Scapular winging with involuntary movement and spreading pain.

by Cat

Scapular winging with involuntary movement and spreading pain.

Hello, and thank you for taking the time to read and answer my question. Like many people writing to you, I have been on a medical treadmill with no end in sight, and apologize for the wordy diatribe in advance. I'm honestly at the point where I'd sacrifice chickens under a full moon if someone told me it could help, and any advice, names, or even a guess as to my next step would be appreciated. I hope you make have some insight as to what is happening or who I can talk to!

I'm 29 and currently very petite at 5'3” and about 100lbs. Before my injury I was quite muscular, athletic, very active, and healthy with no previous history of pain or disease.

I developed severe shoulder pain, instability, and a dramatically winging scapula after a kayaking trip in November 2012. This was not an unusual activity and while there was no obvious moment of injury, the trip involved me attempting to save the kayak from a wreck with an outstretched arm. When I got back to my car I could not control the fingers on my right hand to tie my shoe. There was a deep ache in my shoulder, and felt like it was popped out of place. It also appeared rolled forward and depressed, my scapula winged out, and I couldn't straighten my neck from a hunched forward posture. Since then, the numbness and loss of dexterity have improved after a steroid shot into my shoulder, but it was apparently masking some serious pain!

My symptoms have increased, spread, and I began to have frightening involuntary shoulder rolling movements. Physical therapy has gone nowhere. Since March I have been unable to work or live on my own. I have to take frequent breaks from simple tasks to stretch out on the floor and spend most of my time in bed.

There is pain and cramping in my scapula, rhomboid area, under arm and pectoral area, with a hot wire feeling from my collar bone to my right armpit. The cramps have spread up and around my neck into the base of my skull, causing a choking sensation and severe headaches respectively.

The scapular winging has become very prominent, the tip lifts up and away from my body, and wings even when the arm and shoulder are relaxed. Pressing the tip of my scapula or using my arm too much aggravates these involuntary movements, they became almost constant even waking me up at night. There is also what feels like a tight band around my chest, and I have trouble expanding my chest to take full breaths.

Just recently, while pulling something with my left arm in an awkward position, my shoulder popped and was followed by a familiar deep shoulder and under arm ache, sharp upper back pain, and hand numbness. Now my treacherous left scapula wings laterally during use!

I maintain full range of motion, although painful and compensate for my shoulder weakness with other parts of my body. The pain is constant with activity or rest, but gets worse holding my arms away from my body, or gripping and twisting my hands (Like driving or washing dishes). Sitting and standing also make things worse. It is very painful to look up and hard to keep my neck from collapsing, and I can't seem to straighten my neck or shoulders without involuntarily arching my back.

Pressure to the top of my head increases the pain in the base of my skull.

Raising my arm overhead inconsistently makes my symptoms better, and often I have to involve my chest to do it. Laying flat and very still helps decrease the pain, but not relieve it. Recent Tens stimulation for possible TMJ to my face and neck relieved the involuntary movement and nearly every weird symptom except for the scapular winging, deep ache, and some rhomboid pain. It starts to wear off after about 18 hours though, with a full return to awful in 4 days, and each treatment has been less and less effective.

Before I got hurt, I was an avid climber and kayaker. I worked as a stage and light technician, involving lots of heavy overhead tasks, and also as a jeweler doing lots of repetitive fine hand motions. I admit my lifting techniques and posture were not the best. Also maybe of note, I fell on my face 4 months after the start of my shoulder problems and had a concussion. There was no immediate increase in symptoms, but I busted my head good.

Currently I have no official diagnoses or treatment plan, and have tried a liberal variety of conservative therapies. Muscle relaxers and pain meds were ineffective and I stopped taking them, as was gabapentin and other nerve medication.

Current working diagnostics are Neurogenic Thoracic Outlet Syndrome, brachial plexopathy, brachial compression or irritation, and long thoracic nerve stretch injury or irritation. I have no unusual results from MRIs, EMGs, xrays, or rheumatology panels, no cervical bulges, extra rib, or observable wasting.

I am very interested in your take on all of this, and eager to do what it takes to get back on track.

Hello Cat,
A nasty injury; indeed the Long thoracic nerve which emerges from the lower neck.

Firstly, what's good. Oddly, you may say, but it's good that this hurts. A non-painful winging is much more serious and untreatable.

Several things are significant here. Firstly that you get relief by raising the arm; that's called the Shoulder Abduction Relief sign. Use the search function at Chiropractic Help to find it. It points away from a Thoracic Outlet Syndrome and towards an injury in your lower neck.

Secondly that you have difficulty looking up; that again points to the neck, or upper thoracic spine.

Take note of exactly which fingers are affected.

Do three tests for me; carefully, they can aggravate the condition.

1. Sitting, turn to the left and then look up. Exactly what do you feel and where? Compare with the other side.

2. In this position, ask someone to stand behind you and GENTLY press straight down on your head. Again, what happens.

3. Using the search function at Chiropractic Help, look up Upper Limb Tension Test; do it. Tell me...

4. Prick your fingers and arm. Exactly where is any numbness compared to the other arm. Or is hypersensitive?

5. Ask someone to test your triceps muscle; extending the elbow, with palm towards your body.

6. Ask (politely!) if a second person could read your MRI, without access to the first report, with particularly note of the C5 and C6 area.

This is an unusual injury, Cat; it's unusual for the anterior rami to be affected, a technical term, forget it.

A home traction device might help, done lying down. Not expensive.

Time for a visit to a very experienced and thorough chiropractor methinks.

Let me know the results of the above. I'm away for five days.

Dr B

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Interesting challenges of the day

1. Mr S is a 76 year old man with neck pain of some 9 months duration. Luckily, most of the discomfort is upper cervical which is only rarely arthritic; his lower cervical spine is a degenerative mess that I've left alone. After seven treatments his pain and stiffness is 50 percent better, and he's happy in the circumstances. He can sleep through the night now and that makes a huge difference.

2. Mr P is 32 year old man with very severe lower back pain radiating to the big toe which is 30 percent numb. He had an episode three weeks ago, took anti inflammatories and was soon better as is typical of the medial disc herniation. But before it healed, after a trivia it came roaring back, much worse. The characteristic crossed sign was evident; sitting in a chair, straightening the right leg provoked severe left back pain and tingling in the leg. He's doing well.

3. Severe lower back pain is scary; just ask Mrs P. Just watching her get out of the car I she was in trouble; she had a slipped disc at L4 making her lean towards the opposite side; luckily she had no pain in the leg. Despite family pressure that this was far too severe for a chiropractor, she persevered. Within five days she was standing upright, and after two weeks almost painfree. 

Despite a hectic job, she wisely took my advice and stayed home for what I call exercising bed rest.

4. Mr S has had lower back, groin and back of thigh and calf pain for fourth months.

He has a pincer deformity in the hip causing the stabs in the groin, and a degenerative facet causing the sciatica. Both are responding well to chiropractic and he's well pleased; sixty five percent better after three treatments.

5. Mr T is a wise man; he's taken a warning TIA seriously and has lost 15 pounds, and has at least as much again to lose. A change to a low starch diet and half hour daily walk has made the difference; but the walking is making his foot and back miserable. The expensive orthotic is hopeless; luckily his hips and back are fine, but he needs a simple heel lift.

6. I too have had serious lower back issues, luckily fixed by my own chiropractor; so I too have to do my exercises, take care when lifting supers full of honey, gardening and using the chainsaw. Regaining the function of your spine is just as important as the pain.

7. My own granddaughter, only 7 is hypermobile giving her pelvic, knee and ankle issues. Xrays show a mildly dysplastic hip. Years ago we would have called it growing pains. She too regularly needs chiropractic care and luckily responds well. Increased range of motion is more difficult than too stiff in my opinion. Our care is for kids too.

8. This 65 year old lady is a serious gardener; every day she is bending, lifting and digging for 2 to 3 hours a day. It regularly catches her in the sacroiliac joint, so she has a treatment once a month that sorts it out. She does her lower back exercises faithfully.

9. This 88 year old lady is an inspiration; every day she is busy in the community. With a nasty scoliosis she manages very well with a chiropractic adjustment every six weeks and exercises faithfully done.  

10. Mr X is a 71 year old retired man who wants to continue with maintenance care every six to eight weeks; he had suffered from two years of lower back pain when he first came a year ago. He has no discomfort now after 8 chiropractic treatments, but is aware that danger lurks.

11. Mrs C has been having severe headaches, and taking a lot of analgesics. It's a non complicated upper cervical facet syndrome, and she's doing well.

12. Mr D is a 38 old year man with chronic shoulder pain after a rotator cuff tear playing cricket. It responded well to treatment, but he knows he must do his exercises every day; for two years he couldn't sleep on that shoulder.

13. Mr D, a 71 year old man, has a severe ache in the shoulder and midback since working above his head. Trapped nerve tests are negative but he has advanced degenerative joints of Luschka; after just two treatments he is 50 percent better. Can we reach 90?

And so the day goes; chiropractors shouldn't be treating the elderly most medical sites state but that's so much bunkum.

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