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.

I guess another thing that might be involved is any irritation to your long thoracic nerve, or LTN. You might want to ask your physical therapist or your TOS doc about whether that might be a contributing factor (although I think it might be more likely to happen as a result of TOS surgery...).

Just a thought.

I have two theories apart from the nerve one

Relative stiffness, some muscles are more powerful than others and hence the brain recruits them more and shuts down their antagonist or synergist. Which in turn recruits other antagonists which cause more issues.
For instance, pec minor in forward hunched over posture which acts against lower traps and overpowers serratus.
To counter that, lats are recruited, which hunches you even more and pec minor gets reestablished.
This theory holds that over time, either with stretching or constant vigilance, you can mitigate the effects.

Since exercising for TOS is often shoulders back and down (for lower traps), it ends up recruiting lats too which is a problem.

Second theory, is of some sort of internal trauma which is being masked by these muscles. I think that may be wrong, because sometimes the right muscles kick in and the pain goes down.

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

Winged Scapula can be from damage to the long thoracic nerve which is in the brachial plexus nerve bundle. Thoracic Outlet Syndrome occurs in the lower portion of the brachial plexus. You also need to find out if you indeed have winging scapula. A lot of physicians say you have winged scapula when you really may have Tipping scapula. They are 2 different things but most doctors just lump both of the terms together. If your scapula juts out at the bottom when you are standing with your arms at your side - that is anterior tipping of the scapula and not winging.

You should have a doctor do an EMG of the brachial plexus nerves to see what is going on. I have a tipping scapula and my EMG showed suprascapular neuropathy (upper brachial plexus - innervates supra/infraspinatus) and Dorsal Scapular neuropathy (upper brachial plexus - innervates rhomboid). Keep in mind the Thoracic outlet is located in the lower brachial plexus. Sometimes you can have both upper and lower brachial plexus damage. I was diagnosed with neurogenic Thoracic Outlet Syndrome, suprascapular neuropathy, and dorsal scapular neuropathy. Like you, my biggest complaint was the constant pain in between the shoulder blades/upper back. Constant spasm and irritation in that area. The more I messed with it with stretching, trigger point therapy, or massage the worse it got.