What about your anatomy made you susceptible? Do you have that rib? Im glad to hear that you are improving your situation. Do you feel that its possible in your future to retun to 100% normal function?

Apparently I had an extra cervical disc (a long Neck) and developed fibrous bands on either side to support it which squashed my arteries and nerves. No I have a lot of permanent damage done before the decompression, which is one of the risks of long term compression of sensitive structures. That is, they don't fully recover once you release the pressure. Besides, I had the traction damage as well. The most recovery usually occurs in the first year or so following surgery...I can't really comment further on alternative to surgical options as an active strategy as i only put it off because of risk to right arm as I only had partial use of left...booklover

Hi Booklover, I seem to have injured my LTN in a fall from a bike several years back and have been working on reactivating my right serratus. I can feel a muscle contracting beneath my armpit even if i move my right arm up. Does that mean I can rehab the muscle? Any idea of teh time I'd take and the specific exercises and other muscles to focus on along with it?Also what wre your symptoms. Mine are bilateral TOS, right is (i think) due to serratus issue. Left is due to injured longus colli which is not stabilizing my cervical spine. I have constant pain in my right shoulder/neck area, I think overstressed levator and upper trap and also a supraspinatus injury probably.

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.

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.

My biggest problem is I am in a place where TOS familiar PTs are next to impossible to find. The handful of PTs I have met who are empathetic are so overworked its next to impossible to get time with them. Others, can't help.

I am doing everything on my own, basically with the help of folks like you to provide tips.

Since serratus is already weak, the problem is that rhomboids are probably already strong and overdominant. Antagonists being strong would further weaken the serratus effect. Also, we want to improve our upward rotators. Rhomboids are downward rotators and adductors if I remember correctly.

My other idea is to strengthen the rotator cuff - infraspinatus, supra, teres minor and subscapularis. Guess being that it would take some of the load off the upper trap and levator.

My guess is that more upper trap and levator get overworked worse it is is for us, since they drag on the delicate cervical spine and irritate the structures all of which seem to have nerve endings.

On the other hand, I wonder if strenghtening the upper trap is required if the serratus continues to misfire and is weak.

One thing I have learnt (and I KEEP FORGETTING) is that i shouldnt read/sleep with my head propped up on a pillow, moment i do so my hands start burning up. I wonder whether that is because scalenes activate causing scapular instability or because the neck flexes forward too hard because deep flexors are weak compressing the cervical roots themselves.

I also have a disc bulge at C6-C7 but doctors tell me that is not the issue.