right shoulder blade protruding again?!

[LynnMarie74]

It's been awhile since I posted for myself to complain. I thought I was crazy a few days ago when I looked in the mirror from the side, and noticed my right shoulder blade was sticking out again. I quickly turned to the otherside and noticed the left looked "normal". I paniced of course..took a deep breathe and said to myself "its only in your head" Well, I had a meeting at work yesterday & I sat in a chair that is different than the one at my desk (which has a soft back and has a back support pillow) abd I noticed that my right side touched the back of the chair before the left. I thought ok, maybe Im just sitting a little more to the right, so I adjusted myself and leaned back again...same thing. I couldnt pay attention in my meeting as all I could think about what why it was protruding. After work me and a few of my girlfriends went out to dinner and as we were walking to our table, one friend said "Lynn, you back looks different"....and I just about cried. I blew it off and said that it must be how I was carrying myself. Then, when I got home, I asked Paul to look at my back and be honest...could he tell that the right was sticking out more than the left...he said yes, a little. So, I laid down on the floor, which is hard obviously, and sure enough, when I rolled onto my back it felt like I was laying on a big rock on my right side by the should blade. I lost it! Can something like this just happen? Im worried about the trunk shifting..I think that's what we call it right? As I was lying on the floor the area got really sore and tender to touch...then I thought maybe it was the muscles behind the should blade that were really tense, making it stick out? Could that be a possiblity too? All I know is Im freaked out and really upset about this. Has anyone had anything like this happen to them? What was it? What did you do about it & what was the "final outcome"? Ughhh.....Im at work now..and cant concentrate! Help!?


Lynn :(

[LindaRacine]

Hi Lynn...

I've occasionally heard from others who have reported that some amount of rotation returned within the first year of surgery. I don't know what causes it.

When is your next appointment?

Regards,
Linda

[LynnMarie74]

July 20th. I was thinking of calling today to voice my concerns.....but I dont know where that will get me...I guess I wont know until I try.

[JenniferG]

Lynne, so sorry to hear this has happened, but if some rotation has returned, hopefully, as you fuse, it shouldn't go too much further? I too, suspect I have a little bit of rotation because when I came home, I had a hollow where my rib hump used to be and I was thrilled. But that hollow is now a very slight lump. Probably not even visible yet, but I can feel it. I figure if this is as bad as it gets before the fusion holds it, I can live with it.

Let's hope both our fusions are rapid ones!

[LynnMarie74]

Thanks for sharing Jennifer. I missed my doc's PA call yesterday & wasnt able to reach her after that. Im going to be calling back soon.... :(

[Sherie]

My daughter's shoulder blades were completely flat right after surgery, but within the first year her right shoulder also rotated out. However, at her one year appt., everything was just fine. Not sure if this is right, but I feel like she's "settled" into her new body. Immediately after surgery, she gained 2.75" but has since lost .25". She's stabilized now from what I can tell.

I would like to hear what your doc has to say. I will also address this at the 2 year appt.

[LynnMarie74]

My daughter's shoulder blades were completely flat right after surgery, but within the first year her right shoulder also rotated out. However, at her one year appt., everything was just fine. Not sure if this is right, but I feel like she's "settled" into her new body. Immediately after surgery, she gained 2.75" but has since lost .25". She's stabilized now from what I can tell.

I would like to hear what your doc has to say. I will also address this at the 2 year appt.

when you say after a year the right rotated out but at her check up everything was okay...what do you mean? I would assume that if there is rotation something isnt right.....or am I wrong w/that assumption? I know what you mean w/settling into your new body...Im still getting used to it myself...but something like this seems different to me. To have mine, like your daughters, be straight out of surgery, then all of the sudden, rotate...that doesnt seem like it should happen just because. I dont know...Im a little disappointed and sad about the whole thing as I have been doing really really well & this kind of through me off as I wasnt told post op rotation would be a possibilty & what would it mean if it did happen. Does it mean mean the fusion is not healing right and the spine is curving again, does it mean its the start of "trunk shift"...or what have you? I just called my docs office back...as I didnt hear back from my earlier call from this morning, and it seems as tho his PA is gone for the weekend already. Nice.....blew off again! "Customer service" is not their strong point Im finding out. Ughhh.....

[nervous]

That is very interesting! Keep us posted, Lynn!!!

[LynnMarie74]

Shewww...they didnt forget about me afterall. Doc Tribus says it's probably either some nerve that runs in the neck behind the shoulder blade that has an issue, a muscle behind the blade, but wants do to an XRay asap to rule out fusion issues in that area of the spine and/or rotation. I dont seem to have pain in the area unless Im trying to force it back into place..dont ask...I tried out of desparation! I have however been having alot of "tenseness in my upper right back as of late....is that related, who knows? He's confident the fusion is fine, but wants to be sure...Im going in on Thursday the 28th. I swear you guys...Im going to be glowing soon from all of the xrays. How many is too many and in what time frame? Im truly starting to worry about this...even tho I joke about it. ughhh.....

[JenniferG]

Well, give us an update on what the xrays say Lynne. Glad your Dr. got back to you...mine was four weeks getting back to me!

I am actually not overly surprised that there is sometimes a bit of "settling" to do, afterall, it's only the hardware holding it at present, until the fusion is complete. Did they use BMP on you? If so, your fusion should be well underway.

I know it's a bit of a worry though, when you see something going backwards after all you've been through.

[LynnMarie74]

Well, give us an update on what the xrays say Lynne. Glad your Dr. got back to you...mine was four weeks getting back to me!

I am actually not overly surprised that there is sometimes a bit of "settling" to do, afterall, it's only the hardware holding it at present, until the fusion is complete. Did they use BMP on you? If so, your fusion should be well underway.

I know it's a bit of a worry though, when you see something going backwards after all you've been through.

What is a BMP? Whatever it is, sounds good, hope they used it! lol :D

[Sherie]

When we went for the one year post op, her xrays were fine. The hardware hadn't moved at all and everything looked great. I'm not sure exactly when I noticed the shoulder, but I didn't get too concerned about it and I didn't want to worry Sheena or make her go through anymore stuff. Other than the shoulder, everything else is perfect, back is nice and straight, no rib hump or lumbar hump, no trunk shift.

BMP is bone morphogenic protein, it's used to speed up the fusion. It converts normal cells into bone forming cells. It's not usually used on kids but Dr. Lenke uses it on all of his patients, even adolescents. He used it on Sheena so I feel confident the fusion is good and solid.

I really feel like everything is ok but it would be good to make sure. I'll email Dr. Lenke's office next week and see what they say.

[LynnMarie74]

Sheri--thanks for the info...that term doesnt sound familiar but I guess that doesnt mean that it wasnt used. He very well may have told my husband/myself post op and I just dont recall. Also, thanks for explaining about her shoulder......I guess I will know more on Thursday!

[Snoopy]

Lynn,

My daughter is 4 1/2 years post-op and her left shoulder blade still sticks out. She has had many x-rays since surgery and everything looks great.

Mary Lou

[txmarinemom]

It's been awhile since I posted for myself to complain. I thought I was crazy a few days ago when I looked in the mirror from the side, and noticed my right shoulder blade was sticking out again. ...(

Lynn,

The serratus anterior muscle holds the scapula down toward the ribs, and keeps it from "winging out". Much of the burning pain people report here between the top of the shoulder blades can be attributed to rhomboid overstretching caused by serratus weakness. It makes sense one side would be weak after the correction they achieved with you.

I saw where you were starting PT, and I'm sure they'll address it if it applies. Hang in there and don't assume a moving curve.

Regards,
Pam

[debbei]

Lynn,

The serratus anterior muscle holds the scapula down toward the ribs, and keeps it from "winging out". Much of the burning pain people report here between the top of the shoulder blades can be attributed to rhomboid overstretching caused by serratus weakness. It makes sense one side would be weak after the correction they achieved with you.

I saw where you were starting PT, and I'm sure they'll address it if it applies. Hang in there and don't assume a moving curve.

Regards,
Pam

Pam & Lynn,

I have no idea which muscles have caused my problems, but the tightness/pain around both shoulder blades (particularly the left one) have driven me crazy since day 1. It's getting progressively better, but sometimes I present my back to my husband and command "rub my spot". He presses his fingers right along the shoulder blade and rubs up and down, sometimes quite hard. It feels REALLY good for maybe 30 seconds and then I can't stand it any more and tell him to stop.

So Pam, are you saying that when the serratus muscle gets stronger, Lynne won't notice the shoulder blade sticking out so much? How to you strengthen that muscle?

It's nice to see you posting today. :)

[txmarinemom]

I have no idea which muscles have caused my problems, but the tightness/pain around both shoulder blades (particularly the left one) have driven me crazy since day 1. It's getting progressively better, but sometimes I present my back to my husband and command "rub my spot".

LOL at "rub my spot", Debbe. I don't have a resident "spot rubber", so I have to go pay someone ;-).

One thing I've found that helps for that shoulder blade pain is lying on a tennis ball on "that spot". I usually keep 2 of them handy, and will place them along my spine (especially in my lumbar area) when I find knots. Without fail, if I have a knot on the right side, there's a knot on the left side just a few inches away. Lying on them for a little while makes a difference for me between massages.


So Pam, are you saying that when the serratus muscle gets stronger, Lynne won't notice the shoulder blade sticking out so much? How to you strengthen that muscle?

I obviously don't know for sure this is Lynn's issue, but it's a common cause for a winged scapula. Her PT would be the one to make that determination (and prescribe appropriate exercises for her), but I wanted to voice there could be something causing the scapula to "wing" that's much more palatable than a moving curve.

There are yoga poses (namely the Dolphin (http://www.yogajournal.com/poses/2462)) which focus on the serratus anterior, but Lynn, and everyone, check with your doctor before doing anything I list below that I'm doing and/or have done.

A more gentle way to reach the serratus is simple isometric scapular protraction and retraction (http://www.professionalphysicaltherapy.com/exercises/scap.htm).

Debbe, one simple exercise I've been doing at home combines scapular retractions, chest wall stretching, and bench press type actions for the shoulders and pecs.

DISCLAIMER: I'm 15 months post op - and am not suggesting anyone do this unless they clear it with their surgeon.

Anyway, this exercise has been very beneficial for relief of pain/tightness/burning around my shoulder blades, and it keeps my pecs and shoulders stretched. When the pecs get tight they pull everything forward and you won't believe what a difference it makes in your back by keeping them loose.

The exercise is really easy:

I stand about a foot away from a doorframe, feet spread shoulder width apart, hands placed flat on the doorframe or wall at shoulder height.

As I inhale, I slowly lean into the doorframe until I feel a good stretch across my chest, and hold for 5 seconds. You can add to this by squeezing your shoulder blades together.

On the exhale, consciously releasing the scapular retraction, I push back up to the starting position.

I try to do 3 sets of 10 reps, but I usually throw in extras during the day when I'm going through a doorframe and think about it.

Another note ...

Fusion, by it's very nature, causes some degree of muscle atrophy - particularly in the erector spinae (a large bundle of 3 muscles that runs from the cervical to lumbar spine).

This group of muscles function to hold the spine erect, and are no longer called upon in that capacity - at least to the normal extreme - when instrumentation is placed. The rods hold your spine erect. Just because the muscles aren't needed as much doesn't mean atrophy can't contribute to back fatigue. I know I notice it much more (just to the sides of my spine), when I don't work them.

Hyperextension exercises are the easiest, gentlest way to target them, but definitely check with your doctor before trying these if you have a lumbar fusion - and particularly a few remaining UNfused vertebra below a lumbar fusion (CHECK WITH YOUR SURGEON *ANYWAY*):

One exercise I do is a slow-paced, alternating leg/arm hyperextension:

Lie prone on the floor, lift your right arm/left leg as high as is comfortable (but you want to feel a stretch), hold for 5 seconds and lower.

Repeat with the left arm/right leg.

Another option is the Swimmer's Stretch (http://www.youtube.com/watch?v=O3RLxO0g7do). This video also shows a less stressful version of the prone hyperextension above.

You can also perform a more challenging hyperextension (http://www.youtube.com/watch?v=tvlYhyA47rU) by including a balance ball.

Another exercise is called the "Good Morning", and although it's usually performed as a counter exercise for squatters, you don't have to use a barbell or weights with it. I'm using 5 lb dumbbells, but again, I am not newly post-op.

Wikia Sports describes it fairly clearly:

"Good-morning is a weight training exercise in which a barbell or two dumbbells are held on the shoulders, behind the head.

The person bends forward bow at the hips and recovers to upright.
The good-morning is so called because the movement resembles bowing to greet someone.
It involves the hamstrings but is primarily used to strengthen the lower back; the degree of knee bend used will change the focus -- nearly straight-legged involving the hamstrings most.

It is important to note that the spine does not twist or round at any point during the movement. The lifter should rather concentrate on pushing the hips back while keeping the spine straight ..."

Here's a video that demonstrates the exercise with a barbell (http://www.youtube.com/watch?v=bUpOZnhS4FI). As I said, I use dumbbells held up on my shoulders, but initially, there's no reason you'd even have to use weights.

These bends can also be performed from a sitting position to completely isolate the erectors.

One more time ... clear ANYTHING with your doctor. These exercises have helped me with the same pain/tightness a lot of us have, but get an okay before you even think about it!

Regards,
Pam

[LynnMarie74]

Thanks Pam...I can always depend on you for some good info. Maybe you can teach my surgeon something?! lol Really, tho....thanks for the info. Hopefully I will be starting PT this week! :)

[txmarinemom]

Thanks Pam...I can always depend on you for some good info. Maybe you can teach my surgeon something?! lol Really, tho....thanks for the info. Hopefully I will be starting PT this week! :)

I hope they get you started with PT also ... it's worked miracles with most who've done it, and it really seems to lessen pain sooner and hasten recovery.

Before you know it you'll be back to doing whatever you want!

Pam

[Sherie]

Lynn,

The serratus anterior muscle holds the scapula down toward the ribs, and keeps it from "winging out". Much of the burning pain people report here between the top of the shoulder blades can be attributed to rhomboid overstretching caused by serratus weakness. It makes sense one side would be weak after the correction they achieved with you.

I saw where you were starting PT, and I'm sure they'll address it if it applies. Hang in there and don't assume a moving curve.

Regards,
Pam

Pam

Thanks for this information. This sounds to me a very likely cause. Sheena's also been under a lot of pressure with school and has been having increasing discomfort in her thoracic area which I'm sure is due to tension. I'm thinking of putting her in physical therapy to learn how to stretch this area but I may have her try the simple exercises you posted for the time being and see if it helps.

Thanks:)

[Sherie]

Sheri--thanks for the info...that term doesnt sound familiar but I guess that doesnt mean that it wasnt used. He very well may have told my husband/myself post op and I just dont recall. Also, thanks for explaining about her shoulder......I guess I will know more on Thursday!

Lynn

Did you ever get a response from your surgeon? I emailed Dr. Lenke, he's out of town for another week but the nurse sent me her 1 year post op photo and told me to take another one to compare and send back to them. She didn't have an answer for me.

I think Pam's right on the money with the muscle issues, Sheena's not athletic and doesn't do anything to build up those muscles so I'm considering PT this summer.

[txmarinemom]

Lynn

Did you ever get a response from your surgeon? I emailed Dr. Lenke, he's out of town for another week but the nurse sent me her 1 year post op photo and told me to take another one to compare and send back to them. She didn't have an answer for me.

I think Pam's right on the money with the muscle issues, Sheena's not athletic and doesn't do anything to build up those muscles so I'm considering PT this summer.

Sherie,

I hope PT/exercise helps Sheena, and I'm so sorry she's been in pain. Sending good wishes y'all's way!

Regards,
Pam