T Nation

Scapula Dysfunction/Winging


Hi all,

I’m new to the site but I’ve lurked for a while. I was hoping some of you could provide some insight to a long standing injury I’ve had.

In 2004 I was doing a bench press when I felt something spasm in my right shoulder blade area. It was annoying, tight, and felt knotted. I ignored it and continued to train. Within a few months I have extreme pain through the medial border of scapula, upper traps, the whole shoulder complex really. It got to where I didn’t even want to raise my arm.

I saw a sports med doctor and went for an MRI. I was told I had arthritis in my AC joint and the surgeon suggested a resection. I never had an localized pain in the area but I was young and they said it would help. It did not.

Over the years I stopped lifting weights all together. I couldn’t lift anything with experience pain the tightness in the shoulder blade sometimes lasting for a week or better. This year I decided that I needed to get active again and try to remedy this issue for good. I’ve underwent a whole litany of treatment from chiropractic, massage therapy, accupunture, rolfing, and some physical therapy. I took up yoga for a while and that relieved some of the tightness and pain but as soon as I attempt any type of load bearing movement I’m in pain again.

I mostly experience pain when trying to do any pushing activities or overhead activities. The pain feels like its in the serratus anterior. When I attempt any pushing movements, even pushups, it feels like my shoulder blade isnâ??t secured to my ribcage. Instability ensues. When doing yoga, in downward dog, it feels like my shoulder blade is lifting up and out to the side(towards the arm) and my serratus seems to shake. I seemingly have little control over it. I do get some tingling at the bottom tip of the shoulder blade too. When I was going to physio they focused just on lower trap activation doing retraction and depression exercises.

Iâ??m awaiting an MRI and nerve conductive study but I was curious if any of you might have any input in the meantime. Iâ??ve read several threads on here with awesome advice and was hoping you could send some my way.

Iâ??ve included pictures to show what Iâ??m talking about. I know I also have some posture related issues. Forward head, anterior pelvis tilting, and my left hip appears to be lower than my right but a bit.

I’d appreciate any advice you might have. Thanks!

Hi Curt,

I’m not a physioytherapist, so treat anything I say as just possibly ‘full of shit’, but did they check your subscapularis strength? Is your left way stronger than your right?

Looking at the photo you’ve supplied I’d also be concerned that your rhomboids are out of whack. The Right side looks underdone, this would lead to significant shoulder stability problems. Have you tried pull ups? Is there any problem?

The trouble with overhead pressing could be associated with several problems, traditionally the supraspinatus. But your postural problems would also be a cause. I’d suggest looking into fixing that as much as possible.

I always suggest you try some external rotation work. Face Pulls &/or Dumbell Cubans.

Hope thats of some use,

Feel free to ignore all of this.

[quote]MartyMonster wrote:
Hi Curt,

I’m not a physioytherapist, so treat anything I say as just possibly ‘full of shit’, but did they check your subscapularis strength? Is your left way stronger than your right?

Looking at the photo you’ve supplied I’d also be concerned that your rhomboids are out of whack. The Right side looks underdone, this would lead to significant shoulder stability problems. Have you tried pull ups? Is there any problem?

The trouble with overhead pressing could be associated with several problems, traditionally the supraspinatus. But your postural problems would also be a cause. I’d suggest looking into fixing that as much as possible.

I always suggest you try some external rotation work. Face Pulls &/or Dumbell Cubans.

Hope thats of some use,

Feel free to ignore all of this. [/quote]

Hey Marty,

Thanks for the reply. To be honest I don’t believe they tested the subscap strength. Basically it was several months of heat and ice and lower trap band work. Of course, it didn’t seem to help and was expensive so I stopped therapy. The pain with pressing is mostly along my side, under the armpit. My whole arm/side quivers when I lift on that side.
I haven’t done pull-ups in a long time but I remember they were a little problematic. Definitely doable though, it just felt like I was forcing my body to lift and retract and it wasnt moving as it should…

As for the Rhomboids, I thought that might be it too. I dunno, at this point I feel lost.

Here is a video I made a while ago, I hope it works, of me doing scap pushups and you can see the inferior and outer border of the scapula ‘wing up’ during the bottom of the movement.

http://imageshack.us/clip/my-videos/823/pkji.mp4/

Thanks again!

Hi Curt,

Looking at that video, I think you have an issue with your right upper trap, and I’d be concerned about the lack of musculature in your right Teres Major and minor. But I’m just an internet doctor.

It sounds like you really tore the crap out of something back in 2004. If it was a simple tear then the few months of treatment you’ve described should have fixed things up. But you had an MRI back then as well before the surgey…so I’m surprised that any significant muscle tear wasn’t picked up. It will be very interesting to see what the new MRI shows. However I suspect that if I’m right you could find this out with just a scanning ultrasound and save some money and a lot of time in the process. Any decent sports doctor should have access to one and get you under the scanner within a few days.

I suggest that ypu look up some Rotator cuff rehab exercises in the mean time. Look at Infraspinatus, supraspinatus and subscapularis exercises. They can’t hurt you anymore than you are now, so give them a try.

Chin up buddy, you’re still breathing!

Looks like your shoulders are probobly internally rotated abit. You may also have a slight kyphosis. However much physiotherapy youve done it isnt enough. You need to correct your posture. Read the neanderthal no more articles for how to do this they are great.

Im in a similar boat as you. I have tried everything in the past 12 months to cure it. Nothing has worked. However, better posture, scapular stabalization exersises, naproxen and self massage with tennis ball and foam roller have helped reduce my symptoms. Ive recently started lifting heavy again. The pain sucks, but Id rathar be dead than not lift.