Question
My name is Katie, and I am 21 years old, and have been living in constant
pain for 5 years now.  I would appreciate any help or insight that you have to
offer!

My pain is an intense burning sensation that follows along the border of my
right scapula, up into my neck, and around my shoulder.  The pain worsens
when I am in the same position for a long period of time, when I use my
right arm, or if I do anything with a repetitive motion, or something that
involves putting my arm up in the air.  It also pops, and grinds.  I have
received numerous treatments and tests for this condition throughout the
past 5 years.  I have had many sessions of physical therapy, chiropractic care,
osteopathic manipulations, personal trainers, prolotherapy, acupuncture,
facet blocks, and 2 surgeries.  

The 1st surgery was in December of 2006, and the doctor performed a
capsular shift, to tighten the capsule.  He had diagnosed me with
multidirectional instability.  (I have since been diagnosed with Joint
Hypermobility syndrome since many of my joints pop and sublux).  The 2nd
surgery was in December of 2007 and the doctor performed a partial
scapular resection.  He diagnosed me with snapping scapula syndrome.  
Neither of the surgeries produced any positive results.  

I recently visited a new doctor (physical medicine and rehabilitation), and he
has opened a couple of new doors or possibilities.  He was surprised at how
much my right scapula wings, and suggested that I might have long thoracic
nerve damage.  However, he did not mention getting any testing done for this
issue...like an EMG, which I thought about and was surprised about after the
appt.  He suggested that I get a tens unit to help relieve the pain, and also
suggested that I get fit for a brace to help hold my scapula in.  Additionally,
he gave me a script for Elavil to help me sleep.  I have been taking Flexeril to
sleep, but I still wake up numerous times and do not feel that I get a good
quality of sleep. I even sleep with a foam wedge to help keep me from rolling
over on my right side during the night.

I also take Vicodin fairly regularly because nothing else touches the pain.  I
am a junior in a nursing program, and this pain is getting to be very hard to
deal with.  It is affecting my life, and I am having to make decisions and think
about altering the route of my career if this pain does not go away.  I hate
that at 21 years old, I feel that my shoulder is running my life.  

Thank you for any advise that you can offer.

Answer
Hi, Katie.

I'll get straight to points:

"Multidirectional instability" indicates that you have muscles in varying states of tension that pull the head of the bone at the joint off center" and that modify movement in eccentric ways.  That condition can't be corrected by surgery or by any drug or manipulative therapy; it can be correct by retraining muscular control so that muscle pulls center the bone in the joint and control movement in a well-coordinated way.

"Snapping scapula" indicate the same condition.  Tight muscles, tight tendons:  snapping with movement.

"Winging scapula":  bones go where muscles pull them.  Same situation.  No nerve damage is necessary for that to occur, although that is a possibility from the surgery if the surgeon wasn't careful.

You don't need a brace to keep the scapula in; you need proper muscular coordination.

Injuries and surgeries trigger protective postural reflexes that tighten muscles.

Drugs and TENS do not correct the problem; they hide it.

If you were my client, I would expect rapid improvement on these counts, assuming your nerves were intact.

May I direct you to articles on pain and recovery from injury at somatics.com/page4b.htm.  Sessions with a somatic educator would be best to correct the problem; self-help programs would be more of a challenge, but better than most other options.  You can get access to both at the website.

with regard,
Lawrence Gold