Long thoracic nerve/winged scapula research

    
      Re: Long thoracic nerve/winged scapula research
    


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Posted by ccf neuro M.D. on April 24, 1997 at 14:13:36:

In Reply to: Long thoracic nerve/winged scapula research posted by Ray Haskell on April 14, 1997 at 22:23:55:

: Greetings!!
  I am trying to ascertain any research being done for people afflicted with problems as a result of long thoracic nerve damage and its resultant winged scapula condition.
  My wife....and erstwhile racquetball partner..just had surgery on her shoulder to decompress the thoracic nerve (mumford procedure?) and also had carpal tunnel syndrome decompression. This situation was a result of a previous shoulder injury and work related repititious wrist movements. She's a dental assistant and her fine motor skills were suffering.
  She is recuperating and is in physical therapy now. She is being told that there is no research , immediate or long term help for this condition.
  We realize that physical therapy and weight training may be able to strengthen the muscles above and below, and she is trying to regain the movement she has lost. However, the shoulder does not seem like it's ever going to be as good as it was, and it still hurts her.
  1. Is there any hope on the horizon??
  2. Is there ANY institution/group that is looking into a     fix?
  3.Since the nerve cannot regenerate itself, are there    any  DNA or neuron regeneration related research       activities going on?? I thank you for your help.
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As you are already apparently aware, a "winged scapula" results from paralysis or weakness of the serratus anterior muscle, which normally helps stabilize the scapula, particularly during foreward pushing motion with the arms. It is supplied by the long thoraccic nerve, which arises very soon after cervical spinal nerve roots C5,C6, and C7. It is rare for this nerve to be injured occupationally or for it to become entrapped. Entrapment of another two nerves that supply two other shoulder muscles in the rotator cuff (supra- and infraspinatus muscles) is much more common. The most common neurologic disease that afflicts the long thoraccic nerve is called neuralgic amyotrophy, or Parsonage-Turner syndrome. Usually the disease follows a triggering event (virus, surgery, injury etc.) and then begins as intense pain in one or both shoulders or arms, follwed 3 or so weeks later by weakness and wasting of muscles supplied by one or more of the peripheral nerves that supply the arms. Involvement of shoulder girdle
muscles is very common and fairly distinctive for this syndrome. A particular branch of the median nerve called the anterior interosseous nerve, but can affect other parts of this and the other arm nerves as well. Recovery from the syndrome is usually spontaneous, but on occasion permanent residual weakness may occur. The condition is caused by an intense inflammation of the affected nerves. The only person and institution I can remotely conceivably think of that MIGHT be doing research on long thoraccic nerve injury is Louisiana State University. The chairman of neurosurgery there (who I believe may be very close to retiring), David Kelly, is an expert in the surgical repair of peripheral nerves. You may wish to try to contact his office. In any situation such as your wife's, it is absolutely critical to have an extremely thorough EMG test of at least the affected/injured arm and at least a basic study of the other arm for comparison. This can help sort out the extremely large number of complex patterns of
nerve injury that may occur in the arms. All peripheral nerves can POTENTIALLY regenerate, growing at the rate of one inch per month, up to a maximum of 18-24 months from the time of the acute injury. The rewiring job that the new nerve fibers that sprout form the injury site do isn't perfect, but in the case of a crude, unccordinated muscle like the serratus anterior, this is not important. If you are near Cleveland and would be interested in a second opinion on your wife's case (If you are, I would do so ASAP given the aforementioned time limits on regeneration), I would highly recommend an EMG study performed by Dr. Asa Wilbourne, who is an expert in the electromyography of the brachial plexus and upper extremity peripheral nerve injuries (literally world remowned) in concert with a clinical evaluation by either Dr. Kerry Levin or Robert Shields of the neuromuscular section of the neurology department. This could be arranged by calling 216-444-5559. If Cleveland is inconvenient for you, I would suggest
considering a second opinion at the largest teaching hospital/medical center near you, particularly if you feel time is running out and no progress is being made in PT.

[JB43051]

A related discussion, Long thorasic nerve wining scapula was started.