Droopy shoulder/depressed scapula/dropped shoulder syndrome
 

Hi all,

I am writing this to inform everybody of something that may be causing your thoracic outlet syndrome. This is not a sure cure for everybody as there are many different reasons for thoracic outlet syndrome. I recommend taking a quick read of this article as much of it pertains to depressed scapula.

Overcoming Chronic Neck Pain: Postural Causes and A Unique Exercise Fix | Fix The Shoulder Blades — The Exercise

There's a lot of info in this article relating to studies that have shown that a depressed scapula or shoulder can actually cause thoracic outlet syndrome symptoms. This article provides a lot of information on how to go about fixing this problem. It also has links to studies of people who have dealt with this problem and fixed it. I am currently working on the workouts in this article and am actually seeing results finally.

I am also going to provide you all with a link to a blog that I came across. This particular person had depressed shoulders and chronic neck pain along with thoracic outlet syndrome. If you are in the pain that I have been in I highly recommend you take the time to read his experience. He talks about going through PT doing the typical stretching routines and not finding success. He finally comes across a PT who notices his depressed shoulders and put him on a strengthening routine that he outlines in his blog. He includes videos and lifestyle changes that improved his life tremendously.

Remy's Remedies

I have tried to get ahold of this particular person but it doesn't seem that the comments on his site are working unfortunately. But I would like to give a big shout out to him regardless because I feel like I may have finally found the answer to getting out of my chronic pain. Therefore because I finally have hope and this forum has been a great place for me I thought I would share this with all of you in case it might help.

I am still going to PT and I brought this up with them and fortunately they are very receptive to my ideas. They did indeed tell me that this goes against traditional thought. But after months of minor success and setbacks we have agreed to try something different.

Also here is one more scientific article about dropped shoulder syndrome.

Dropped shoulder syndrome: a cause of lower cervical radiculopathy. - PubMed - NCBI

I hope these resources do good for some. I have spent months researching my own issues. The traditional shoulders back and down and stretching routines just weren't doing it for me and actually made things worse. I feel that I still have a long road ahead but I also feel like there may be a clear path forward now.

Best of luck! Let me know what you all think and if you pursue this avenue please share your results for others.

Hey. I actually have trapezius injury on my right side and my shoulder is a little pushed forward. the situation is quite bad that I cant elevate the shoulder up as it is stuck. but I do not have T.O.S on that side. Roo's test is false.
anatomically speaking, only an extra rib/medial scalene/anterior scalene
can cause compression in the brachial plexus area...
shoulder related injuries are different syndromes.
on my left side though - I have T.O.S(A. Scalene is deformed) but my shoulder is perfectly well, I can easily move it around/elevate it whatever.
so; bad shoulder muscles like traps and scapula in my opinion can aggravate T.O.S - not cause it.
if you are serious about studying the neck muscles and diseases...
1) study neck anatomy such as muscles and blood vessels
2) study thier function(google it)
3) perform tests that are available on youtube to see if they are injured

that's what I did and that's how I know exactly whats wrong with me.

Hate to disappoint you but if you read the links I posted you would understand how a droopy shoulder can cause tightness in the scalenes and cause TOS. Please read the material before replying as your reply might scare people away from beneficial information.

These are studies carried out by doctors in the field. So yes, droopy shoulder can and does cause TOS. Is it the sole cause? No. Of course not. Nothing is that black and white.

Thanks for your input but I do not agree with you. I have studied the neck, the nerves and vessels/arteries of the thoracic outlet. The roos test and many other tests are not even viable tests. Often times people fail these tests and have no symptoms.

I am not going to type why droopy shoulders can cause TOS because I already linked the scientific studies and info on it which you apparently did not read :(.

Hey again. I did read your articles but T.O.S was only mentioned 2 times, 1 time it even says " Thoracic outlet syndrome may be involved".

I am just trying to understand what you are trying to say here - shoulders are dropped, so fix shoulder muscles, and that will fix T.O.S because magic? all of the sudden the scalenes will be healed? pec minor? would it not make more sense to actually work on the bad muscles such as pec minor and scalenes? work on the shoulder too just as a precaution because when the shoulder is dropped the hand is also dropped and that can further damage the muscles. that's called an aggrevator, not a direct cause - rather indirect.

and Roo's test is indeed accurate but needs to be combined with other tests such as laterally raising the hand up and waiting a few seconds, or stretching the median & ulnar nerves and seeing if they are tense(it should hurt a lot. look these stretches up on youtube). so don't doubt these tests man. they specifically activate certain nerves and they can imply T.O.S. remember that many syndromes can happen simutainsly to people like the two of us who worked infront of the PC. so you can have T.O.S from simply straining the muscles.

If you read the blog and read the exercises.. and watched the videos there are actually videos on how to strengthen scalenes. If your shoulder is dropped or droopy it puts excessive tension on the neck muscles including the scalenes. By strengthening the shoulder girdle and neck musculature it allows the shoulder to rise up and lifts the collarbone. When the shoulder is lifted the scalenes, levator scapulae, and upper trap are no longer put on a chronic stretch which causes the atrophy. So no. It's not magic. Pec minor is also a shoulder muscle. The pec minor and latissimus dorsi pull you into hunched posture and also can aid in the process of droopy shoulder syndrome. By strengthening the shoulder and stretching the lats and pecs minor, they will slowly work back to their lengthened state.

I'm not a big fan of your condescending tone in your messages. If you didn't notice I said this isn't a cure all for everyone. I also linked to several scientific studies where they had success treating some people with thoracic outlet syndrome "like" symptoms. My point is that thoracic outlet syndrome is a series of symptoms, it is not a proper diagnoses. By that I mean just saying you have thoracic outlet syndrome does not imply any cause. There are many causes of thoracic outlet syndrome. This is ONE of them. I do not have cervical ribs, and quite frankly I don't buy that I suddenly have a deformation or issue with a muscle for no reason.

My reasoning is such that I got myself here with poor habits and movement patterns, therefore there must be a way to restore proper movement and habits and heal. If you choose to believe that you have lived your entire life with a deformed scalenes that all the sudden began causing you symptoms that is fantastic. I hope you find your answer to your problems. I am just trying to provide ideas for people that are suffering as I am.

There is no need for you to shoot down ideas, and reputable research. That only adds to the hopelessness that I am sure many people feel. There is no magic in working hard to fix your body. What is "magic" to me is that you can "release" a muscle and it magically heals people. If that worked would this forum even exist? Everyone would just go to the massage therapist every once in a while and be fine.

By the way I know about the nerve glides, and yes they hurt. But imply does not mean you have it. Like I said. Many people can show false positives, this is why they are not considered reliable tests. But I am honestly done replying to you. You choose to believe what you want. I will continue to try and find answers and share what I find.

Based on what I have read from you, you have accepted the idea that you just have a bad scalene and it can't be fixed. If you feel that way, go get the surgery and be done with it.

" If you choose to believe that you have lived your entire life with a deformed scalenes that all the sudden began causing you symptoms "
I didn't say that. only a VERY small precentage of T.O.S sufferers are born with a deformity. most of them get the deformity by doing repetitive hand motions over a long period of time without rest(or having extra rib grow all of the sudden). I got that info by data that I read online from PubMed etc.
Now coming back to your droppy shoulder... yes I understood that collarbone theory very well and I agree with it to an extent. but I will continue to support my position that it can put extra pressure on neck & chest muscles, therefore contributing to existing T.O.S. but I will not agree that it is a direct cause and that is where we will not come to agreement. maybe in rare cases it will actually cause T.O.S.

That's fine. Don't need you to believe it. Lol there's plenty of studies on pubmed that prove it can cause it.

For those of you following this post. I would like to add that trigger point work in the lower trap as well as the latissimus dorsi seem to help tremendously in practicing to raise the shoulder blades. These two muscles in particular can radiate pain down the inner side of the arm into the 4th and 5th fingers. They also work to depress the scapula, so if they are tight you will find a lot of restriction in the upward rotation of the scapula. The upper traps will feel tight and if you try to do shrugs you'll notice it's very difficult. I'd recommend investing in a lacrosse ball and releasing these muscles before doing any upper trapezius exercises, and also think about releasing them if you are having a lot of pain down into the 4th and 5th fingers. Releasing is a great way of symptom control but strengthening and lifestyle changes seem to be the only way to get lasting results. Cheers.

Figured I would add this link.

How to truly identify and treat thoracic outlet syndrome (TOS) - Treningogrehab.no

I think I may have posted it somewhere else as well.

This is a rather technical article. I hope in the future once I have gotten myself back to mostly normal or normal to write a bit of a guide from my own perspective. Until now I will share what I learn in bits in pieces as a sort of journal. :)

You can also add info links to the TOS sticky threads, for future members.

Thanks Jo :)

Hi! I live in Norway and have now finally been diagnosed with TOS by an excersise correctional specialist named Kjetil Larsen here in Norway ** I also have depressed shoulders and have been advised by him to raise my shoulders by about 1-2 cm, because veins/nerves are being crushed between collarbone and first rib. I’m having to learn new posture with shoulders and how to correctly use shoulder blades etc. I notice a big difference in ulnaris pain when I hold my shoulders up, it’s a big relief. Kjetil recommends no stretching of neck muscles, because these muscles are often very weak on TOS patients.
I recommend checking out his website or looking him up on YouTube. He has also published an article about how to correctly identify and treat TOS.

Dude that is crazy?!! I posted his article and I have an online appointment with him! So nuts man you are lucky you get to see him in person. I am following his protocols as best I can and I've seen huge leaps in improvement in the past. Month or so! Please keep us updated with your progress!

Yes, I wish I had found about him a long time ago. I wonder why physical therapists don’t have the knowledge he does!! It’s kind of scary getting advice from them, then getting contradictory advice from him. He told me he has patients all over the world. It costs a lot of money, but if it helps me, it’s worth it.
I’ve got another appointment on July 29. Good luck with your appointment!!

Hi Dontbeamelvin, Hi Sahol78 (and everybody),

How are you today ?

I sincerely hope your condition continue to improve.

From my side, i did shrug, or rather monkey shrugs, and diagonal wall slides for nearly 10 days but this regimen didn't seem to improve my TOS (not sure of this).

I had the feeling that the disconfort and tightness in neck and traps slightly increased by doing these (not during the exercices but after at rest).

So i say myself that maybe a 10 days trial of this routine is too short for real improvement and that temporary discomfort's increase is not abnormal ?

In other words, do you think that 10 days of this routine is too short to give up ?

Also, in how many days/weeks did you saw improvement by strenghtening your upper traps/ serratus anterior ? Was there initially an increase of pain and tightness in neck and shoulder/elbow/hand ?

I would be very happy to have your thoughts.

God bless you.

Hi!

Kjetil Larsen has me doing shrugs with very light weights or an elastic band, and more excersises to help strengthen neck muscles. I think these can be found on YouTube (??). I can only do a few of these and only 2x week. I get really sore/tight muscles in neck afterwards. Don’t see any results with this yet, but have only been doing it since end of June and only 2x week. I think it will just take time. Yes, I agree that 10 days is probably way to short (but I don’t know) to expect improvement, who helped you with your routine? Maybe you’re doing the excersises too often?? I was told that if I do my excersises correctly, they should be done slowly, 1 set to moderate fatigue, 2 x week that I should expect to have a mild worsening of my symptoms, but not for more than 1-2 days. I get this, mostly tender and tight scalenes and sore shoulder (I do some shoulder excersises because of some damaged muscles do to wrong shoulder posture and wrong use of shoulder blades over many years). Sometimes my fingers tingle more and I have a general achy feeling on my right side-my worse side.

I don’t know what monkey shrugs are or the diagonal slides. I think it’s probably normal to be sure and tight a few days. Good luck with your recovery! Hope you find some relief!

Have you checked out Kjetil Larsen on YouTube? He has a website, but I can’t post website name in here. He does a lot of online appointments with people who can’t come to his clinic, it’s pricy but probably worth it if you can do it. His clinic is called Trening og rehab in Norwegian and I think it’s Training and rehab in English??

Things I have learned from him about my TOS and TOS in general:

-never ever!!!!pull shoulders back and down as it crushes brachial plexus and can contribute to damage shoulder muscles
-lift shoulders 1-2 cm straight up, this helps my ulnar pain, but it takes a lot of time to get used to keeping this posture.
-get out of the cervical hinge-neck should be long (probably on YouTube)
- all excersises should be done slowly!!! It targets the muscle you’re working in, not all the other muscles. This makes the excersises much more effective and it’s much harder to do them.

Again! Good luck!

Hi SAHOL78,

First of all, thank you for your feedback.

This said, I hope sincerely that you will soon get improvement and cure by doing Kjetil's program.

To answer your question, i went in a shrug's regimen since Dontbeamelvin wrote on this thread that he underwent improvement by doing them on consistent basis and also i have watched Kjetil Larsen videos on youtube that advocate traps and scalenes strenghtening.

Moreover, if i well understood your sayings, you are to do 1 set of shrug 2 times per week and also 1 set of scalene's Kjetil's exercise 2 times per week ? Is it what Kjetil Told you ?

If i am right, i was maybe doing way too much since during this 10-12 days, i daily did 3 sets of 8 reps of "monkey shrugs" (without any weights by the way).

For "monkey shrugs", you could find some vids on youtube that show this exercise (i think it is basically the same exercise your are doing for your upper traps).

Thank you again in advance for your thoughts and God bless you in your struggle against TOS.

Yes if you overdo it you will really increase your pain. You should only have a slight increase if you do the exercises correctly. The biggest thing that has helped me so far is raising the shoulders straight up about 1/2 inch. This has made a dramatic improvement after a couple of weeks.

Hi Dontbeamelvin,

I'm really happy for your continuous recovery.

This said, i have a few question for you that are the following ?

1) Before things got better for you, did you have pain/disconfort in your ulnar nerve, from shoulder to little finger (that is now my case) ?

2) If it was the pain, how long did it it take to relief these ulnar symptoms by constantly raising your shoulder blade (in other words shrugging) ?

3) Also, have you had "first rib mobilization" ? I ask you because a chiro show me a self rib mobilization's exercise and I have the feeling it has increased my discomfort in this ulnar zone..

Thank you again for your thoughts.

God bless you.

I will add, there is no one thing that works for everyone..it takes some experimenting to find what works for you..
But if something you try increases your pain/discomfort for more than a few days, you either pushed too much or it isn't the thing for you..

Baby steps to adding any activity is the best way to move forward.. pushing too hard will set you back..

Many with TOS have the delayed pain, a day or so after the activity.. (even a dr visit or PT) so that is something to be aware of also..

The first rib mobilisation is in my experience somewhat useless. It is a symptom reducer but your scalenes will pull it right back up if they are weak and spasming. A lot of the self mobilisations also release the upper trap. You don't want this because it causes the trap to deactivate and further weaken. I had a lot of pain down the inside of my arm and it actually usually bothered my middle finger. Not sure why. I still get irritation and I'm not 100% by any means but I am improving. The first 2 weeks of raising the shoulders actually caused a lot more discomfort because the muscles are weak and unable to hold proper positioning. Now it is pretty natural but sometimes they still drop and I have to be aware of that.

I have overdone my work outs several times since I had my Skype appointment with Kjetil. It is really easy to overdo because you want to get better fast! However the body just does not work like that. Like I always say, it likely took you years/months to get here. It can take years/months to get you out. The key is knowing how to get out so you have a clear path to recovery.

Good luck

You have to approach all parts, spasms and or trigger points in the muscles as well as any stuck or raised top rib..
Just focusing on 1 part will not do much in the long term..

Other areas to look at -
pec minor
lymph drainage
overall body postures & uses..
past whiplash or old injuries
sleeping postures- pillows/mattresses
ergonomics

site search can find those topics for more on them..and more in the sticky threads..
https://www.neurotalk.org/search.php

Hi Dontbeamelvin,

And so, if i well understood you, you didn't experimented instant relief of your arm pain with elevating/shrugging your shoulder blade ?

How many days/weeks did it took roughly before your had relief of your arm's pain with this shoulder blade's constant elevation ?

I thank you again for your thoughts.

Best wishes for your recovery

Hi! Sorry for a late reply, have not been on the forum for a few weeks! To answer your question, I was told to do just one set of scalene excersises, on set of shrugs for traps, one for levator scapulas (spelling???), and a few other excersises to help muscles in shoulders that have been damaged/weakened by improper use of shoulder blades and depressed shoulders. I’m still struggling to keep shoulders up and neck long (out of cervival hinge), but hopefully with time that will become natural. Holding shoulders up helps with ulnar pain when I raise my arms out to the sides. I think getting better is going to just take a long time. My neurologist has “insisted” I take Lyrica for nerve pain, I’ve started taking it though I really don’t want to just cover up pain, I want to fix it. But I’m giving it a try. Hope you are doing better! Don’t overdo workouts, it’s so easy to do it because you think you will get better faster.
Good luck with your improvement. I’m on the train to my next appointment with Kjetil right now. We’ll see what that brings😂

You might want to search the site for lyrica experiences.. before you get too far into it.. If you haven't web searched it yet.. some have issues with it..

Hi there. Yeah I mean I'm not 100% by any means but some days I make it through the day and I realize it was a really good day. My range of motion has greatly improved. I've been doing his protocol for probably 2 months or so. Maybe 3

I have TOS and my shoulder quite often falls forward and compresses the nerves in the neck. However in my case the TOS is causing this and not the other way around.

I was diagnosed with the exact thing that you mention here (muscle imbalance in the shoulder girdle causing TOS). And I was given exercises to do. Intense, hourly exercises every day.

Well I continued that for 18 months and my condition got worse so I got a second opinion. After some scalene block tests (us guided injection), I was told that the exercises were totally pointless because the only thing that would fix my TOS is surgery.

Through overuse, muscles had grown abnormally and were compressing the nerves and arteries in the Thoracic outlet region.

The shoulder falls because the scapula (shoulder blade area) is not getting enough blood so it weakens and is often painful with pins and needles. Like I said, in my case the TOS is causing this.

If you are reading this please do not just simply do exercises hoping your TOS will go away. In some cases it might but the clock is ticking and the longer the nerves are being compressed, the more likely it is that they will become damaged permanently.

Ask your doctor for a scalene block test. Even if you have to pay for it yourself. It's worth it.

According to How to truly identify and treat thoracic outlet syndrome (TOS) - Treningogrehab.no

It is the scalenes that are incredibly weak and that is why they are "overused". He recommends strengthening the scalenes. We're you doing any scalenes exercises/neck or just strengthening your shoulder?

Did you have surgery and how did it go?