History of My Injury and Treatment

9/98: Rolfing injury to R scapula, trapezius and neck.

On 9-18-98 I tried one sample Rolfing treatment at the recommendation of a swimming acquaintance. The Rolfer told me I held my R shoulder too high, so he proceeded to work in the R upper quadrant of my body.

He pressed deeply into my paraspinal muscles and rhomboids on the right side. This caused sharp nerve pain next to the R scapula. He pressed hard and painfully under my R armpit between all ribs there. He said he was "turning ribs." He pressed hard under my R collarbone with his fingers. My R arm went numb down into my last two fingers of my R hand. When I complained, he stated he was just "overstretching a nerve." His final manipulation was a hard, abrupt yank of my head. I screamed out in pain.

Later that evening I got a bad headache in the back of my head. The next morning my shoulder blade was hanging from my body, and my R arm kept going numb as it did on the Rolfer’s table.

The injury resulted in eight months of R scapula and shoulder pain, a mildly "winged R scapula," and inflamed muscles. I could no longer swim and had trouble using my R arm.

5/99: Re-injury

My R scapula improved for three days after a gentle spinal massage by a physical therapist. She clicked my spine gently into place while I lay prone. I felt greatly improved. Then three days later I yawned and stretched on the floor, while lying supine with my R arm abducted near my ear. As I was stretching, my R scapula tore away from my body at the bottom and I could feel a fiber detach.

My scapula lost stability and felt "out of place." I had severe pain the next day which included numbness, pain and pressure in my thoracic spine and around my R scapula. Later an MRI of the thoracic spine revealed a herniated disk at level T6-7. In hindsight and through consults with physicians it is believed I re-injured my long thoracic nerve and overstretched my serratus anterior muscle and more. My scapula drooped and was unstable, and protruded at the inferior angle. I could not strengthen my shoulder for a long time and had to give up driving my stickshift car.

5/2000: Surgery in Houston, Texas to release the long thoracic nerve and R front neck.
In the report the MD states he dissected the long thoracic nerve out of my middle scalene and removed scar tissue from my brachial plexus. Surgery caused complications which included a large seroma in my neck which lasted for months as well as marked weakness in both of my arms which gradually improved some. I still had scalar instability and mild prominence at the inferior angle. I had trouble swallowing pills because my omohyoid muscle was cut during surgery. I had voice loss off and on and eventually marked difficulty turning my neck and chronic pain and weakness down my R arm. I have intermittent problems walking on my left leg.

(I chose to do surgery after 18 months of conservative rehabilitation which did not improve the overall scapula function. Also I could not return to my previously active lifestyle or any sports.)

6/2001: Second Surgery - MD in Dallas, Texas to release scar tissue in my neck and nerves.
The surgeon states he resected my middle scalene and sutured in and vascularized a fat pad to cover my long thoracic nerve. He also removed scar tissue from my brachial plexus. (In both surgeries the first rib was never removed.)

Results: immediately following surgery my R arm and scapula felt great. For 36 hours my R scapula held firm to my back and my R arm felt normal again. (Though I must admit my neck felt very taxed.) I was given no post-op instructions so when I returned home to my friends in Dallas my arm felt so normal that I reached for a hanger in the closet without thinking. When I brought my arm down my R scapula felt caught, then later became droopy and unstable. It was worse than before any surgery at all and my trapezius became depressed as well. Later my neck pulled really tight and my platysma scarred down asymmetrically.

Eventually I was able to rehab and build up the muscles in both arms and back by swimming under water in the therapy pool from April 2002 till August. This also improved the pain I had in my thoracic spine. However, on land my arms were weak, R more than L.

8/2002: A neurologist diagnosed Thoracic Outlet Syndrome and thought Botox might help with my tight neck in the right front region but too many muscles were Botoxed including my R trapezius muscle. The next day my scapula dropped still lower than before and soon became completely unstable. I developed bone crushing pain down my entire right arm. My R arm lost all strength (grip strength, wrist flexion / extension, and more.) My entire shoulder and collar bone dropped. I developed swallowing problems and intermittent sleep apnea. My Botoxed muscles became rigor mortis-like. I had transient severe laxity and rigidity of all Botoxed muscles that still today causes severe problems. My trapezius muscle drooped more than ever before. I developed intermittent severe spasticity in my front neck muscles which spread to the left side of my neck. My neck and head became tethered to my right rib cage by these tight scarred inflamed Botoxed muscles.

Thoracic Outlet Surgery

3/2004: surgery performed
My third and last surgery on 3-25-04, was a Thoracic Outlet Surgery (TOS). The purpose of the surgery, as I understood it, was to untether my neck from the rib cage where the muscles had become scarred and tight following the Botox injections in August 2002. I had also hoped by releasing the long thoracic nerve from my tight scalene muscle that my shoulder blade would become stronger.

Before the surgery, I understood that the first rib would only be removed if it was absolutely necessary for vascular reasons. However, according to a prior Doppler of my right arm, I had no vascular blockage or impingement.

The TOS surgery was brutal and caused devastating results. The surgeon made two horizontal incisions on my right and center chest, one along the old incision of the collar bone and a second two and a half inch horizontal incision about two inches below the first. From this approach and according to the surgery report, he completely cut out my anterior scalene muscle, most of the middle scalene muscle, and most of the posterior scalene muscle. He also removed the entire first rib from front to back.

During the surgery, my phrenic nerve was damaged or cut because my right diaphragm is still paralyzed (see photo).

Today at eleven months post-op, my right shoulder blade is more prominent, loose and lower than prior to surgery. I am in constant and often severe pain. I am now more tethered by tight scar tissue in my neck than before surgery despite the surgeon telling me he used an anti-scarring agent. I have a large sinking depression in my right neck. My physical therapist says that he can no longer help me despite ongoing therapy for one year.