I’m Chris Short and I have Long Thoracic Nerve (LTN) Palsy with Winging of the Scapula. On October 12, 2003, during a military hurricane evacuation exercise at Avon Park Air Force Range, I managed to permanently damage my LTN leading to winging of my right scapula. Continued service and aging has led to multiple bone spurs in my neck.
My life has changed dramatically since I got hurt. Pain is something that I am constantly learning to live with and occasionally thrive with.
Winging of the Scapula
According to Wikipedia, “A winged scapula (scapula alata) is a condition in which the shoulder blade, or shoulder bone, protrudes from a person’s back in an abnormal position. It is a rare condition with the potential to lead to limited functional activity in the upper extremity with which it is adjacent. It can affect a person’s ability to lift, pull, and push weighty objects.”
My winging is “managed” meaning, the only change is when there’s an increase in inflammation under the scapula. Where it current sits is its new normal. This took a lot of physical therapy.
Long Thoracic Nerve (LTN) Palsy
The long thoracic nerve (LTN) is a nerve that arises from the fifth, sixth, and seventh cervical nerves, descends the neck behind the brachial plexus, and is distributed to the anterior serratus muscle.
Palsy is a medical term derived from the word paralysis that is defined as paralysis often accompanied by loss of feeling and uncontrolled body movements such as shaking.
wiseGEEK provides one of the best explanations that I have found of what Long Thoracic Nerve Palsy actually is:
Long thoracic nerve palsy is caused by injury and damage to the long thoracic nerve. This nerve runs from the neck vertebrae along the side of the chest to the muscle that holds the scapula bone to the chest wall. When this nerve is damaged, the scapula - or shoulder blade - becomes abnormally positioned, resembling a protruding wing. This odd positioning has led to the name “winged scapula.” Shoulder pain and loss of movement occur as the imbalance in muscle functioning causes stress to the muscles of the shoulder.
There is not much that offers pain relief from the nerve damage itself. The muscle in my shoulder and upper back tend to always be sore from everyday use due to the winging. But, muscle relaxers are incredibly important in keeping my pain under control. Eliminating muscle spasms leads to a better life experience overall and prevents nasty flare ups before they can start. It took ten years to realize this and hopefully others can learn from this.
I am taking Cyclobenzaprine (generic Flexirl) three times a day to keep spasticity is held at bay.
At one point I was taking Baclofen, Cyclobenzaprine, and Methocarbamol during the course of the day. This combination apparently has some memory loss side effect. I was subsequently taken off the Baclofen and I could tell my short term memory was a little better.
Narcotic pain killers have helped over the years but their side effects have also been harmful. Staying off of them is a goal that I have set but after years of taking some form of narcotic pain relievers getting off of them is a challenge. Currently, I am prescribed Norco (tramadol had become ineffective) to help with breakthrough pain. It is not very effective unless I take it long before a potentially painful event.
Belbuca has been a more recent addition, to my medication arsenal. It is incredibly effective at beating back pain and keeping the baseline level of pain more tolerable. I still deal with normal discomfort and trigger point pain. But, a heating pad and/or supportive arm sleeve is usually helpful.
At the advice of my Pain Medicine Doctor and a chiropractor I have experimented with some herbal remedies. Milk Thistle is something I take to help with liver health. I take a lot of Tylenol throughout the day. The main ingredient, acetaminophen, is known to have some adverse affects on liver functions.
After some research into normal chemicals and their ability to help with muscle spasms, I added Magnesium Citrate to the mix. It helps with the knocking or tapping kind of spasms (it won’t touch the big ones). It also helps digestive functions.
I also take turmeric to help with inflammation. After years of taking a variety of NSAIDs like ibuprofen and naproxen multiple ulcers have formed in my stomach. Turmeric has been known to have anti-inflammation effects.
Trigger Point Injections
Trigger point injections into two regions have been the go to relief option. However, getting trigger points in a panic can be next to impossible. I typically get injections once a quarter.
Pulsed Radiofrequency Lesioning
While deemed “experimental” by insurance companies due to overuse, pulsed radiofrequency lesioning has provided significant pain relief to me.
As of late, I’ve been dealing with more nerve pain than muscular. After trials of Gabapentin and Lyrica, neither drug was considered useful for me. Gabapentin, at an effective dose, would overly suppress the nervous system. I was found on a couch one morning when I was supposed to be watching my son. He was fine. Everyone was safe, but it was a real scare.
For whatever reason, Lyrica puts me excessively on edge and makes me very irritable. This has been consistent over two stints with the medication.
As a result of all this, we’ve flipped to superscapular nerve blocks. This is an injection of lidocaine and a steroid that floods the area in the superscapular region where the long thoracic nerve ventures further down into the body. I can get them as frequently as once a quarter, but they should last longer than that in theory.
The latest treatment is going into my pain management office every six months and cooking the nerves in the facet joints in the C-spine so that they detach. Nerves at that small a level and as young as I am, tend to reconnect.
The procedure itself is incredibly painful and is not for the faint of heart. Seriously consider all your options before going down this route. It’s effective for me. But the recovery time is sometimes a couple weeks.