Disclaimer: I am not a doctor. This is not health advice. It would be best to work with your doctors to determine what works best for you. This records what has worked for me, specifically given my unique health situation.
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 the winging of my right scapula. Continued service and aging have 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. I have many issues up and down my spine as a result of my military service.
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 currently sits is its new normal. It took a ton of grueling 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 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. My shoulder and upper back muscles 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; hopefully, others can learn from it.
Sadly, I can’t take NSAIDs orally anymore due to the US military and Veteran’s Administration’s excessive prescribing of 800 mg ibuprofen over 15 years. I was often in situations where I was not able to eat but needed to treat pain to sustain mission priorities. This has led to severe digestive complications over the years. The one thing I can’t effectively control is inflammation, and it’s a big, thorny problem.
I am taking Cyclobenzaprine (generic Flexirl) three times daily to keep spasticity at bay.
At one point, I was taking Baclofen, Cyclobenzaprine, and Methocarbamol during the day. This combination has some memory loss side effects. Once off the Baclofen, my short-term memory was a little better. But there are many other lessons I want to cover more specifically.
Narcotic painkillers have helped over the years, but their side effects have also been harmful. After years of taking some form of narcotic pain relievers, we realized that I am always going to need something better than over-the-counter (OTC) pain remedies. Currently, I am prescribed Norco to help with breakthrough pain. It is not very effective unless I take it long before a potentially painful event (as you can imagine, this is tough to juggle).
The Veterans Administration had tried everything up to morphine. We realized that they were going to keep medicating me until I stopped breathing. Getting off morphine is incredibly hard, and I never want to be so dependent on a medication like that ever again. But, we also realize I will need something for the rest of my life.
Belbuca has been a more recent addition to my medication arsenal. It is incredibly effective at beating back pain and keeping the baseline pain level more tolerable. I still deal with normal discomfort and trigger point pain. But a heating pad or supportive arm sleeve is usually helpful.
I have experimented with some herbal remedies at the advice of a handful of doctors and a chiropractor. 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 effects on liver functions. Subsequent tests on liver function have shown no significant issues.
After researching everyday chemicals and their ability to help with muscle spasms, I added Magnesium Citrate to the mix. It helps with the knocking or tapping spasms (it won’t touch the big ones). It also supports digestive and nervous system functions. Friends have also recommended Chelated Magnesium if you want to avoid the improvements to digestive functions.
I have also taken turmeric to help with inflammation. However, it interacts with other meds I need to take. It wasn’t a game-changer for me. But if it boosts your anti-inflammatory response, that can’t be all bad.
I also take glucosamine, chondroitin, and MSM supplements for their joint and heart health benefits.
Trigger Point Injections
Trigger point injections into two regions have been the go to relief option. However, getting trigger points in a hurry can be next to impossible. I typically get injections at least 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 when done on a regularly scheduled basis. But, outside the VA systems this is impossible to get.
As of late, I’ve been dealing with more nerve pain than muscular. After trials of Gabapentin and Lyrica, neither drug was considered helpful for me. Gabapentin, at an adequate dose, would overly suppress the nervous system. I was found on a couch one morning when I was supposed to watch my younger son. He was fine. Everyone was safe. But, it was a real scare as it had never happened before, and I have no recollection of ever feeling tired.
For whatever reason, Lyrica puts me excessively on edge and makes me very irritable. This has been consistent over two stints with the medication. I typically stay away from this class of drugs (gabapentinoids).
As a result, 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 in theory, they should last longer than that.
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 from the spinal cord. Nerves: The separation of the nerves is measured in millimeters, and as young as I am, my nerves tend to reconnect over time somehow.
The procedure is excruciating 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 measured in weeks.
We do know after a few of these that regular doses of anesthesia are pretty ineffective. However, my doctor and I have figured out the why and what to do as a result. I mention this because when you are on as many drugs as I am, certain anesthesia meds don’t have as significant an impact, so we’ve had to go down the Propofol route (this is the drug that killed Michael Jackson)