Unique Nerve Impingement Issue - Seeking Experience/Advice

[Robert Pretorius]

Anyone ever experience severe nerve impingement in the shoulder/neck?

 

I currently have no nerve circulation going into my infraspinatus - external rotation is impossible for me, it's as if the wire got cut to the brain. The strange thing is, I have no pain whatsoever, i'm still able to do all levers, flags, planches, handstands, pulling, pushing, etc. etc. 

 

Due to this, I've had other muscles compensating for this issue resulting in elbow pain and nerve pain going into my wrist and fingers. My subscaps (the front of my shoulder, right above the bicep) are always severely tight and I have to spend a long time doing trigger point therapy, a recent individual suggested that this may be due to my subscaps working harder to keep my shoulder internally rotated? 

 

I've been to 8 physios, and 3 sports doctors, had an EMG, 3 MRIs, and 1 x-ray - still suffering with this injury and it's been 2 years. Currently doing physio twice a week and my therapist is simply digging everywhere in my shoulder and neck since MRIs and EMGs have been stating that I have nerve impingement stemming from my neck. (This issue arised from Brazilian Jiu-Jitsu as I was constantly upside down on my neck doing inverted guard and everyone would just drop their weight on my neck and put consistent pressure on me while upside down)

 

Anyone have any ideas or experience as to what else I can do?

 

Currently doing trigger point therapy, anti-inflammatory diet, ICF, powerball, rice buckets, nerve flossing, and heat. Will be starting heavy resistance band training on my shoulders which I learned over the weekend today. 

 

I planned on taking a month off to see if it heals, but I just came back from a handstand workshop with Yuri and the shoulder prep done with the resistance bands allowed me to train at 100% with no problems.. but issues with my elbow still remain as they are both irritated at fairly simple movements sometimes. Planning on doing many battle ropes and high volume rope climbs to increase blood flow. 

 

If anyone has any experience or advice, please enlighten me  

[Kasper Stangerup]

That sounds a lot like what I have been dealing with for the past 5-6 years. Also from grappling and too many small neck injuries. The message I got from the MRI scan was that I have some degenerative arthritis around my C6 which impinges on the nerves going to the left side of my torso. The doctors said that chronic neck injuries aren't really something that they can do very much about, but generally speaking, strength training alleviates degenerative arthritis. So, I have been using an amalgam of the neck training from Convict Conditioning 2 and the program I put my own ju-jutsu pupils through. It has been working very well, and most of the time I am completely free of the symptoms. But sometimes I will do an unfortunate movement and the problem will return for a few months. One month ago I did the forward arm circles and bang! It came back and is still bothering me (though it is in decline).

[Andrew Lester]

We need more information to determine a course of treatment in this case. EMG results would be very useful in determining where the site of issue is. I am basing this information solely on the fact that weakness is your ONLY symptom.

 

The most likely answer is you have an injury to your suprascapular nerve. It supplies infraspinatus as well as supraspinatus and can be susceptible to injury in four locations:

• As it bifurcates from the upper branch of the brachial plexus
• **As it enters the suprascapular notch**
• As it passes under the supraspinatus tendon
• As it exits the spinoglenoid notch

There are many documented cases of infraspinatus weakness due to entrapment as the suprascapular nerve enters the suprascapular notch.

 

The theory that the upper branch could be entrapped by muscle is not likely. There are no real players in the vicinity (you could argue middle scalene and or more so the upper portion of serratus anterior (serratus magnus).

 

It is possible (however not likely) that you have had an injury to the posterior trunk of your axillary nerve. This nerve supplies your teres minor (the other shoulder external rotator). This is a very different nerve pathway than the infraspinatus and not a likely answer to this mystery.

 

If you had compression of your C5 or C6 nerve root as it exits your spinal cord in your neck (through the intervertebral foramen), you would most likely have diminished sensation in your forearm and or thumb, a weak biceps reflex and likely weakness in your biceps/ brachialis muscles. Since your only reported symptom is weakness into external rotation, this again is not a likely answer to this mystery.

 

Get some IMS acupuncture and deep tissue mobilization (ART/ massage) by a VERY experienced practitioner on:

• The upper medial corner of your scapula (deep and lateral to the insertion of the levator scapula).  You would be working on the assertion that you could release the upper branch of the serratus anterior (serratus magnus).
• The supraspinatus (deep to the trapezius). A shearing type massage motion would work best to try and mobilize the supraspinatus (almost like scooping the supraspinatus out of it’s fossa). Working on the theory that the nerve could be trapped by the tendon of the supraspinatus
• In the infraspinatus itself near where the nerve exits the spinoglenoid notch. Again a shearing type motion should be employed to liberate the infraspinatus from the infraspinous fossa.

 

1. Nerve injuries can take up to 2 years to recuperate. Continue to work on the strength of your external rotation (your teres minor will get stronger and take up some slack!)
2. Do some home soft tissue work with a lacrosse ball on the upper medial corner of the scapula, the infraspinatus and your teres minor.
3. Work on Kit Laughlin’s Neck Side bend stretches beginning lying on your back and progress to sitting. Working on the theory that your middle scalene could be entrapping the nerve.
4. Work on Kit Laughlin’s internal shoulder rotation stretch or the sleeper/ swimmer’s stretch to help restore length to this weak muscle.
5. Your therapist should be applying cervical traction manually or mechanically to take pressure off your C5/6 just because they can, not because the nerve is trapped there.

Good Luck.