Have you suffered from something similar?

If the shoulder is rotating anteriorly that's exactly why you have to loosen up pec minor. Pec minor, if tight, will pull that shoulder forward so no matter what kind of strengthening you do to the posterior muscles, it wont budge. All you'll create is more tension due to the tug of war going on.

Having a tight pec mnor and having my shoulders too internally rotated has no doubt contributed to my bouts with TOS.

KY

Thanks for the advice. I've been getting the hockey ball involved for the past few months and gave up a couple of weeks ago as I was dubious about progress. I got it back out again today and will be for the foreseeable. Have you made progress with yours? Mine seems to be getting worse each day,

I have.

I keep getting out of trouble with pec minor massage.

I just need to stay out of trouble. That seems to be the problem.

I hope you recover and fast!

I've undergone all these same physio for years now and it's gotten a lot worse over the past 3 months. There's a trapped nerve in there somewhere, the ulnar I reckon as my cheek and ear is numb.

What does your rehab programme look like?

What's your advice on my opposite site subsiding?

I keep getting into and out of trouble with the following:

Stretching/Tissue:

* Pec minor
* Subclavius
* Scalenes

Resistance Training:

* Cable rows
* Rear delt work
* Prone cobras
* Lat Pulldowns
* Face pulls
* Scapular wall slides

All of the above works the mid to low traps, rhomboids, and lats. This helps pull the shoulders back and down which can further stretch out the thoracic area.

Most recenty, I've started Foundation Training. This focuses on strengthening the core which is defined as low back, glutes, and hamstrings, but it really helps to decompress the entire spine and promotes good posture.

So far so good, but I have a feeling that the presence of cervical ribs and my stubborness in the gym will keep getting me in trouble here and there.

KY

Will you continue with these exercises and stretches?

I'm following a similar programme and have been for over two years with no affect. I'm adamant the nerve that fires the lower trap is compressed as my left side is beginning to anterior title now.

I also have numbness is the cheek and my hand swells is certain positions. Would you recommend an MRI?

I will continue with this.

If you haven't had any diagnostic tests to confirm TOS I'd do so. I'd find the nearest specialist. Usually a vascular surgeon.

Any updates ?

I am struggling with a lot of you symptoms. Winged scapula and weak lower trapezius.

I have tried every strengthening technique there is .

I am starting to think it is due to apical breathing and anxiety. The thing is, apical breathing contributes to anxiety because lack of oxygen.

My levator scapulae is really tight. I have been doing active release with a lacrosse ball.

I also have a "flat" thoracic spine which may be contributing to symptoms.

Of course rotated hips can be a prominent issue in worsening your muscle imbalances. Usual pattern is elevated hip on one side and higher shoulder on that side. Lower shoulder & rib cage on the other, and forward rotated hip. Find a PT to release the right muscles and get your shoulders evened out That in itself may release chronically tight muscles.

PS: your symptoms are the same as mine. Mine started after a horrible bike fall, whiplash injury.

Is the winged scapula possibly due to nerve compression? Have you seen an orthopedic shoulder specialist? Maybe he/she can tell you exactly which muscle is not functioning properly and look into the nerve that supplies it (i.e. if it's the serratus anterior muslce, then maybe there's compression to the long thoracic nerve). Unfortunately, it seems that the human body likes to compensate and then we have to deal with a domino effect. Please keep us updated. All the best.

I have winged scapula, significantly lower right shoulder and significant muscle atrophy of the upper and lower trapezius. I had TOS surgery that somehow gave me very brief relief (2 months) but have had serious problems since. I had a second surgery 15 months later to remove scar tissue that had no impact. About a year after that surgery I took another dive in the wrong direction.

I am now seriously doubting that my problems are TOS. My rationale is I do not have and never had any arm problems which seem to be present in all cases of true TOS. My symptoms are also aggravated more by neck movements (especially looking down) than use of my right arm/shoulder.

Based on what I have learned myself (don't we all become internet research doctors when we have suffered for years) I believe I have some sort of nerve damage/entrapment/lesion/something with my spinal accessory nerve. It innervates the traps and that is where I have pain and atrophy. I have had several nerve tests over the last 10 years and I do not have a lot of confidence in them as I get a different result each time. I have shown abnormal suprascapular nerve, then normal, then abnormal long thoracic and dorsal scapular in the three tests I took from 2009 - 2013.

My next step is to try and get somewhere that can do a more thorough and exhaustive evaluation. I am not sure where that is and I am open to suggestion if anyone has knowledge to share. I have doctors that will gladly refer me as they admit it is outside their area of expertise. IMO that is the biggest problem for a lot of us. Doctors seems to have a narrow space or niche that they do - even the prestigious ones. Also the more prestigious the bigger the ego and the more they are concerned about being right. I'm sure there are exceptions to this but I have seen several and that is my take.

I am wondering about the same thing. I have atrophy of the traps (mostly middle, but also upper and lower to a lesser extent) as well as weakness and pain in that area. There is also a mild scapular winging.
Symptoms in arms have not been a major issue for me - some on and off pain and weakness which are mostly gone by now,
At least one dr agrees it could be an accessory nerve problem. He suggested an accessory nerve block, but I did not try it yet. Don't know what to expect.

First, hang in. I am well into my third year of pain that is largely debilitating, and it has been almost 12 years since I was able to exercise at 100%. Plugging away is the best option.

Second, I find it helpful to think in terms of "what can I do?" instead of "I can't do all this stuff." When I stop and ask myself, "what can I do?" I am usually surprised at how long the list is. Examples: walk, jog, tai chi (carefully), meditate, various lower body stretches, self massage, and more. None of this has been a cure, but much of it does provide temporary relief.

Third, this is a wild guess, but have you looked into diet? I have a couple of friends who have had pain issues that improved with certain diets. This sort of thing is highly individualized and remains on the outer reaches of what modern medicine would take seriously. Still, shooting in the dark is better than nothing.

Well one thing I have learnt, that muscle inhibition is an issue. If your lats are very tight, they will pull your arm down even if you try to raise your arms and that might cause a perception of lower trap and serratus weakness.

Levator is tight as a symptom, not a cause by itself. I have the same issue.

What are your symptoms - I thought Edgelow's protocol had improved things a lot? Could it be that your lats or other tight muscles are pulling on your scap and making it harder for your lower traps?

I face this exact issue!! Are you sure there is no cervical disc bulge or stenosis?

Makes sense. Glad that you are taking charge of your evals and care.