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Long Thoracic Nerve Pain
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Long Thoracic Nerve Pain

I have had a problem with long thoracic nerve pain off and on since 1975. The pain was severe and last a few days. Weeks after the pain went away I noticed scapular winging and muscle weakness in my shoulder. I was given the advice by an orthopaedist to rest that arm and give it time to heal. The problem seemed to resolve itself with that protocol. Years later, I noticed that the pain would come back, but the scapular winging never got as bad as it did the first time. I finally figured out that when I did anything like ironing, or any repetitive movement in front of my body, the pain would return and last several days. The only relief I can get from the pain is to lie on that side and stretch out the muscle, or place something behind me and put pressure on the muscle. I usually have to just wait it out and the pain will finally leave. I have also noticed a problem in the past couple of years, with pain and stiffness in my neck, especially on the same side as the long thoracic nerve pain. I don't even know if they are related, but it is very frustrating. I have seen doctors who have no clue as to how to treat this problem. I have also even done physical therapy, with no results.
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Thanks for using the forum. I am happy to address your questions, and my answer will be based on the information you provided here. Please make sure you recognize that this forum is for educational purposes only, and it does not substitute for a formal office visit with your doctor.

Without the ability to examine you and obtain a history, I can not tell you what the exact cause of your symptoms is. However I will try to provide you with some useful information.

The long thoracic nerve innervates the muscle called the serratus anterior. The long thoracic nerve is most often injured traumatically, such as during sports, or surgically. When the serratus anterior muscle is weak, winging of the scapula occurs. It sounds like your injury occurred several years ago. Given that it is likely the injury was a one-time thing (from a process that occurred just once, such as trauma etc) it is likely your continued pain is not from continued injury to the nerve or muscle, but rather muscle strain. If your serratus anterior muscle is weak, in order to compensate for it, you may be using other muscles, putting strain on them. In order to learn how to compensate appropriately, physical therapy is needed, which it sounds like you have had without benefit. Continued physical therapy is recommended. Perhaps evaluation by a physical medicine and rehabilitation specialist (PM&R specialist, an MD that specializes in these types of things) would benefit you. These are available in most university hospitals or tertiary care centers and in most rehab facilities.

Your neck pain as you mention may or may not be related. Neck pain is often due to arthritis of the spine or herniated discs. If you have not had imaging of your neck (MRI of the cervical spine) this may be useful, to check and see if you have some arthritis of the spine or a herniated disc leading to what is called a radiculopathy. The spinal cord is encased by bones called vertebra. Nerves start to form as they come off the spinal cord and exit through holes formed between the vertebra. If a nerve is compressed on as it exits through these holes, particularly in an area called the nerve root, a radiculopathy results. The compression could be due to arthritis of the spine or due to a herniated disc or other lesions. The symptoms include pain at the level of the problem (i.e. neck or back etc) and pain that may radiate down the arm or leg (depending on where the problem is). In more advanced cases, muscle weakness or sensory symptoms such as tingling or numbness may occur. A radiculopathy is often diagnosed based on history, physical examination, and MRI of the spine.

It sounds like you have been evaluated by an orthopedic specialist; if you have not been evaluated by a neurologist, this may be beneficial to you. A neurologist, and specifically a neurologist specialized in neuromuscular disorders, may be able to better elucidate the extent of injury to your long thoracic nerve etc. using a study called an EMG/NCS which tests how electricity is being conducted along nerves and how the muscles respond.

Thank you for this opportunity to answer your questions, I hope you find the information I have provided useful, good luck.
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