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Athletic Thoracic Outlet syndrome/scapular winging/ shoulder impingement

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Old 07-06-2015, 08:28 PM   #1
jzp119
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Default Athletic Thoracic Outlet syndrome/scapular winging/ shoulder impingement

Hi guys,

I'm new here, never started a thread before, but I'm looking for some guidance. Okay here goes, so 3 years ago after starting university I developed this horrible ache in my shoulder, I had a single strap bag that I would carry all my books in and would constantly sit at my desk hunched over to study. I also was doing a rigorous weight training program with no real guidance (I was 18 and didn't know it was possible to be hurt). The combination of these things are what I believe pushed me into this situation. Over the last three years I have had highs and lows ranging from absolutely crippled to just a slight itch/pain in my left shoulder.

My symptoms are (both arms but way worse in left):

-dull aching pain in my left shoulder that has made me strongly consider cutting off my arm
-pins and needles only while sleeping in some positions
-terrible pulling feeling from my neck, through my shoulders, under my bicep, and into my fingers whenever I hold my arm out at my sides (adduction)
-Scapular winging or S.I.C.K scapula which can be determined by its resting position or prominence of the inside edge of the scapula sticking out both at rest and with movement. (As diagnosed by PT and orthopedic surgeon)
- severe scapular depression
- popping clunking and crunching from my shoulders, neck, and scapula

As far as tests go I have had
-neck MRI (normal)
-nerve conduction study at rest (normal)
- shoulder MRI of only the left side (tendonosis of the supraspinatus, mild inflammation of the subacromial bursa, and labral cysts associated with a small labral tear. These symptoms are commonly found in those with shoulder impingement syndrome)


Okay so my question is this:

Could my scapular winginging be the cause of all this? Or is it a symptom of a problem in my neck or something (i question this because my neck MRI was normal). Has anybody else had similar discomfort coupled with scapular winging? How about shoulder impingement, could that be caused by winging? If so what are some things I can do to help this? I already do upward rotation shrugs to improve my depressed scaps and wall slides for my serratus To improve scap position. What else can I do? Am I attacking this the right way? If you guys direct me toward articles and other threads I would really appreciate it, I would also love to hear your stories. I sometimes forget what its like to feel completely normal, there are good days and bad days. I appreciate any input you guys, thanks.
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Old 07-10-2015, 10:34 PM   #2
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I am not a medical professional so I can't give you much specific advice, but I can relate a bit of my story. Sadly, your story and mine have some common threads, but since you are younger you may be in a better position to get well.

I am 29, with a wide array of upper body problems including thoracic outlet syndrome, cubital tunnel syndrome (probably related), pain in my neck and scapula, and intermittent pain in my lower back and right glute. But the problems started when I was 17 and doing a lot of, wait for it, weightlifting without a proper instructor.

Like I said I'm not a professional, so I only feel comfortable giving general advice. How is your flexibility? How is your muscle balance? Posture? Do you breathe correctly (into your diaphragm instead of into your chest)? Have you seen a skilled physical therapist or other professional bodyworker who could assess some of these things? If you haven't, I recommend it. I also recommend sticking with it until you find someone who is highly skilled, analytical, and willing to listen. I had a lot of early diagnoses when I was your age that basically went like this: "You have tendinitis, you're young, it will clear up." It only got worse. Had I seen the right people 8 or 9 years ago, I might be in much better shape now.
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Old 07-10-2015, 10:42 PM   #3
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Old 07-11-2015, 12:52 AM   #4
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Have you looked into shoulder nerve injuries? I think, for example, the long thoracic nerve supplies the serratus anterior muscle. When this doesn't function properly, it can cause winging of the scapula.

As mentioned above, I'm not a doctor. There are probably lots of conditions that can cause your symptoms (the more I read, the more possibilities!) Have you seen an orthopedic doctor who specializes in the shoulder?
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Old 07-19-2015, 10:13 PM   #5
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Hey! Welcome to the crappy club that apparently doesn't exist.
Your dull ache, desire to lop off your ow arm for escape, and neck pulling sounds Real familiar to me. And forgetting what it was like to be human once.
I hope you find help soon, but just steel up to do a lot of self advocating, and convincing doctors that it actually Does friggin hurt. There are surprisingly few docs that are familiar with winged scapula outside of text books.

I have a very similar issue, a totally debilitating TOS that began after dislocating my arm and developing a really intense winged scaupla. I could hold oranges under the damn thing if I could control the muscles around it. It looked like a shark fin. It could have also been my unguided weight training, extensive backpacking, carrying kayaks on my shoulder, working as a jeweler, or stage tech where I would hold about 100 lbs over my head for a few hours. Hard to tell, and it's taken me 2 years of no longer being able to do daily care to begin convincing doctors it's real. SICK scapula diagnoses, chronic dislocation, TOS, and it spread to my left arm about a year in my desperate pleas for help. I just had capsular plication surgery to make my shoulder stop popping out and winging, but the PT to regain my range of motion further irritated my nerve issues, and now it's Winging again! AH!

Did any direct trauma or dislocation precede this?
What sort of shoulder MRI did you get? (No contrast or arthogram?)
What was tested on your EMG?
Where is/what do you mean by scapular depression?(The depression sounds worrisome as possible wasting. As crappy as that is, it Will give doc a definite thing to trace back to the source of the issue)
What sort of doctors have you seen thus far?
Do you have pain and cramping under your arm? Around your scapula? Between both scapulas?

Now.. It's totally possible that the winged scapula itself is contributing to the issue, especially if it's winging medial and turning upward, your shoulder rolling forward. This could your clavicle to narrow and compress your brachial plexus on your first rib (that's my deal). It does kind of put things in this crappy cycle where you can't control the muscles to pull back your shoulder, so it rolls forward compressing the space and aggrevating you scalenes, which irritates the nerves that allow you to pull back your shoulder.
However, it may not be the root of your issue. If it's been going on so long you may have developed other compressions or muscle hypertrophy in your neck. For me, all the the PTs I saw to try and get my scap to sit down made the issues with scalenes WAY worse.

My research material on this subject has become quite extensive in my years of trying to find some answers, but I'll dig up some of the most relevant ones for you soon.
Try to stick to scholarly articles if you can (google scholar is a gem) and check out Long Thoracic Nerve Injury and Quadrilateral Space Syndrome. Look in to your impingment theory as well (although it would likely be the impingment, which caused the winging, which made the symptoms more severe)

I have a few posts floating around on here about my battle with winged scapula hell, and Please feel free to hit me up with any questions or if you want to vent.
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Old 07-20-2015, 12:50 AM   #6
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Quote:
Originally Posted by thortime View Post
Have you looked into shoulder nerve injuries? I think, for example, the long thoracic nerve supplies the serratus anterior muscle. When this doesn't function properly, it can cause winging of the scapula.

As mentioned above, I'm not a doctor. There are probably lots of conditions that can cause your symptoms (the more I read, the more possibilities!) Have you seen an orthopedic doctor who specializes in the shoulder?
Good advice there. I'd look in to this one more thoroughly. I have similar sx but my nerve conduction/ emg test were normal. Eleven years later neurosurgeon requested they were redone before putting in a spinal cord neurostimulator. Of course, they found long thoracic nerve palsy and chronic dennervation of anterior serratus muscle! Apparently, it's commonly overlooked as they do not test far enough down the nerve tree. Too late for me to look at any remedial surgery, though may have been from the start as likely mechanism was traction.Good luck, booklover
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Old 07-21-2015, 01:12 AM   #7
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Quote:
Originally Posted by SnappleofDiscord View Post
Hey! Welcome to the crappy club that apparently doesn't exist.
Your dull ache, desire to lop off your ow arm for escape, and neck pulling sounds Real familiar to me. And forgetting what it was like to be human once.
I hope you find help soon, but just steel up to do a lot of self advocating, and convincing doctors that it actually Does friggin hurt. There are surprisingly few docs that are familiar with winged scapula outside of text books.

I have a very similar issue, a totally debilitating TOS that began after dislocating my arm and developing a really intense winged scaupla. I could hold oranges under the damn thing if I could control the muscles around it. It looked like a shark fin. It could have also been my unguided weight training, extensive backpacking, carrying kayaks on my shoulder, working as a jeweler, or stage tech where I would hold about 100 lbs over my head for a few hours. Hard to tell, and it's taken me 2 years of no longer being able to do daily care to begin convincing doctors it's real. SICK scapula diagnoses, chronic dislocation, TOS, and it spread to my left arm about a year in my desperate pleas for help. I just had capsular plication surgery to make my shoulder stop popping out and winging, but the PT to regain my range of motion further irritated my nerve issues, and now it's Winging again! AH!

Did any direct trauma or dislocation precede this?
What sort of shoulder MRI did you get? (No contrast or arthogram?)
What was tested on your EMG?
Where is/what do you mean by scapular depression?(The depression sounds worrisome as possible wasting. As crappy as that is, it Will give doc a definite thing to trace back to the source of the issue)
What sort of doctors have you seen thus far?
Do you have pain and cramping under your arm? Around your scapula? Between both scapulas?

Now.. It's totally possible that the winged scapula itself is contributing to the issue, especially if it's winging medial and turning upward, your shoulder rolling forward. This could your clavicle to narrow and compress your brachial plexus on your first rib (that's my deal). It does kind of put things in this crappy cycle where you can't control the muscles to pull back your shoulder, so it rolls forward compressing the space and aggrevating you scalenes, which irritates the nerves that allow you to pull back your shoulder.
However, it may not be the root of your issue. If it's been going on so long you may have developed other compressions or muscle hypertrophy in your neck. For me, all the the PTs I saw to try and get my scap to sit down made the issues with scalenes WAY worse.

My research material on this subject has become quite extensive in my years of trying to find some answers, but I'll dig up some of the most relevant ones for you soon.
Try to stick to scholarly articles if you can (google scholar is a gem) and check out Long Thoracic Nerve Injury and Quadrilateral Space Syndrome. Look in to your impingment theory as well (although it would likely be the impingment, which caused the winging, which made the symptoms more severe)

I have a few posts floating around on here about my battle with winged scapula hell, and Please feel free to hit me up with any questions or if you want to vent.
Hi!!!

Yes I did have an injury that sent me into this situation. I dislocated my shoulder multiple (like 20) times over the 6 years that I played linebacker when I was younger. I never had problems until I decided to finally go for the surgery and have my labrum repaired. After that surgery my good arm developed the dull ache of death and I haven't been able to shake it for 3 years. Like what the hell?

My shouder MRI was no contrast. I'm pretty sure that all of the issues in my shoulder that were found by my MRI are what cause the eternal dull ache.

My EMG tests were done to test "nerve conduction and velocity"

The scapular depression was something a random physiotherapist mentioned months ago. He said that my upper trap was likely extremely weak and strengthening it should alleviate my symptoms. I did, and still do upward shrugs to isolate my upper traps and they have helped a lot. Not even close to fixing the problem, but helped.

I have seen 3 massage therapists, 2 chiropractors, 3 general physicians, 4 physiotherapists, 2 ortho surgeons, and a neurologist.

Overall my pain is a consistent 3/10, I have not had less than a 3/10 since I was 17 years old. Sometimes the dull ache can decide to go nuts and get to a 5 or 6/10. I get sharp pains between my shoulder blades sometimes and my shoulders, neck, and scapulas all crack and pop and clunk. I hope its my winged scapula causing all this, that would mean that there is still a chance to have a normal fun life, I mean Jesus can't a guy just go lift weights with his friends? Also yes, the dull ache sometimes sits in my armpit and just drives me insane. I would say of all the different forms of discomfort that come with this injury, the dull ache is the king.

Thanks so much for contributing your experience to the thread. We will figure this out and hopefully one day have no need to even be on these forums.
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Old 07-21-2015, 01:15 AM   #8
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Quote:
Originally Posted by booklover View Post
Good advice there. I'd look in to this one more thoroughly. I have similar sx but my nerve conduction/ emg test were normal. Eleven years later neurosurgeon requested they were redone before putting in a spinal cord neurostimulator. Of course, they found long thoracic nerve palsy and chronic dennervation of anterior serratus muscle! Apparently, it's commonly overlooked as they do not test far enough down the nerve tree. Too late for me to look at any remedial surgery, though may have been from the start as likely mechanism was traction.Good luck, booklover

Oh wow. So there is nothing for you to work towards as far as improving symptoms? I wasn't aware that nerve injuries were so permanent. So let's say, in the event that I do have an injury to the long thoracic nerve, would my only option be surgery? I absolutely HATE surgery. everything about it. Electing to have surgery on my shoulder is what put me into this situation in the first place.
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Old 07-21-2015, 01:22 AM   #9
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Im responding to everyone by pressing reply on each post but it isn't posting? Am I doing this wrong?
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Old 07-21-2015, 01:40 AM   #10
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Welcome to NeuroTalk!

You're doing just fine!
Sometimes there can be a short delay.
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