Hi guys,

I was just wondering if somebody could explain the connection that my TOS has with the pain between my shoulder blades and my scapular winging. Why is it that a problem originating up high in my neck/thoracic outlet would have downstream effects this severe? The pain in my upper back is by far my biggest complaint.

Also, is there anybody out there who has gotten surgery for TOS and found that there winging stopped? I've had physios tell me that my scapular winging came first and thats why I developed TOS, but that can't be right as all attempts to strengthen my back and shoulder blades do nothing to help the problem.

Thanks

That Nagging Pain Between the Shoulder Blades
[These people will complain of a nagging pain between their shoulder blades, usually on just one side of their back but sometimes on both sides. Trigger points in several muscles can cause this type of pain but the pain produced by the rhomboid trigger points tends to persist longer than the others.]
http://www.triggerpointtherapist.com...oulder-blades/


I had it, mine was from poor posture that fatigued the rhomboids.
Posture work, expert chiro, and being aware of any forward shoulder posture has resolved it in my case.
some self helps -
http://neurotalk.psychcentral.com/album.php?albumid=422
our trigger point sticky -
http://neurotalk.psychcentral.com/thread125577.html

Were your symptoms amplified by breathing deeply or by tilting your head/neck? I just wish I could understand the full anatomy of what was happening to me. If Rhomboid trigger points cause the pain in my upper back, and rhomboid trigger points are caused by poor posture, then why would I develop TOS at 17? why not when I was 15? My posture has been the exact same my entire life. Also, I work on my posture as much as possible and do all of my work at a standing desk, while also doing strengthening every other day for my back with a physio therapist. This is honestly the strangest condition ever, it's like it's resistant to change.

The winging complicates things, I didn't have that issue.
My theory..At some point our body just can't handle the abuse anymore so it starts to complain to us.
If we pay attention and really try to repair things, internally & externally as soon as possible, we might get lucky enough to resolve most symptoms..
I admit I read some of the stories early on and I did not want to end up is serious pain like some talked of.
So I really focussed on learning about the body and how to repair it, and spent a lot of my time doing self care at home many times a day.
Spent a lot of time finding many of the links in the sticky threads.
You can't learn it all at once , take time try a few things on some of the links there, find what works for you and what doesn't.

I also found really good PTs and the DC that was very helpful.
Some of it pure luck and some was just time & learning from all the PTs I did go to due to work comp , some were good and some were rookies still reading in the books.. do not stay with poor PT find a better place..

Have you been able to get any expert PT or DC , ones that address all aspects and uses various therapies to find the best things for you?

you might find helpful info in old posts by towelhorse -
http://neurotalk.psychcentral.com/se...g_searchinfo=1

a few others had winging too, a site search should bring those posts up.

As I understand, scapular winging may be caused by tight pecs major/minor and weak mid-lower traps and rhomboids which is common in TOS.
The weak upper back muscles are overworked and overstretched which causes pain.

The longer we have bad posture the more severe the problem gets. After a while the muscles can't cope with this anymore, develop spasms and trigger points and hurt all the time.

From my experience, it takes very little to send the sick muscle into spasm and very long for it to recover. The bad posture can't resolve overnight and may require many months of PT.

Upper back pain may or may not be a TOS symptom. Dorsal Scapular Nerve (innervating rhomboids) can be entrapped in the scalenes and Spinal Accessory Nerve (which innervates the traps) can get entrapped in SCM. But it may be that those muscles are not to blame.
TOS surgery may help in case of scalene entrapment, but probably not in other cases. E.g. if pain is from trigger points due to overstretching then the surgery won't help.

+ Hiker

In fact when I exercise my upper back, however mild, my pecs flare up and then i spend the day with nerve pain in my arms and hands. And muscle tension. Breathing helps but I have to do it for a long time and get marginal relief.

JZP can you detail your symptoms and when they flare up?

Yeah sure.

So when I'm not flared up I am mostly okay. I don't lift heavy anymore but I still run track and workout my lower body hard, so to everyone else I am mostly fine. But flare ups are a different story altogether. I get the dull/diffuse difficult to locate pain in my shoulder and tricep that just kind of sits at a 2/10 on the pain scale, my hands throb with my pulse and I have this gross pulling feeling down my arm in between my bicep and tricep. My shoulders/shoulder blades crack and grind when I move my arms around laterally and I feel like I have dead arms if that makes sense. Like it feels like I just did a rock climbing workout and arms and shoulders are just dead. I also have a sharp pain between my shoulder blades that is exacerbated by taking deep breaths or turning my head, which is absolutely the worst. I usually just take aleve and hide in my room until it reduces.

Flare ups are super weird, like I have had this since I was 17 (21 now) and I still am not 100% sure what causes them. They just seem to happen. If I decide to say **** it and lift really heavy on my upper body or wrestle with one of my friends that will for sure cause a flare up, but I can also get them from sitting and studying/playing video games. I now have a standing desk which helps a lot. Another sure fire way to get one is to lay or sit on anything soft like a couch or bed. I know it probably sounds silly but I have to sleep on the floor flat on my back, sit with perfect posture, or stay standing.


I am rambling a bit, but yeah that's the gist of it.

This sounds really similar to what I have experienced. I was a heavy weight lifter - and now I have to take it very easy or it will surely flare up. I also have a stand up desk which helps a ton. Reading, using an ipad, or even checking my phone will cause irritation. I refuse to sit in couches as well, have to keep posture perfect as much as possible. If I sit in a couch it causes a flare every single time. MY thoracic spine/shoulder blade locks up. I also flare up for no particular reason at times. I try to stand as much as possible. I sleep on a very hard bed...soft bed and I wake up with that nasty spasming/burning feeling in neck, thoracic spine, upper arm and shoulder blades. I used a theracane for months and it really just made things worse. Countless massage therapists and Physical Therapists without really any relief.

If I were you, I would try to find a neurologist who is skilled at doing an EMG on the brachial plexus. They are hard to find...I went to 2 other physicians who said my nerves were fine just like you, the 3rd one said I had chronic suprascapular/dorsal scapular neuropathy which explains the symptoms. He is the only one who performed the EMG on the brachial plexus. I would bet the problem itself lies above the collarbone.

Also, I had surgery for thoracic outlet syndrome 3 years ago hoping that it would stop the pain in between the shoulder blades and correct the scapular winging/tipping. Unfortunately, the surgery did not help at all. The spasm and irritation is still there and the scapula is actually worse than before. My supraspinatus muscle was visibly atrophied after the surgery, meaning the doc probably irritated the suprascapular nerve even more while performing the surgery. I went to one of the best TOS surgeons in the country - Dr. Robert Thompson. If I could go back, I would have never had the surgery. Now I'm dealing with all sorts of new issues because of scar tissue surrounding the brachial plexus nerve roots...confirmed by MRI.