T Nation

Delt/Trap/Neck Limitation


Hi chaps, first post over here, I’m just hoping someone has been in a similar position and can shed some light on my situation. I reckon there are probably a lot more of you that may be able to help?

Basically, I’ve done a variety of training for years (Swim/Cycle/Run) and have always included weights in my routines. A few weeks back I had done a pretty hard workout involving my shoulders throughout the session, didn’t sustain any pain or injury but two days later before I was about to go to sleep I managed to somehow end up with a pinched nerve in the neck, causing a hell of a lot of pain in my left arm / shoulder.

Now the physio I saw initially put this down to a stiff muscle in my neck and over the past two weeks I had some treatment but nothing giving quick relief. It’s been slow to get rid of the pain (trouble sleeping for sure) and even though it has eased up greatly, I still have seriously limited movement in my arm - it initially felt like it was separated at the delt and that’s where more recent pain has been. The scapula is now ‘winging’ if I try to lift my arm out in front, and hasn’t got much better at all. The delt seems to have disappeared and my lat seems to hide away too when both arms are raised in your typical ‘gun pose!’!.

Hope the pictures attached show this well - I’ve reversed the good (right side) for comparison. I’m pretty convinced I may have caused this by some shrugs at the end of my routine as I ended up rounding the shoulders, but nothing past what I’ve done in the past.

The physio reckons there is no muscle problem, based on the lack of pain when she manipulated it a little. I’m not convinced that the nerve problem can still cause so much loss of movement especially since it has subsided. Its as if the trap or delt has stopped working, the scapula is not in control and is sore towards the outside too.

Anyone had a similar problem and how the hell do you fix it?!

Really hoping someone can help me get back to what I love to do best!

Thanks in advance

Tony.


Relaxed position - trap raised!

It definitely seems like a nerve problem. The trap is likely raised as a guarding response to your injury. I’m just trying to figure out where along the nerve pathway the problem lies. The muscles affected are the deltoid, lats, and possible serratus anterior. These all have the C6 nerve root in common, so it might be that. It might also be a peripheral nerve, such as the axillary nerve, which innervates the deltoid. Is there any way you can figure out exactly which muscles aren’t working and if there is any loss or difference in sensation on the affected side, and where?

Here is one possibility–does it match your symptoms?

Hi and thanks for the response.

It is difficult for me to explain exactly which muscles are being affected, but it mainly seems that the deltoid is being affected most. I can only raise my arm out in front and also to the side to shoulder height before it becomes completely weak. It will go a little further to the side so it appears that the front delt is more affected - the loss of any size / shape of the front delt is what is strange - the trap takes over completely and the scapula jumps right out to the back at any further attempt to push the arm up.

There doesn’t seem to be an issue with taking my arm back and up. There isn’t any pain associated with this now - just complete loss of range of motion.

There is no sensory loss as far as I’m aware. I wouldn’t expect rapid atrophy after 3 weeks either but it does look like that! It’s as if my delt is hiding, like the trap has taken over completely. I’ve been doign various stretching etc and mainly resting it. I tried to bench press 2 x 10 kg dumb bells this morning and failed miserably on this side!

I think the physio identified the C6 area with the tight muscle here to begin with but on another session thought it could be further down as well. My guess here is the T2 / T3 area is being affected (maybe the nerve but something that also could be tight too?) - on that side of the scapula too - it often feels like it needs to pop or crack - it certainly doesn’t feel right.

The inferior angle (? tip of the scapula at bottom) has also felt tender throughout this too. The neck in the C6 area is still stiff when I turn my head to the left too.

I may post a video up later from various angles showing what is happening, bit easier than trying to describe it. I though it may have eased up by now but its really bugging me. I was aiming to work my way up to a 1 rep max of 100Kg Bench Press just before this occurred!

Although the arm has eased up, its still lame. the only exercise I can currently do is run. I actually tried to get the arm working a bit by swimming a little yesterday, which was not easy but not painful, just awkward - today my trap had really stiffened up all the way up my neck…urghh…back a step…

So, just over 4 weeks on, no real pain now, just the odd ache here and there. I’m trying to get to the bottom of this and fix myself as quick as I can, but its a miserable affair! So limited in what exercise I can do because of this. The video below illustrates the extent of the winged scapula, any input is highly appreciated, although I’m pretty convinced without serious physio help, It’s going to be a long while fixing itself…

It definitely appears to be a serratus anterior problem. The job of your serratus anterior and your traps is to upwardly rotate your scapula so you can elevate your arms above shoulder level; your serratus anterior isn’t doing its job so your trap is trying to compensate by contracting hard (which results in a lot of scapular elevation–compare it with your normal right side).

I still think it is likely a nerve injury, so you will just need to wait for the nerve to heal and then strengthen your serratus anterior once it has healed. If it is a nerve injury, nothing a physio could do would make it heal significantly faster. The physio would just have you doing exercises for your serratus anterior in the meantime. He or she might also try to discourage left upper trap activation so you don’t develop faulty motor patterns with scapular retraction and depression exercises.

[quote]smallmike wrote:
It definitely appears to be a serratus anterior problem. The job of your serratus anterior and your traps is to upwardly rotate your scapula so you can elevate your arms above shoulder level; your serratus anterior isn’t doing its job so your trap is trying to compensate by contracting hard (which results in a lot of scapular elevation–compare it with your normal right side).

I still think it is likely a nerve injury, so you will just need to wait for the nerve to heal and then strengthen your serratus anterior once it has healed. If it is a nerve injury, nothing a physio could do would make it heal significantly faster. The physio would just have you doing exercises for your serratus anterior in the meantime. He or she might also try to discourage left upper trap activation so you don’t develop faulty motor patterns with scapular retraction and depression exercises.
[/quote]

Thanks for you input, it is highly appreciated, a video is obviously easier to see some of the problem. The physio said it was the cause of a very tight muscle high in the neck, and if it was all related to this, then I need to try and figure out what caused it in the first place - assuming I eventually fix things, I certainly don’t want it happening again! I also agree that the physio won’t be able to do much, except more of the same as I’ve already been trying to do. I can tell it appears to be getting better but progress is very slow, most people know how frustrating it is when you can’t train due to injury!

Thanks again, I’m sure I’ll update when there is progress!

If the issue is with your neck you may want to get treat your own neck by robin McKenzie that was the only form of treatment that helped me

Looks like a highly recommended book, will look into that for sure, thanks!