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.