Question
I had shoulder surgery in Feb. 2007. A simple bone spur removal and minor rotator cuff stitch. I also had this same shoulder repaired in 1996, rotator cuff repair, AC joint removed and part of the clavical removed. I had a shoulder block for this most recent surgery. A few days after surgery we noticed what looked like a seperated deltoid, then a winging scapular. Therapy was tried for three months. However the pain was too much so therapy was discontinued.

I have had several EMG's. The findings were chronic denervation in muscles supplied by the right thoracic nerve and right axillary nerve consistent with meuralgic amyatrophy. No evidence of upper brachial plexopathy or ongoing acute denervation. There is mild chronic bilateral primarily c5-c6 radiculopathy.

I have seen many doctors, the latest saying to observe for 6 more months. If not improved at that time, then we will discuss a pectoralis major transfer using Achilles tendon allograft. I have also been advised not to work on active elevation due to the extra forceit requires. This same doctor has advised me that the deltoid did not seperate but has fallen off the clavical.

My question is this, how safe is a pectoralis major transfer, could I be worse afterwards? do you know of any other options? I have been told the deltoid cannot be put back on the clavical, is this so? Could the LTN injury be from the block or was it something that was occuring from my prior surgery? I was fine from 1996 - 2006. The pain I am in now is far grater then what I was experiencing prior to surgery. do you have any words of hope for me.

Thank you.  

Answer
Dear Virginia,

Unfortunately, the long thoracic nerve is often cut in surgeries like you have experienced, while the axillary nerve can be as well.  The resolution of this problem is unlikely though as your initial rehab program did not give you appreciable results.

Concerning further surgical applications, this question is really out of my area of expertise, and I don't think my opinion would be of benefit to you.  I would suggest that you utilize another section of all experts for a surgeons opinion on this, (preferably an orthopedic surgeon) as they have been better trained in this area.

Good luck Virginia, I wish you all the best.

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