Gina has been corresponding with a young American woman who had extensive corrective surgery with Dr. Fonkalsrud a couple months ago. She's very pleased with the result, but is really at wits end with the shoulder area pain. And of course her local doc hasn't a clue -- he thought it came from using the telephone too much at work!! What a nincompoop :) The pain she has is mostly on one side, running deep beneath the shoulderblade, and in her case also causing the armpit on that side to swell and ache. Off and on during her first couple months after the op, Gina had very similar pain , with numbness and tingling from the shoulder on that side right down to the little finger. And she likewise experienced an armpit ache on the painful side.
All these painful areas are served by specific major nerves whose paths SHOULD be known by any doc worth his salt! I've got open in front of me a popular illustrated family "reference" book called "The Human Body" (we bought it in the hospital bookstore!) -- and it shows very clearly just what areas of the body are served by which nerves. You'd think the docs could at least open a book to check something so obvious....
The upper body, or thoracic, nerves serving those areas are being "pinched" where they come out of the spinal cord. In PubMed abstracts you'll see this referred to as "thoracic outlet syndrome" (TOS) -- and it appears to be a common after-effect of any accidental or surgical injury to the upper ribcage. Hope of avoiding TOS is one reason many PE surgeons avoid working on the higher ribs when they reshape the ribcage during surgery. The only unknown in the situation is exactly what's doing the pinching of the nerve where it leaves the spinal cord. Neurological tests may help determine whether there is tissue swelling, vertebral disk protrusion or rupture, bone misalignment, scar tissue, or even a growth causing the pinching.
When this kind of pain occurs after corrective surgery for PE, I suspect the pain is part of the body's adjusting to the new ribcage dynamics, and is related to a posture problem common in PE called "shoulder rolling", which often happens on just one side.
Before surgery, Gina had asymmetrical PE, with her heart pushed into her left ribcage, that side developing larger than the right, and the right upper ribcage flattened. This unnatural leftward pull on her breastbone really pulled on her right pectoral muscles -- stretching them unnaturally -- and caused her right shoulder to roll forward a bit, while her left shoulder was quite straight. Strangely, after the op the situation was reversed! I noticed this in the first few days post-op -- that while her right shoulder was now held straight, her left one was now rolling forward a bit.
I think that rolling is due to the corrected ribcage now "stretching" (pulling) on those left upper chest muscles which had probably become shortened during the growing years as they adapted to the asymmetry. Sort of like what happens if you wear highheels all the time -- after a few years your ankle muscles in back have become foreshortened and you can't easily flatten your foot without pain. With time the muscle will adapt to the new tension, but in the meantime it can certainly be uncomfortable. And until the chest muscle there does stretch out more normally, it's going to pull that shoulder forward. And MAYBE the shoulder rolling caused by that pull on those shortened muscles is what is behind the pinching of the nerve that runs under the shoulderblade.
That continued unnatural tension and forward pull on the shoulder area is bound to cause the muscle tissues being stretched on the high BACK to cramp or swell and possibly even inflame. And swollen tissues alone can press on the spinal column "outlet" of the nerve serving that area.
I often wish I'd followed an impulse I had just after Gina's op to get her one of those soft strap-like shoulder braces I saw at the hospital pharmacy. I wonder whether if she'd had its help in keeping her shoulder from being pulled forward, she might have avoided the back pain altogether. Unfortunately, as such things go, if you wait a couple weeks before trying such mechanical help, there's already so much muscle and nerve irritation that nothing gives a quick fix.
So, to wind this up -- even though the shoulder rolling might have been present before the op, there is usually no pre-op pain because it was a gradual adjustment as the body grew. But the op changed the whole ribcage dynamics in one day. It's not surprising that the body has aches and problems as it tries to re-adjust so rapidly. While I think it's likely the nerve pinching behind the pain is caused by tissue swelling, it's just possible the forward pull on the shoulder bone structure has tilted the vertebra surrounding the nerve out of alignment, possibly compressing the disk as well, and that this is adding to the damage.
Be that as it may, TOS does often occur in the first few months after PE surgery. And -- be reassured! -- it fades over the following months. But -- how to deal with the pain in the meantime?
Conventional medicine doesn't seem to have much to offer by way of resolving the pain for good. When this pain first hit Gina, at the end of her second week post-op, it was so sharp she had to take codeine again -- after being off all painkillers for the previous week! It originated high in the back, ran beneath the left shoulderblade, radiated down the ribs on that side clear around to the upper ribcage in front, and down the left arm to the outside fingers. She hated the effects of codeine, and was determined to find another answer quickly. That same day she tried a heat pad and TEMS unit -- which sends small electric pulses to the area in hopes of relaxing it. Neither did much good.
She then visited a chiropractor who uses the very gentle Sacro-Occipital Technique (SOT). The chiropractor was able to make some adjustments to her spine and upper back muscles while Gina sat upright -- no pressure on her fragile ribcage was needed. And when she finished, the pain had dramatically decreased.
Next day we followed this up with a visit to a practitioner of Traditional Chinese Medicine, who prescribed a "brew" of many dried herbs to deal with the nerve problem. Boiled up and drunk 3 times a day, the concoction looked like muddy water and tasted worse -- but did it ever work! Within an hour of taking the first cupful, the pain was gone from her arm and ribcage, and the back pain much reduced. Several days later, when the improvement seemed to have plateaued, she was given a new concoction to resolve the remaining dull pain, and improve her sleep and stamina. Again the results were immediate. After the first dose, the pain went, she slept deeply that night, and next day her energy was terrific. The day before beginning the second brew, she'd not even been up to walking down the street; after the first 2 doses, she was able to handle a four hour shopping outing, including walking several blocks to catch a bus!
Worth a try:)
I should add here that now, 7 months post-op, Gina has none of this shoulder or arm pain, and the shoulder that was rolling forward several months ago is now held straight.
