NeuroTalk Support Groups - Athletic Thoracic Outlet syndrome/scapular winging/ shoulder impingement

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- Thoracic Outlet Syndrome (https://www.neurotalk.org/thoracic-outlet-syndrome/)

- - Athletic Thoracic Outlet syndrome/scapular winging/ shoulder impingement (https://www.neurotalk.org/thoracic-outlet-syndrome/222608-athletic-thoracic-outlet-syndrome-scapular-winging-shoulder-impingement.html)

Quote:

Originally Posted by Akash (Post 1159919)

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.

This is exactly where I had bad pain for over a year on both sides and where I now have atrophy. I thought for a while it could be supraspinatus, but it is the middle trap in my case. They attach to the scapula in the same place.
Supraspinatus works on arm abduction (raising arm to the side) and middle trap does scapular stabilization and retraction when reaching backwards.
If any of these movements increase the pain, it might be the clue.

Quote:

Originally Posted by Hiker (Post 1159958)

TY! In my case the pain appears when I reach for a computer mouse. I first thought its due to serratus not working due to LTN getting caught in the scalenes. Since this is where the rhomboid and levator attach and both hurt if serratus is weak (unopposed), but then I realized that even though I seem to have got my serratus working somewhat, and can raise my arms now, this pain is still there at the exact spot.

Another thing is I can work with elbows to the side on laptop with horrible posture from time to time, and my shoulders hiked (which would mean Upper Trap is working, right?) but this pain occurs when i work with my hand to the side since my chair has an arm rest located to the sides.
http://www.med.umich.edu/lrc/coursep...r_limb_05.html

This says serratus and upper trap become useful only after 90 degrees.
http://anatomyresources.hsc.wvu.edu/...Abduction.html
Neuromuscular deficit: Weakness/paralysis when abducting at the shoulder under resistance. In normal subjects the supraspinatus initiates the first 15 degrees of abduction along the vertical plane. The deltoid functions from 15 to 90 degrees, while synergistic actions of the trapezius and serratus anterior abduct from 90 to 180 degrees by rotating the scapula laterally. Denervation is accompanied by muscular atrophy, shoulder adduction, ‘winged’ scapula, and cutaneous deficit along the distribution of the axillary (superior lateral brachial cutaneous) nerve.

Another thing I just realized is this always made me feel worse. But this comes up as a supraspinatus stretch too in the google image search!
http://www.teachpe.com/images/jenny/...r_stretch2.jpg

I was trying to stretch my rhomboids since they would be overstrong with a very weak serratus.

So its probably supraspinatus i guess.. is that logical

Question is how to rehab it.

Yes, for me computer mouse is the worst offender. I think this is the prolonged static load on the muscles that is the problem, not so much a particular motion.
I switched to a handheld trackball which I hold behind my back so that I don't need to use any shoulder muscles. It helps.

Quote:

Originally Posted by jarrodethan (Post 1159897)

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

Yep we have the exact same symptoms and likely the exact same (or similar) problem. Do let me know how your recovery goes alright? Feel free to PM me or anything. I am glad you are optimistic and looking to get things fixed 100%, that's always the best mindset. It can be hard to maintain when the aching shoulders are at their worst.

Quote:

Originally Posted by Akash (Post 1159919)

Holy ..
This is what I just discovered my pain area is:

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.

Hey, cool to hear someone feels the same weird sensation
But here's where I might confuse you a bit, my supraspinatus tear was confirmed by ultrasound and did take a long time to heal but I'm sure it is definltely healed by now as I can easliy abduct my arm and am strong (lateral raise in weightlifting).
So the original diagnosis of of supraspinatus tear is different to my current TOS sypmtoms, and quite possibly my original tear may have been caused by the then unrecognised TOS.

As for PT I did; nothing seemed to make it significantly better. I did external rotations and shoulder abduction with therabands mostly. I finally made progress when I started lifting decent weights and concentrating on the back muscles. Dumbbell rows significantly strengthened my trap and rhomboids and provided stability. Doctors are now shocked at first when the hypertrophy of my trap muscles in the injured shoulder. If you want to know more details let me know.

Either way I'm going to get to the bottom of it so I'll keep you posted
Also I'll check out Lynn Watson, I appreciate the tip

There are only three things I can think of when abducting the arm in "computer mouse" position.

Serratus problem
Trapezius issue (upper, mid traps)
Supraspinatus -
Deltoid

I am thinking it shouldn't be Long Thoracic Nerve/Serratus as if we are sitting with arms very slightly abducted, the Serratus requirement should be minimized, correct?

Is your pain area the same as I linked?
http://www.physio-pedia.com/File:Self_Exercise.png

Quote:

Originally Posted by jarrodethan (Post 1160198)

Supraspinatus injury is very common with scapular instability. Mine has tendonosis. I think that it is mostly a symptom of a larger problem. But what do I know.

Also, jarroddethan, please share any info with me, because our conditions are so similar that your progress might be super helpful.

Quote:

Originally Posted by jzp119 (Post 1160893)

So a weak, misfiring serratus --> scapular instability---> supraspinatus tendinitis.

Can strengthening the rotator cuff take some of the load off the traps and scapular stabilizers?

I think mine are very weak as I get my humeral head click/impinge when I reach overhead.

JZP, just sent you a PM. Please check.

Quote:

Originally Posted by Akash (Post 1160899)

Yep I think so but I think it would go more like this (in my non medical meaningless opinion)

For unknown reason, be it postural change, trauma, the scalenes become the primary stabilizing muscles of the cervical spine--> the brachial plexus become pinched between the anterior and medial scalene--> the increased size of the scalenes may cause the first rib to rise, further compressing the nerves--> serratus misfires-->shoulder blade unstable-->decreased subacromial soace--> supraspinatus injury