Question
ABOUT 2 YEARS I SUFFERED FROM A WINGED SCAPULA. BOTH TRICEPS SHORTLY BEGAN TO SUFFER FROM MUSCLE ATROPHY AND DETERIORATE. AFTER ABOUT 1 YEAR MY RIGHT ARM BEGAN TO FIRE AGAIN WITH NO LOSS OF STRENGTH BUT MY LEFT INNER TRICEP WILL NOT FLEX IS THERE NERVE DAMAGE OR WILL IT COME BACK TO LIFE

Answer
Dear John,

The cause of a winged scapula is damage to the long thoracic nerve of Bell. The long thoracic nerve is composed of fibers that originate in the fifth, sixth and seventh cervical nerve roots. It descends along the lateral chest to supply the serratus anterior muscle which is the muscle responsible for holding the scapula to the chest wall. Damage to it allows abnormal positioning of the scapula.

I am not sure how you wound up with damage to the nerve, but common causes are injury by carrying heavy weights on the shoulder, diabetes, neuralgic amyotrophy, systemic disorders and a traction injury may damage it. Some cases are classified as idiopathic which means no specific cause was found. With your complaint of bilateral tricep problems, I must assume that there is a central cause for the problem rather than two peripheral causes.

Now, the triceps muscle gets its nerve supply from the radial nerve.  The radial nerve is part of the brachial plexus that innervates the entire arm, and  is composed of fibers that originate in the sixth, seventh, and eighth cervical nerve roots as well as the first thoracic nerve root. It is largest & most frequently injured branch of both the posterior cord as well as the brachial plexus.  The predominant fibers are from the C7 nerve root.

In the supraclavicular region (above the collar bone), the long thoracic nerve (upper division) has a trajectory parallel to the brachial plexus, therefore an injury at this site could easily affect both structures and the function of the triceps.

So what does this mean?  It means that the injury causing your problem is likely to have occurred either at the base of the neck as the nerve roots exit the spinal cord from trauma, or that you have a central cord/disk type of injury/dysfunction that has affected both the serratus anterior and the triceps.  Concerning the return of function on  one side versus the other, I definitely suspect continued nerve injury.  The big issue is to what nerve root because of the overlapping fibers, and at what location... cord/nerve root/peripheral fibers?

Specifically concerning the return of function, it is important to determine the amount of injury to the nervous tissue, this will allow a better prognostic indicator of return to function.   Two types of recoverable injury exist: NEUROPRAXIA and AXONOTMESIS:

Neuropraxia is the least severe injury and is characterized by a conduction block or nerve impulses. The structures are preserved but there is focal demyelination (loss of nerve covering/insulation). Recovery is evident and function may return within days.  Once the myelin insulation is restored the conduction block is restored complete healing is said to have occurred (taking weeks to months).

Axonotmesis is a more severe injury, with disruption of axons (central fiber of the nerve)& surrounding tissues.
Recovery is good but may require many months.  Regeneration called axonal sprouting begins within 96 hours.  If axonal regeneration is delayed damage becomes more severe with time and recovery takes longer.  These types of injuries may not ever fully heal, but most function can be restored.

The bottom line John, you have a good chance of regaining the function to the left inner tricep muscle in question, but remember that nerve regeneration/healing will take time.  You may also have residual nerve damage that will never heal fully, but it should not completely effect the ability to extend the arm due to the additional heads of the tricep firing with the help of a smaller muscle in the arm called the anconeous.  The anconeous is considered a secondary muscle but is very effective working to extend the arm.  

The only way to truly evaluate the functional level of the nerve supply to the affected tricep is with a nerve conduction velocity test. A nerve conduction velocity test (NCV) is an electrical test that is used to determine the adequacy of the conduction of the nerve impulse. This is used to detect nerve injury.

In this test, the nerve is electrically stimulated while a second electrode detects the electrical impulse 'down stream' from the first. This is usually done with surface patch electrodes (they are similar to those used for an electrocardiogram) that are placed on the skin over the nerve at various locations. (This test may also be performed with actual needles that are placed into the nerve.) One electrode stimulates the nerve with a very mild electrical impulse. The resulting electrical activity is recorded by the other electrodes. The distance between electrodes and the time it takes for electrical impulses to travel between electrodes are used to calculate the speed of impulse transmission (nerve conduction velocity). A decreased speed of transmission indicates nerve disease. A nerve conduction velocity test is often done at the same time as an electromyogram (EMG) in order to exclude or detect muscle conditions.

Clear as mud right?  Listen , I know this is a lot of information, but I want you to be able to understand the complexity of the issue. I hope I have been able to relate this information to you without confusing the issue and getting to the root of your question.  If you have any further comments or questions John, feel free to write back.

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