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Nerve compression from skiing accident -- how it was diagnosed

Mike King

AKA Habacomike
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Nov 13, 2015
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Louisville CO/Aspen Snowmass
A member of the forum contacted me by PM to inquire how the nerve problem associated with my injury was diagnosed. I think it maybe informative to others to post my reply to their inquiry here, so I've started this post to capture that.

Five months after the accident, I simply was not gaining strength so my PT suspected that either there was a rotator cuff tear that was not showing up on the MRI or there was a nerve problem. So she sent a note to my orthopedic surgeon, and he thought that there might be a nerve issue. He then referred me to a physiatrist, who conducted an EMG (electromyography) study. The EMG study uses electrical probes that are placed at predetermined locations on the skin to excite the nerve, with an ability to read the connection of the nerve to the muscle as well as, as I understand it, the location of any interruption in the circuit. So the EMG can be a very useful diagnostic tool to identify the location of a nerve problem.

The results of my EMG study found that there was no connection between the suprascapular nerve and the two muscles it attaches to, the infraspinatus and the supraspinatus. These muscles are responsible, in part, for external rotation of the humerus and the first few degrees of shoulder flexion. The surgeon and the physiatrist thought that there was a likelihood that the nerve was compressed in the suprascapular notch, which is a notch in the scapula. So the surgery enlarged the notch, presumably freeing the nerve and giving it a chance to regenerate. A nerve grows about a millimeter a day starting 30 days after surgery, so it is still too early to determine if it will solve the issue and there are no guarantees, but the surgeon thought it was the best chance for a recovery. So far, I think I getting a bit of strength, but it is still a bit early to tell.

One thing to realize is that if it is a nerve without a connection to a muscle, you only have 1.5 years for the connection to be regenerated. After that time, there's no chance of recovery. So you have to budget the time for the surgery, nerve regeneration, etc.

Of course, anyone should consider the value of this information, which is uneducated, uninformed, a case study of one, and provided by a lay person. Your doctor and physical therapist should be the source of your care, not the internet.

Best of luck!

Mike
 

Scruffy

Making fresh tracks
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Thanks for sharing. Good luck with your recovery, Mike.
 

Kneale Brownson

Making fresh tracks forever on the other side
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So, did the surgery remove the nerve from the notch? Or does it just have more room in the notch?
 

Ski&ride

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Do you feel the lack of strength specifically in certain muscles? Or more of a general lack of strength overall?
 
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Mike King

Mike King

AKA Habacomike
Instructor
Joined
Nov 13, 2015
Posts
3,381
Location
Louisville CO/Aspen Snowmass
I didn't have great awareness of specific muscles prior to the injury, so it is more specific types of movements that highlight the weakness, rather than specific muscles. Also, there are two types of nerves: sensory nerves and motor nerves. Sensory nerves are associated with the sensory systems of the body and responsible for things like touch, heat, and pain. Motor nerves are involved in the contraction of muscles, and do not transmit pain. My issue is a motor nerve, so there is no pain involved.

The specific weakness for my injury was external rotation and the first few degrees of shoulder flexion (lifting the arm either in front or laterally). These weaknesses are most often involved in a rotator cuff tear, but mine was not affected.

I'm not sure how rare my circumstance is. My orthopedist said that my specific type of injury is most common in volleyball players where there is a lot of overhead use of the arm. Still, I offered this post for the information of folk who may have some sort of strange weakness that persists after an injury as a possible pathology to eliminate in their path to recovery.

Mike
 

no edge

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Did you discuss the nature of your injury in another threat. This is of interest to me. I am really struggling with an injury to the neck area. The pain and weakness is located around my neck and downward into my scapula then along the side of my spine. I am seeing six doctors right now. Cardio and neurologist seem to be taking priority. I had a stroke nearly two years ago so I have to look after that.

It would be really nice to address this. I am so weak, foggy, without balance and lacking in conditioning to name a few. But I can't wait for opening day at Killington... any day now!
 
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Mike King

Mike King

AKA Habacomike
Instructor
Joined
Nov 13, 2015
Posts
3,381
Location
Louisville CO/Aspen Snowmass
I’m not a medical professional so am unqualified to offer much advice, but your symptoms sound like they might involve the Brachial Plexus nerve. If it was me, I’d discus with your doctor if it might be a nerve problem and if an EMG might be warranted. An EMG can detect the degree of compromise in muscle/nerve connection and its location. Good luck and best wishes for a full and speedy recovery!
 

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