Question
my son(17) was in a car crash almost a year ago.. He was turning left(stopped) and a car going UMP swerved and ended up hitting him on the right side of the car.. He had a right shoulder AC tear.. it seems to have healed after physical therapy.Two weeks into physical therapy he started having tremors(for lack of better word..) more like seizures.. they start in the middle of the back and move out to the fingers.. they take about 10-30 minutes and he can tell when they are coming and it severely fatigued after they pass. They happen from 3-6 times a day.. He is very athletic and is quite concerned that the fatigue will mess up his track scholarship he just signed.. He has had cervical MRIs and complete cardiac workup with nothing much. He does have chest pain when this happens but it seems skin deep not cardiac.. the neurologists are stumped and the heart is clear.. the orthopedic guy is concerned but has no answer.. Hmmmm if it were the long nerve would he not have pain.. ? he has gripping trouble while the tremors are happening but no pain.. he has very weak legs and after the neurologist pushed on his back last week his ankles have been on fire and stabbing knee pain.. our next stop is a neuromuscular massage therapist.. any suggestions.. ?
thank you..

Answer
Dear Diane,

What you have described does not sound like an injury to the long thoracic nerve per se.  The long thoracic nerve innervates the serratus muscle which serves to stabilize the motion of the shoulder blade, and when this nerve is injured the shoulder blade will float outward from the torso and leave a visual hump to the side.  This is called "winging of the scapula".

The fact that he has chest pain with this can indicate muscular trigger point pain referral, possibly in the anterior scalenes or the serratus anterior.  So, a neuromuscular massage therapist would be good for that...I use them in my office daily.

Trouble with grip strength in the hand indicates dysfunction with the median nerve in the arm/hand.  When there is an injury to the median nerve, patients will typically have pain into the hands, wrist and forearm, with a lack of muscular strength to the hand especially with the grip.  You can also look for muscular wasting in the palm of the hand...just compare the palm musculature near the thumb (palm side) of each hand to look for loss of muscle tone.  If this is an issue only when he has the tremors, this is definitely perplexing.

My suggestion to you is not to give up on this as many times the injuries sustained in crashes are often not visualized on x-ray or MRI, and this obviously makes accurate diagnosis much harder.

Lastly, why have you not tried a chiropractic physician?  We are very successful in treating car crash injuries, and have the most well respected post-graduate training programs on the subject matter.  I would suggest that your son most likely has sustained biomechanical dysfunction injuries in the neck and low back which respond well to gentle chiropractic adjustments by allowing pressure and irritation to be removed from the spinal cord and associated nerve roots of the spine.  These nerve roots supply information to the long thoracic nerve and the median nerve as well.

Hope this helps Diane.

Respectfully,
Dr. J. Shawn Leatherman
www.suncoastehalthcare.net