Expert: Dr. J. Shawn Leatherman - 6/26/2008

Question
I am going friday for an EMG to test for long thoracic nerve palsy.  For a year and a half I have been exiriencing pain underneath my shoulder blade up into my upper trap and into my shoulder. My right shoulder is slightly winged. I've been to physical therapy and serveral orthapedists with no relief. It has affected my carreer as a personal trainer and my active lifestyle.  My question is, how effective are chiropractic adjustments for this condition and should I try this before considering some type of surgery?

Answer
Dear Don,

Chiropractic care may benefit this issue only if the compromise of the long thoracic nerve is due to spinal nerve root related issues, however this is not likely.  

The long thoracic nerve arises off of the C5, C6, and C7 nerve root, so you can see that it has some redundancy in it's sources.  Specific injuries to one of the nerve roots may result in compromise of the long thoracic nerve however, the other nerve roots can often supply enough collateral information to allow the long thoracic nerve to work appropriately.  With this in mind, winging of the scapula due to long thoracic nerve damage is usually due to direct damage of the long thoracic nerve itself which compromises the ability of the Serratus Anterior muscle to hold the scapula to the chest wall.

There are a few things you can try to improve the winging such as serratus push-ups.  You start in a traditional push-up position, but when lowering the torso, you do not bend your elbows.  So the motion is just the torso slightly lowering between the shoulders...about 2-3 inches.  Then you thrust the torso back up into the starting position...this uses the serratus anterior and posterior musculature rather than the chest and arms, and can help to reduce winging if the nerve is still somewhat functioning.  Additionally, rotator cuff exercises will help to stabilize the shoulder and scapula, but only on a limited basis.  Rhomboid exercises will also serve to stabilize the scapula on a limited basis.  A combination of rhomboid, rotator cuff and serratus strengthening should be the conservative care focus...however, the clinical literature I have read on this all say that some residual dysfunction will remain and that full shoulder abduction will be limited.  

Chiropractic adjustments to the neck may help to increase nerve function if the problem was initiated by a compression or stretch injury that had an effect on the cervical nerve roots.  There is often significant vertebral restrictions in motion that reduce the nerves flexibility with movement and can cause continued low level irritation to the nerve roots with inflammation.  I would not expect a significant improvement unless the nerve roots are involved, however, cervical spine adjustments may also quickly reduce some of your associated neck and shoulder pain if present.  Chiropractic care is definitely an option to try, but if you are not seeing any improvement in the first 6-8 visits, then you are not likely to afterward.

Hope this helps Don.  Good luck.

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