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Scapular Winging after total thyroidectomy for Pappillary Ca
Dear Doctor,
This is my first visit to this site. In May 09, I was diagnosed with Pappillary Ca with multiple nodes (likely Ca) on left side of neck. Histopathology confirmed Pappillary Ca in thyroid and ONLY ONE neck node with Ca growth. I underwent complete thyroidectomy and left neck lymph nodes removal on 25 May 09. Post surgery, I have difficulty in moving my left arm upwards above shoulder level and am unable to do even simple tasks with this hand. Occasionally, there is shooting pain across the entire arm. From 2 July onwards, I have been undergoing physiotherapy with IFT, stretching exercises and ultrasound. The physiotherapist says I have Scapular Dyskinesis (which is apparent to me too !) and I also have winged scapula of left shoulder. I read online that radical neck dissection has the added risk of damage to Long Thoracic Nerve and Spinal Accessory Nerve which in turn may cause winged scapula and shoulder dysfunction. However, when I consulted my operating surgeon, he confirmed that none of the above nerves have been damaged during surgery. Even after 6 weeks of physiotherapy, there has been no improvement to my shoulder and left arm.
1. What could be the cause ? Is it damage to SAN or Long Thoracic Nerve ?
2. Should we opt for EMG to confirm the nerve damage ?
3. If the EMG shows damage to a nerve, what then ?
4. Does the nerve heal itself ?
5. Is nerve graft a viable option and how much delay is acceptable ? I cant get it done before Nov 09 which would be 6 months from (likely) trauma.
6. In the meantime, should I start exercises for strengthening of muscles related to shoulder movement, as advised for scapular winging ?
Thank you.
This is my first visit to this site. In May 09, I was diagnosed with Pappillary Ca with multiple nodes (likely Ca) on left side of neck. Histopathology confirmed Pappillary Ca in thyroid and ONLY ONE neck node with Ca growth. I underwent complete thyroidectomy and left neck lymph nodes removal on 25 May 09. Post surgery, I have difficulty in moving my left arm upwards above shoulder level and am unable to do even simple tasks with this hand. Occasionally, there is shooting pain across the entire arm. From 2 July onwards, I have been undergoing physiotherapy with IFT, stretching exercises and ultrasound. The physiotherapist says I have Scapular Dyskinesis (which is apparent to me too !) and I also have winged scapula of left shoulder. I read online that radical neck dissection has the added risk of damage to Long Thoracic Nerve and Spinal Accessory Nerve which in turn may cause winged scapula and shoulder dysfunction. However, when I consulted my operating surgeon, he confirmed that none of the above nerves have been damaged during surgery. Even after 6 weeks of physiotherapy, there has been no improvement to my shoulder and left arm.
1. What could be the cause ? Is it damage to SAN or Long Thoracic Nerve ?
2. Should we opt for EMG to confirm the nerve damage ?
3. If the EMG shows damage to a nerve, what then ?
4. Does the nerve heal itself ?
5. Is nerve graft a viable option and how much delay is acceptable ? I cant get it done before Nov 09 which would be 6 months from (likely) trauma.
6. In the meantime, should I start exercises for strengthening of muscles related to shoulder movement, as advised for scapular winging ?
Thank you.
MEDICAL PROFESSIONAL
Could also be the result of brachial neuritis. An EMG seems like a very good idea at this point.
Thank you for your prompt reply. I agree that I should immediately go for EMG and NCV test. That would help me decide further course of action.
Will keep in touch.
Will keep in touch.
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