Question
Dear Doctor,
Twelve years ago, I was pushed off the highway by a truck (lateral impact). An hour later, I started having a numb pain at the lower left corner of my right scapula. Emergency services only took X-Rays of my neck (standard practice here) and found a whiplash injury (C4-C5-C6). Further EMR screening stated a "small paramedial disc protrusion on the right at C5-C6". The pain in my shoulder has been present for 12 years now. I can't work for more than two hours on a PC and many other tasks will result in excruciating pains - immediately or during the night, going on for days. The pain "travels" along my right arm into my hand. Lately there's a pain in my armpit as well, that travels along my chest toward my solar plexus. In the space of twelve years, my right arm dropped about half an inch and my right clavicle has lowered to a horizontal position (originally both clav. had the typical V-shape). Sometimes, I even get muscle(?) pains and stiffness in my right jaw and temple... Six years ago they found a partially healed lesion of the right serratus anterior (EMR with contrast fluid). There is scapula alata. Electromyography showed a "small yet non-significant" deviation on the right. As the medical/administrative processing of insurance cases in my country may not involve contrast fluid injections, I'm stuck with normal EMR that did not reveal what the study six years ago revealed. Meanwhile, I can't do PC work and I lost about 200,000 dollars in wages since it's too painful to do my original job that required mobility and precision (scientific cell cycle research - I was a very promising PhD student at the time of the accident) and nobody looks into the source of the pain as I'm stuck with the standard medical examination protocol. I don't know what to do as a "regular doctor" is deemed unconvincing by the third expert handling the case. In a short while, they might dismiss the shoulder injury altogether since they "lack" evidence of a lesion. Could you give me some advice as to the culprit of my pains so I can seek a local expert who knows which techniques to use to pinpoint the issue? I would be ever so grateful if you could point me into the right direction to identify and treat this pain, so I can resume a hopefully pain-free and normal existence.

Answer
Dear Fae,

You are going through what a lot of people go through.  Some lesions or injuries are hard to diagnose due to limitations of imaging and limitations of other technologies.

First off, if you are suffering from a weak serratus anterior muscle, that will cause the winged scapula deformity.  This can be caused by damage to cervical spine nerve roots C5-C7, or damage to the long thoracic nerve, which is part of the brachial plexus of nerves exiting, again, out of the spine in the mid to lower part of the neck.  The winging of the scapula could also be the result of serratus anterior muscle injury itself, with NORMAL nerve function.

Your best option is with a neurologist who is willing to perform electrodiagnostic tests and other imaging/physical examination tests to help pinpoint the lesion, if it is the result of nerve damages or muscular damages.  A neurologist will also be more "believed" than your primary care physician, no matter how skilled he/she is.

Keep pushing and fighting for answers.  Insurance and government agencies will try and minimize injuries because of the substantial cost to the system. You must exercise your right to have your side of the story told, but it might require you pushing outside of your government medical system to get the examination and tests that you want and need.  Your primary care doctor should be able to direct you to a neurologist that will do a good evaluation.  You might have to pay for this on your own if not covered or offered by your health care system.

Good luck. I hope that you are able to get to the bottom of the cause of your symptoms.

Keith Biggs, DC
http://www.eastmesachiropractor.com