Question
My situation started when I tore my right upper bicep tendon at work when I was torqing a bolt on a automotive front suspension component. The surgeon recomended reattaching the tendon. Prior to this injury,I did not have any pain or lack of range of motion in either of my shoulders. The procedure that was performed on my right shoulder was a biceps tenodesis, and an acromioplasty with coracoid ligament resection. Approx. 2-3 weeks after the surgery I had started physical therapy, and did not continue due to excessive pain , and lack of movement at that time. The symptoms I was experiancing at that time were pain in my arm pit, and through the whole shoulder. I could not lift my arm past shoulder height to my side, and had numbness, and tingling in the shoulder area. My shoulder felt very unstable. I seen a neuroligist, and he performed a physical examination to diagnos possible nerve damage. his conclusion was the nerve responded ok. At that time I started therapy with a new therapist, and after three visits he felt that there may be another problem due to   the pain, and lack of motion I was experiancing. Therapy stopped at this time with this therapist. This is a work comp. injury, and I do have a QRC who had set up an appointed to have me see a shoulder specialist with another medical group. I had a new MRI taken, and showed no significant neurological cond. at that time. I started therapy with a sports therapist, and worked on light shoulder, and scapula strenghting excersises. After multiple sesions my shoulder condition stayed the same. At this point a emg was scheduled, and the nerves were checked from my shoulder down to my hand, and at that time the conclusion was that the nerves were healthy. I continued therapy twice a week for a total of 34 sessions with no progress. The comment this therapist made is that I have a weak scapula or a winged scapula. The doctor still beleives strenghting is going to correct this issue. I am now seeing a differant therapist who is doing a new evaluation. The program I am in now is called work hardining. This surgery was performed in aug. of 2008. At this time I have a winging scapula, pain in my shoulder, pain radiating down my arm to my middle finger nuckle, and thumb. My shoulder is sagging, with no strength, and I can not lift it from my side over shoulder height. There is pain radiating from my shoulder into my neck, and into my jaw. I did have a nerve block in my lower neck when I got out of surgery to to the extreme pain. Most of these symtoms were noticable shortly after surgery. I have been doing some research on my symtoms at this time, and I keep reading about symtoms exactly the same as what I am experiancing relating to nerve damage. Could a nerve in my shoulder have been damaged from the surgery or nerve block? My shoulder was healthy prior to the bicep tendon tear. The more therapy I do the worse my condition is getting. It has been almost a year since the injury.
At this point I can't see the light at the end of the tunnel. Very frustrated, any help would be appreciated Thanks, Rick  

Answer
Hello Rick,

I am sorry to hear of your complicated and deteriorating condition.

First of all, I would refer this question to an Orthopedic Surgeon MD, or perhaps a Physiatrist MD, perhaps a sports medicine MD or rehab MD.  SURGERY has been performed, and MDs are familiar with surgery, we DCs are not as familiar with surgery,,,,,

"....Prior to this injury,I did not have any pain or lack of range of motion in either of my shoulders....."- we start here- obviously you were fine before the injury- normal range of motion (ROM), normal strength, no dysfunction you can remember.

After your injury,,, you did have Xrays, MRI and or CT scan, EMG/ncv, a second opinion ?

Was the only injury from the incident the bicep tendon???- was anything else injured ????

You have an injury, and then you have a procedure to repair your torn bicep tendon.  See: http://orthopedics.about.com/od/shoulderelbow/g/tenodesis.htm

After surgery, ".....I was experiancing at that time were pain in my arm pit, and through the whole shoulder. I could not lift my arm past shoulder height to my side, and had numbness, and tingling in the shoulder area......"; certainly these symptoms can be related to the injury OR due to the surgery-- and expected as you heal,,,,
       These post surgical symptoms may be normal, may be expected,,,-did you communicate with your surgeon over these symptoms?
        These post surgical symptoms-  these are why post-procedure rehabilitation/ massage/ physical therapy are necessary.

Very often surgery is the easy part of a musculoskeletal problem: an hour, or two, or three--- under anesthesia, and the surgery is done, finished, over.   THEN the hard part starts: weeks, months, sometimes a year or two of rehabilitative care.

"....My shoulder felt very unstable....."- this might not be unusual, again, you have had surgery.  Did you discuss the procedure- AND THE FOLLOWUP CARE and expectations with the surgeon?  Did you have a second opinion??  Did they concur?

Neurologist said nerves were a-okay.

"....I had a new MRI taken, and showed no significant neurological cond. at that time....."  MRI can identify structural nerve damage and impingment; checking the function of the nerves would be an EMG/ncv or a Neuralscan such as I have in my Staten Island Chiropractic office ( neuralscan = http://www.nervepathology.com/ ).

"....I continued therapy twice a week for a total of 34 sessions with no progress....." = 17 weeks = 4 months = I must compliment you, you are trying! You are a compliant patient, trying your best!

:....winged scapula. The doctor still beleives strenghting is going to correct this issue. ...."- WINGED SCAPULA?- could be an intrinsic muscle problem, but could also be a neurological problem.  Here I recommend your Doctor of Chiropractic.  Your DC could/ should also have additional credentials- see: http://www.acatoday.org/pdf/ApprovedChiropracticSpecialtyPrograms.pdf  from these specialties I would recommend the Chiropractic Doctor with Neurology, Sports Injury, Orthopedic or Rehab credentials.

(winged scapula +
http://peterbrownson.co.uk/images/uploaded/winging_scap_1.jpg ,

What causes a winging scapula? http://www.google.com/imgres?imgurl=http://peterbrownson.co.uk/images/uploaded/w...
A winging scapula is associated with damage or a contusion to the long thoracic nerve of the shoulder and / or weakness in the serratus anterior muscle. If the long thoracic nerve is damaged or bruised it can cause paralysis of the serratus anterior muscle and winging of the scapular or shoulder blade.
Damage to the nerve can be caused by a contusion or blunt trauma of the shoulder, heavy weight lifting, repetitive throwing, traction of the neck or can also sometimes follow a viral illness. Some cases of long thoracic nerve injury are of unknown origin.

^^^ nerve ^^^^ = this is why I am recommending at least a Chiropractic Evaluation )



"......I did have a nerve block in my lower neck when I got out of surgery to to the extreme pain. Most of these symtoms were noticable shortly after surgery....."- 'most of these symptoms were noticable... AFTER surgery...." , , , , ,  you noticed these NEW symptoms; AFTER surgery - did you speak with the surgeon about this ?


".....Could a nerve in my shoulder have been damaged from the surgery or nerve block? My shoulder was healthy prior to the bicep tendon tear....." - 'could a nerve ... have been damaged from ... surgery or ...block?..."--- possibly.  From your description,,, possibly.

"....My shoulder was healthy prior to the bicep tendon tear....."- you had no prior neck/ shoulder/ trapezius/ scapula symptoms; you had none of: "....winging scapula, pain in my shoulder, pain radiating down my arm to my middle finger nuckle, and thumb. My shoulder is sagging, with no strength, and I can not lift it from my side over shoulder height. There is pain radiating from my shoulder into my neck, and into my jaw.....".  Perhaps the surgery did (didn't) repair the tendon?  Perhaps the surgery initiated these other problems???

#1)  Have you communicated these concerns/ questions to your Orthopedic surgeon?

#2)  have you communicated these concerns/ questions to ANOTHER Orthopedic surgeon (second opinion-- different office, different hospital, different town ) ?

#3)  "...the worse my condition is getting...."- perhaps your tendon has healed, but perhaps there is something else, something different going on.  winged scapula video = http://www.youtube.com/watch?v=d7_GzNSM2mE


Additional articles:
http://www.chiroweb.com/mpacms/dc/article.php?id=44042
http://www.chiroweb.com/mpacms/dc/article.php?id=36146
http://forum.bodybuilding.com/archive/index.php/t-2195941.html


Your scapula/ shoulder problems, pain radiating to your fingers/ thumb; sounds like it could be a 'pinched nerve'.  You have spent a lot of time rehabing the muscle, perhaps it is time to let a Doctor of Chiropractic look at the nerve aspect of things.



"....At this point I can't see the light at the end of the tunnel. Very frustrated, any help would be appreciated Thanks, Rick...", Rick, I suggest talking with your surgeon, AND talking with a second- totally unrelated surgeon.  Rick, I suggest a visit to a Doctor of Chiropractic- specialties listed above.


In my Staten Island Chiropractor office I utilize handout information, perhaps these will be of help to you:





揚inched  Nerve? ---- and a  'Pinched nerve' could be your culprit, Rick;


( Also Known As-  neuritis, neuralgia, brachial-neuritis, sciatica )

損inched nerve??is only ?a diagnosis,  WHAT is causing the 憄inch? Your Doctor of Chiropractic will examine and evaluate you to make sure you are not showing signs of neurological damage or disease, tumors, cancers,  severe pathology, perhaps a Herniated Disc, or a Vertebral Subluxation Complex.

Sometimes  we  can  wake  up  with  a  憄inched nerve?  or  a  muscle spasm.... sometimes a slip, trip, fall, heavy lift, or even a motor vehicle accident can cause a 憄inched nerve?  Very often -  the true    c a u s e   of  the pinched nerve, painor numbness  in the:    neck and/ or  shoulder  and/ or  arm  and/ or  hand;   pain in the back and/ or   buttock/ hip/ leg/ knee/ foot -  is a misalignment,  a  慿ink?in the neck or back - more properly termed a Vertebral Subluxation.

             Vertebral   Subluxation   Complex    (a.k.a.  憇ubluxation?
The vertebral subluxation complex is the underlying cause of many healthcare problems.

A subluxation interferes with the proper functioning of the nervous system (the master system which controls and coordinates all function within the body) and may cause various other conditions, symptoms and problems.


This is a serious condition identified by its five parts:

     Spinal Kinesiopathology:
        This is fancy way of saying the bones of the spine have lost their normal motion and position. It restricts your ability to turn and bend. It sets in motion the other four components.

     Neuropathophysiology:
        Improper spinal function can choke, stretch, or irritate delicate nerve tissue. The resulting nerve system dysfunction can cause symptoms elsewhere in the body.

     Myopathology:
         Muscles supporting the spine can weaken, atrophy, or become tight and go into spasm. The resulting scar tissue changes muscle tone, requiring repeated spinal adjustments.

     Histopathology:
        A rise in temperature from an increase in blood and lymph supplies result in swelling and inflammation. Discs can bulge, herniate, tear, or degenerate. Other soft tissues may suffer permanent damage.

     Pathophysiology:
        The VSC contributes to OsteoArthritic degeneration.  Bone spurs and other abnormal bony growths attempt to fuse malfunctioning spinal joints. This spinal decay, scar tissue, and long-term nerve dysfunction can cause other systems of the body to malfunction.



The Vertebral Subluxation Complex describes what happens when spinal bones lose their normal movement patterns and position.

        Automobile accidents, improper lifting, improper posture, alcohol, emotional stress, chemical imbalances, and long periods of sitting can cause the Vertebral Subluxation Complex.
         Vertebral  Subluxation  cannot be corrected through chemicals (medicine), stretching, yoga, vitamins or physical therapy alone.  Subluxation- a neuro/skeletal/muscular- mechanical- problem requires a mechanical correction-  -  -    a manipulation,     best performed with the chiropractic adjustment.    For good health-
Treat   the   Cause,  not just the Symptoms.

Dr. Victor E. Dolan,   Doctor of Chiropractic;   Diplomat, American Chiropractic Board of Sport Physicians; Diplomat, American Academy of Pain Management; Certified Clinical Nutritionist (IAACN); FIRST  Chief of Chiropractic  in  a  Hospital  in  New York State (DHSI);  As  Seen  in  PREVENTION  Magazine


揚inched  Nerve?  ( Also Known As-  neuritis, neuralgia, brachial-neuritis, sciatica )
損inched nerve??is only ?a diagnosis,  WHAT is causing the 憄inch? ?That 損inch?has to be taken care of FIRST!

As the 損inch??the MECHANICAL component of the problem, the CAUSE of the problem is being taken care of  through Chiropractic treatment, perhaps additional help would speed your return to health:


Nerve Health Support:

-----B complex containing thiamine, folic acid, B-12 and niacin is highly suggested for nerve support.  High dose
B-vitamins should only be taken at the advice of a licensed healthcare professional.

-----B-6 is lower in patients with neuropathy.  Vitamin B-6 reduces the glycosylation that can cause nerve damage.  Amounts greater than 200mg/day can cause neuropathy symptoms.

-----Calcium and magnesium are important for nerve conduction and as muscle relaxants.

-----A multi-vitamin/mineral supplement is suggested for comprehensive support.

-----Essential fatty acids are necessary for nerve health.  Essential fatty acids include omega-3 fatty acids (fish and flax oil) and omega-6 fatty acids (black currant seed oil, borage oil and evening primrose oil).

-----Proteolytic enzymes may be beneficial in neuritis for the inflammation.

-----Lecithin aids in nerve support.

-----Natural herbal remedies including passion flower, valerian, chamomile, scullcap and white willow bark may be helpful.

-----Eat a healthy diet.  Avoid foods that stimulate the nervous system such as caffeine, chocolate, refined sugars, soda pop and cigarettes.

-----Drink plenty of filtered water.


-----Chiropractic care is imperative to remove nerve irritation.
Joint Support:
-----Glucosamine sulfate helps strengthen joint integrity.  Glucosamine is effective in relieving joint pain associated with osteoarthritis.  Glucosamine's pain-relieving effects may be due to its cartilage-rebuilding properties.  These disease-modifying effects are not seen with simple analgesics and are of particular benefit.

-----MSM is known for its pain-relieving properties in such conditions as fibromyalgia, osteoarthritis, bursitis, tendonitis, back pain and muscle soreness.  Not many clinical trials have been done using MSM, but clinical observations support the theory that MSM is beneficial in pain managment.

-----White willow is an antiinflammatory and analgesic agent.  White willow was used as far back as the Middle Ages to reduce pain and fevers.  The salicylates found in the white willow bark are responsible for the anti-inflammatory and anti-fever effects.  Acetylsalicylic acid, otherwise known as aspirin, is chemically similar to the salicylates.

-----Boswellia and turmeric (curcumin) are potent antiinflammatory herbs.  Curcumin may have similar action to aspirin.

+++++++++++++++++++++++++++++++++++++++++++++++


I hope the above helps.

Go Get Checked Out at your local Doctor of Chiropractic; I would not be surprised if chiropractic could help.

If you need further,,, do not hesitate to REcontact me here at
AllExperts.
http://www.allexperts.com/ep/965-100794/Chiropractors/Victor-Dolan-DC-DACBSP.htm



Wishing you Good Luck, Good Health and a quick recovery,
your Internet Chiropractic Staten Island Expert,


Dr. Victor Dolan, DC DACBSP
http://drvictordolan.chiroweb.com - - -- - Email NewsLetter