Long Thoracic Nerve injury/Wing Scapula/No ability to raise arm overhead w/o assitans

[Misledmadman]

I am dealing with this as well for 6 years. Has not gotten any better. Can't do chest, shoulder, some specific lifts because it hurts my shoulder too much. My right shoulder is lower than my left and rounded forward. Have seen countless doctors and it wasn't until recently I was finally diagnosed with LTN damage. It really sucks because I can't fire my serratus anterior muscles or keep my shoulder blade in place. The bigger problem is my left side has been overcompensating and it hurts a lot. Ortho offered scapular fixation but I did research and found it not to be worth it. This is the surgery where they fix your shoulder blade to your rib cage with metal wires. So basically I'm stuck with this. Going to see if regular massages help at all.

[jgoldstein001]

I'm dealing with the same condition at the moment. 44 years old. 6 4", 182 lbs. Good athletic condition. Used to play handball as a kid in high school, working out at the gym, 3 times/week for the past 7/8 years or so (20 min cycling/running warm up and some light weight lifting and upper chest/shoulder work) until about 7 months ago at which point I decided to make a change and work on endurance/aerobic sport. I went into triathlon/ironman training (cycling and running with no swimming for now) and hard road biking. These past 7/8 months I did mostly running and extreme road biking (i.e. 100-200 miles/week with 10,000 feet climbing/week). I enjoyed this so much. I lost ~25 lbs, strong legs but also lost just a lot of chest and arm muscle as a result of the cycling. I therefore decided to purchase some light dumbbell weights and work on my shoulders and arms at home these past 8 weeks and then it happened, just around 7 weeks ago, - sharp shoulder pain one night following by weakness/fatigue in my right arm the days after and winging scapula. Can lift and rotate my arm but back/shoulder muscles are off balance.

I went to an orthopedic surgeon who performed a physical exam and diagnosed with Long Thoracic nerve injury. Recommended EMG to confirm and said it may take a 1 yr to regenerate.

I'm trying to figure out what could possibly have caused this? I don't recall any injury or trauma to my shoulder area. The only extreme exercise as far as I can tell was the very intense bicycle riding. Bike fit may not have been ideal so for sure - a contributing factor when riding 200 miles/week and back/shoulder/neck pressure but still...... Also, may be related to the sudden return to weight lifting after months of only working on endurance......?

Is there any physical exercises program I can follow to stimulate the nerve? Would appreciate any help. I understand its a rare condition. Not sure how I got this and was really wondering if my bicycle riding/change in workout focus/weight loss had anything to do with this?

[EnzoNgo]

. Same as you guys, 4 weeks ago, woke up one morning and felt the horrible pain on my left shoulder and my arm can not raise up. Now I can move my left arm freely, the only pain I still have is where the rhomboid is , my left trap get fatigues when I lean my head back. my left scapula still sticks out. when I am cooking and try to pick up the wok But can not, It's like that wok is 100lbs.
I can see my left shoulder is a bit lower than the right when I pose, and when I try lats spread, I can see only my right one.
My question is what's caused the long thoracic nerve injury?

[armant16]

Hey everyone I have been following this thread since my symptoms developed back in July 2017. It is now January 2018 and in this time I have been doing physical therapy and had an EMG test which ruled out nerve damage.

However, I feel the nerve test may have missed something because my experience is exactly what the signs/symptoms are for Parsonage Turner Syndrome/Neuralgic Amyotrophy/ LTN Damage.

I have been able to strengthen surrounding muscles through Physical Therapy and continuing to to what I can at the gym (I train 7 days a week). Fitness has become my life and the limitations caused by this have ruinined my progress. I can't really bench, shoulder press, Dips, pull ups. And, just about every other upper body movement is performed with instability due to my scapula being all outta wack.

Before this injury, I was steadily bulking while maintaing 10% body fat. For everyone who continued training, did you change your diet at all? I am afraid to eat in a caloric surplus became it is difficuilt to create a stimulus for my muscles (can't lift heavy.) And, do you guys recommend I keep training to put on size and strength or just maintain what strength I have?

Thanks for this thread!

[8michael8]

Hey everyone I have been following this thread since my symptoms developed back in July 2017. It is now January 2018 and in this time I have been doing physical therapy and had an EMG test which ruled out nerve damage...

I would say I felt nearly the full effects of this for several years. Here we are nearly 7 years later and I am nearly back to 100%, or what I perceive to be 100%, but there's really no way to know where I'd be had this never happened. The only reminder that I'm not completely recovered is when I do overhead presses I can feel my right scapula push out slightly, and then I adjust myself so the scapula is pushing into and supported by the vertical part of the bench.

Based on my experience and from what I've read from others, I'm still convinced that physical therapy or trying to alleviate the problem by strengthening the surrounding muscles does little to no good. It won't hurt, but it's not going to fix anything. The only 2 things that seem to consistently work are surgery or, as is the case with me, the passage of time. There is no way to know how long that time will be. For me, it's been many years. For others, including some of the people in this thread, it was resolved or mostly resolved in months.

I would do whatever you're comfortable doing as far as workouts go. I would however try to use a foam roller, or even go for massages, on the areas around the base of the neck on the right and left sides, front and back of the shoulders, and even down around the serratus on both sides. There seem to be indicators that this condition is caused or aggravated by scar tissue or adhesions pressing on the nerve. If you can manage to roll those out, you might severely shorten your recovery time. They might be located in an area which you can't really get to manually, but it's worth a try.

[armant16]

I would say I felt nearly the full effects of this for several years. Here we are nearly 7 years later and I am nearly back to 100%, or what I perceive to be 100%, but there's really no way to know where I'd be had this never happened. The only reminder that I'm not completely recovered is when I do overhead presses I can feel my right scapula push out slightly, and then I adjust myself so the scapula is pushing into and supported by the vertical part of the bench.

Based on my experience and from what I've read from others, I'm still convinced that physical therapy or trying to alleviate the problem by strengthening the surrounding muscles does little to no good. It won't hurt, but it's not going to fix anything. The only 2 things that seem to consistently work are surgery or, as is the case with me, the passage of time. There is no way to know how long that time will be. For me, it's been many years. For others, including some of the people in this thread, it was resolved or mostly resolved in months.

I would do whatever you're comfortable doing as far as workouts go. I would however try to use a foam roller, or even go for massages, on the areas around the base of the neck on the right and left sides, front and back of the shoulders, and even down around the serratus on both sides. There seem to be indicators that this condition is caused or aggravated by scar tissue or adhesions pressing on the nerve. If you can manage to roll those out, you might severely shorten your recovery time. They might be located in an area which you can't really get to manually, but it's worth a try.

Thanks for the reply Michael. It seems as if my injury was less severe than most, as I maintained full range of motion and control. The only problem was a severe lack of strength in my left shoulder/back and the winging of the left scapula. I was foam rolling, bhut will definitely take it more seriously.

As far as training goes, how have you trained chest/shoulders and back all these years? I can't even bench my bodyweight for reps with this and overhead pressing is a mess too. The only solution I have found is using hammer strength machines and light dumbbells.

Also, have you or anyone else been able to gain muscle/progress with this injury? I hate going into the gym every day feeling like all I'm doing is hanging on. It's depressing

[8michael8]

Thanks for the reply Michael. It seems as if my injury was less severe than most, as I maintained full range of motion and control. The only problem was a severe lack of strength in my left shoulder/back and the winging of the left scapula. I was foam rolling, bhut will definitely take it more seriously.

For me, back was never as much of a problem as chest and shoulders. I was always more about aesthetics than maximum weight, so it wasn't as difficult as it might have been for me to just drop the weights and increase intensity until things slowly but surely started to get better and I could increase the weights. There are lots of ways to maintain and/or build muscle without relying primarily on the amount of weight you're using. You can do things like decreasing the time between sets, doing drop sets or rest-pause, or "constant tension.

Look up Jason Huh to get a better idea about constant tension. I used the principle a lot when this first happened and still mix it in often along with a more traditional range of motion. The great thing about it is, particularly with pressing exercises for chest and shoulders, is that it's a much smaller range of motion that stays closer to your body. The scapula winging gets a lot worse the farther your hands move away from your body and this alleviates that.

[916biking]

First of all I would just like to say that I am very glad to find out that I am not the only one on this planet with this condition, because it sure felt like it. I have had this issue for almost 2 years now, and I can say that I haven't seen any progress. I originally thought for awhile that this problem would just work this out on itself so I decided to just keep on lifting, but avoiding any shoulder or bench pressing. But clearly I was wrong and I have been wasting countless hours at the gym only to make minor progress. I have also taken breaks outside of the gym and other physical activities with no positive results. Other than one biking incident I had 2 years ago that was sort of minor with only a week of my left shoulder pain, I can't really pinpoint how my winging started. Either way, it sucks. There is no point in explaining all my conditions because they are almost exactly the same as most people on this thread. (can't do any presses, awkward looking scapula/shoulder, pain in my rear delt, etc.) My winging is on my left side and I can barely lift my left arm above my head making the "Y" notion but only with major focus and discomfort. Also many times when I angle my arm or delt in a certain way my delt will crack and I feel a sharp pain in my rear delt area (assuming it's my labrum scraping or something). Like most people I have seen my normal orthopedic doctor only for them to prescribe me to normal shoulder rehab exercises which I had already been doing, and they have not been effective whatsoever. I do plan on getting an EMG, MRI, and hopefully see a chiropractor too. Maybe even surgery if that's what it really takes.

If anyone can update us on their progress or have overcame this condition like others have mentioned and give us some more insight on how to tackle this awful condition I'm sure many people including myself would be very appreciative. To all of the people that have explained that their winging has been fixed with just time and not exercising or lifting, I really don't think this applies to everyone. 2 years is a long time, especially when you are in your prime college years (I'm 23). I miss being in great shape. Thank you and all the best.

[e37557]

I’d also be very keen to hear recovery stories and durations.

My serratus stopped working about 5 weeks ago and I can’t pinpoint it to an event. My long thoracic nerve isn’t transmitting signals.

[johnno1998]

Finally able to find some people who seem to be in exactly the same boat. Been to orthapedic, physio, neurologist etc. and have had emg and ncs and been diagnosed with LTN damage. The only advice any of the professionals could offer was be patient and it may heal with time. Has anyone experienced anything to speed up the process/ alleviate the paid to return to lifting 100%. Acupuncture, Electrical stimulation, massage, any successful nerve transfer surgery (not fixing scap tp ribcage)????????/

ANY comments are appreciated.

Happy healing.

[mzsolti]

Hello guys! I'm very happy to find this helpful forum (although I wish I never had to look). Lots of great advise to read...

It seems like I have the exact same issue with the winged scapula problem. Exactly 24 days ago, I was doing my regular workout routine, when, during chin-ups, I felt some very minor, but uncomfortable stretch in right scapula. In the middle of my workout session... (I work out more or less every day. Doing calisthenics, body weight stuff. I ALWAYS pay careful attention to proper warmup, and I do always focus on the shoulder area with extra attention.) Anyway, something felt wrong, so I stopped immediately training. I tried to stretch out the area etc.

In the next 3 weeks, I was trying to carefully move, stretch my scapula, but without any "weights" on it.
My symptoms were pretty much as everyone else. I had radiating pain in my shoulder joints, elbow. The end of my thumb and index finger were numb a bit. (No pain under scapula.) After, like 20 days of the injury, I wanted to do a pushup - just to see how it felt - when my girlfriend took a picture of my scapula. Well, ughh, it was ugly. Winging like hell. So the next day, I went to see (some) doctors, being afraid, that my LT nerve was broken.

I had several X-rays (to see if vertebras are in place) and an ultra sound test (to check for hematoma under my scapula) made 3 days ago. Everything is pretty much normal. Spine is good, no signs of leftover blood (indicating a muscle split) under scapula.
So far, 4 different doctors are diagnosing 3 different things. The traumatologist said, that it is split muscle under my scapula, and I shall rest my right arm as much as possible for 4 weeks. The neurologist is pretty much sure, that it is the LTN stuff, and suggests to lightly and carefully move it, stretch it, massage it asap (I shall swim, and do light exercise with very light or no weights, to avoid muscle breakdown). The orthopedist is guessing for a slipped disk in my the neck area of the spine (guess is based on my numbness in my fingers). A radiologist - who was preforming an MRI yesterday - was guessing that it is either a slipped disk, or LTN. (He has not received MRI result yet.) I'm getting an ENG test next week. This will be able to tell the extent of nerve injury...

This is where I'm at after 24 days of the injury:
- Range of motion of my arm is pretty much full, but it is difficult to raise it above 90 degrees in front of me. Full range of motion to the side is not a problem.
- Weakness, severe weakness
- Muscle under scapula is gone. It simply does not get impulse to move. This, of course leads to winging.
- Radiating pain is totally gone (as of last night, this morning) from shoulder joint and down my arm.
- Thumb and index finger are still a tiny bit numb.
How I currently try to recover:
- I take lots of vitamins. Doctors advised to get extra vitamin B complex (B1 and B12) to support nerve regeneration.
- I will buy some evening primrose oil too, because of its GLA content.
- Tennis ball massaging scapula against wall
- Lightly moving my arm around lying on the floor.
- Once I have a 100% diagnosis, I will see a physical therapist to discuss further steps
- Ready for a long, patient recovery time. (And saying good bye to muscle ups, static holds, pushups for quite a bit of time...)

I will try to post updates of my recovery, because it was so helpful to read other people's examples as well.
Best of recovery to everyone!!!

[jgoldstein001]

mid 40s. cycling athlete for almost 2 yrs now. Its been 10 months since having this and no change! EMG confirmed (deep) injury to long thoracic with no clue as to why and how. Right arm weakness, winging scapula, right rear delt muscles tight. Range of motion is OK but w/out stratus anterior functioning I'm limited. Still, keeping my bike exercise (100k-150 miles/week). Can't go on drops due to the weak shoulder. Lucky not playing basketball. Wouldn't be able to make any shots with this. Trying massaging the rear delt every now and than. No PT. Can't lift heavy weights, can't bench. Other than, feeling great and in great shape!

[mzsolti]

Hi Melanie,
Were you able to recover from that terrible LTN damage??? I have the exact same thing going on in my right scapula. My serratus anterior is basically dead at the moment (6 weeks after injury).
I would appreciate any suggestions on how to get better (without surgery).
Thank you!
Zsolt from Hungary

[armant16]

Hi everyone. I posted in this thread a few months back after desperately searching the web for answers to our condition. Since then, I can't really say much has changed. It is hard because this condition is subject to relapses. I could slowly be regaining serratus strength only to wake up one day and not be able to lift my arm. I continue to go to physical therapy once per week and incorporate the exercises on my own before and after my main workout.

Many complications have arose. I now have a 5 degree s****osis curve. Also, the imbalances of my upper torso have affected my whole body, causing a hip misalignment and leg length discrepancy. This affects my gait and makes me susceptible to strains.

Probably the worst part was that I tore my left pec a few weeks back because it lacked support from my shoulders, and was taking excessive loads. That has since healed though.

I've come to a point plateau in terms of progress. Sure, in everyday life my scapula doesn' wing and I feel 90% okay. But any physical activity causes its presence to be known. And, doctors and therapists just dont get that to be ok in everyday life is not enough when you LOVE TO TRAIN. I do not consider myself healed until I can bench, dip, pull up, lat pulldown, plank, row, curl, and raise like I ****ing use to. I'm 20 years old, I could have been competing by now if I had stayed the course.

I would even do surgery at this point. However, I have no idea what kind of surgery one could perform and if it would allow me to train normal again.

[Matan11]

Been dealing with this for almost 2 years. It all started with a bad shoulder trauma in a scooter accident.
The first few weeks I had burning pain right in my scapula. Then after, neck pain started - I guess from trapezius compensation for inactivity of the serratus anterior, combined with tingling and clumsiness of my entire arm (loss of grip strength, weakness, arm just feels tired.)

I have experienced SOME improvement. I can activate my serratus but it feels WEAK. Currently my assumption (my own thinking, not brought up by a doctor or anything) is that the nerve has recovered to some extent, but it's surrounded and pressured by scar tissue. I heard about decompression surgery, going to see a shoulder orthopedist.

[follothry]

Hello, I have read this entire thread and I didn't see the solution anywhere so felt compelled to share my experience.
I am not a bodybuilder, just the opposite actually, I'm an accountant
While at a training seminar (read conference room for 4 hours of videos) my right arm started hurting (at rotator cuff and radial from there, up and down) dealt with it until about 12 hours later. Could do absolutely Nothing without excruciating pain. Went to the ER scared of a heart attack. Got cleared of that worry and told I had a myalgia. Given muscle relaxers which honestly worked a little. I could not move my right arm at all by this point.

Went to my GP the next day for an orthopedic referral. GP says looks like you're shoulder is displaced (included winging and dropped shoulder) which finally made me think of my chiropractor.

Instead of going for an MRI as directed, I went to see my chiro. He told me the damage to my thoracic nerve came from me watching the video with my head turned for hours. He did a neck adjustment first that allowed me to use my arm again, then some shoulder adjustments, before continuing on to a regular check up alignment series. While still sore, I had complete mobility again.
This is the morning after that...I'm no longer sore, have full range of motion.

Guys...go see a chiropractor. If they can't help, they'll tell you immediately. Best wishes to you all.

[jk1890]

Have had for a little over 2 years, and just when I think it’s getting better it starts again. What kind of exercises have the most beneficial outcome for the condition, and has ANYONE had any surgery that isn’t stabilizing the scapula to the rib cage? I’m hoping to go see a doctor soon, and figure out options, if any. Was really nice to find a place though with like minded people, going through the same thing. It’s super depressing to deal with.

[8michael8]

Have had for a little over 2 years, and just when I think it’s getting better it starts again. What kind of exercises have the most beneficial outcome for the condition, and has ANYONE had any surgery that isn’t stabilizing the scapula to the rib cage? I’m hoping to go see a doctor soon, and figure out options, if any. Was really nice to find a place though with like minded people, going through the same thing. It’s super depressing to deal with.

I've not had surgery, but here are a few links to check out with information on causes, possible treatments, and detailed pictures on what the LTN looks like and the path it follows from the neck down to the serratus. One of the possible surgical options, and the one that would most appeal to me, is surgically relieving pressure on the nerve.

sciencedirect.com/science/article/pii/S1877056814000589

chiroup.com/differentiating-scapular-winging/

orthobullets.com/shoulder-and-elbow/3062/scapular-winging

academyofclinicalmassage.com/long-thoracic-nerve-compression/

researchgate.net/figure/Anatomy-of-upper-part-UP-and-long-thoracic-nerve-LTN-The-upper-part-of-the-serratus_fig1_5268505

[squinty91]

Hi all, I came across this forum and see a lot of questions to share success stories. Not sure that mine fully qualifies as that but I'm going to share.

I have always been an active person, I danced most of my life and got into weight lifting around 15. In Aug 2014, I was in the gym when I suddenly couldn't press overhead. After 2 weeks of not being able to lift my arm I started my journey to diagnosis. Luckily I never had any pain just very limited ROM and a winging scapula. After seeing about 5 PT/ortho/neurologists I had an EMG which showed no signal from my LTN and I was diagnosed with idiopathic LTN injury (later I found out my LTN was very superficial and I was prone to this injury). From there I started PT and continued until July 2017. I saw about 4-5 PTs during that time with no improvement. The PTs had me basically stop all activity for fear of impingement (this is bull**** advice and if someone tells you that don't do it). In that 3 years I was told to stop everything including back squats (because of the angle of my arms) even though none of it caused me any pain. I was also told to wait to have surgery and see if the injury resolved naturally. During that time I got significantly weaker and my serratus completely atrophied.

Finally, an ortho told me it was time for surgery and suggested a muscle transfer (again really ****ty medical advice). I decided to go online and do my own research, which is when I found Dr. Nath. Dr. Nath specializes in LTN damage caused by muscle compressions and he performs neurolysis surgery. After reviewing my case I was deemed a candidate for his surgery. He also told me that for the type of LTN damage that I had (the muscle was compressing the nerve), if the injury hasn't resolved in 3-6 months it usually doesn't. I had surgery in July 2017 and saw some minimal improvements but my full range of motion never returned.

About 9 months after surgery I still had very limited mobility but I said screw it and joined a crossfit and started training (against the advice of many PTs). Since then my arm has only improved. It was very slow and I was extremely careful along the way but I was always able to get a barbell overhead. I now can do pretty much all the movements and I am only limited by some strength. I can even do single arm DB overhead with my bad arm. While I still have limited range of motion with just my free arm, I can do any movement I want as far as working out.

I think if I hadn't waited so long for surgery and let my muscle atrophy so much I would have had a much better prognosis and fully recovered. Be careful what medical advice you listen to because most PT and orthos have never treated LTN injury and don't know what they are doing. With that said maybe with time I will get my full ROM back but until then I'll be doing 100+# snatches and getting stronger.

[Szyszak]

Hi all, I came across this forum and see a lot of questions to share success stories. Not sure that mine fully qualifies as that but I'm going to share.

I have always been an active person, I danced most of my life and got into weight lifting around 15. In Aug 2014, I was in the gym when I suddenly couldn't press overhead. After 2 weeks of not being able to lift my arm I started my journey to diagnosis. Luckily I never had any pain just very limited ROM and a winging scapula. After seeing about 5 PT/ortho/neurologists I had an EMG which showed no signal from my LTN and I was diagnosed with idiopathic LTN injury (later I found out my LTN was very superficial and I was prone to this injury). From there I started PT and continued until July 2017. I saw about 4-5 PTs during that time with no improvement. The PTs had me basically stop all activity for fear of impingement (this is bull**** advice and if someone tells you that don't do it). In that 3 years I was told to stop everything including back squats (because of the angle of my arms) even though none of it caused me any pain. I was also told to wait to have surgery and see if the injury resolved naturally. During that time I got significantly weaker and my serratus completely atrophied.

Finally, an ortho told me it was time for surgery and suggested a muscle transfer (again really ****ty medical advice). I decided to go online and do my own research, which is when I found Dr. Nath. Dr. Nath specializes in LTN damage caused by muscle compressions and he performs neurolysis surgery. After reviewing my case I was deemed a candidate for his surgery. He also told me that for the type of LTN damage that I had (the muscle was compressing the nerve), if the injury hasn't resolved in 3-6 months it usually doesn't. I had surgery in July 2017 and saw some minimal improvements but my full range of motion never returned.

About 9 months after surgery I still had very limited mobility but I said screw it and joined a crossfit and started training (against the advice of many PTs). Since then my arm has only improved. It was very slow and I was extremely careful along the way but I was always able to get a barbell overhead. I now can do pretty much all the movements and I am only limited by some strength. I can even do single arm DB overhead with my bad arm. While I still have limited range of motion with just my free arm, I can do any movement I want as far as working out.

I think if I hadn't waited so long for surgery and let my muscle atrophy so much I would have had a much better prognosis and fully recovered. Be careful what medical advice you listen to because most PT and orthos have never treated LTN injury and don't know what they are doing. With that said maybe with time I will get my full ROM back but until then I'll be doing 100+# snatches and getting stronger.

I think low shoulders might have big impact for scapula winging, and often time cue "back and down" can create that issue as well. Second thing is, people dont do enough of over head movements, when your muscles which create upward rotation of scapula can really work