United Brachial Plexus Network, Inc.

Just wondering what different types of surgery everyone has had recommended for scapular winging? Thanks - CMB

Our dr. advised not to do anything about the it because the winging of the scapula facilitates the movement of her arm and shoulder.

Alanna,

Paul St. John, a neuromuscular therapist in St. Petersburg, Florida, cured my daughter's scapular winging in just 10 treatments. She was in chronic pain for almost 5 years and was given differing diagnoses/prognosis by 8 orthopedists suggesting differing, horrific surgeries.

She has now been pain and wing free for almost a year. The man is truly amazing. Three people from this board have gone to him after reading my posts and have had the same success,one of them is the wife of a neurologist who couldn't help her and who flew her all over the country, trying to find someone to cure her.

Also, there are St.-John trained therapists throughout the country and several people have called myself or Paul's office to get the names of therapists.

My daughter's story is so very long and she and I have both written extremely long posts trying to help people on this website and most of them have been deleted so I'm not going to write another one, but I would be very happy to talk to you.

My name is Susan Frey and my phone number is 727 729-1223. My e-mail address is susanfrey@swfla.rr.com.

Paul's office number is 727 347-4325. If you call the office, please tell Mary Beth,his assistant that I referred you.

His website address is www.stjohn-clarkptc.com but his website doesn't do him a bit of justice. Read his bio, it's really fascinating how he got into what he's doing as he was a chronic pain patient himself.

I don't know where you live or what your situation is, but if you are at all able to get to Florida to at least have Paul evaluate you and then refer you to someone that he trained in your area, it will really be worth your while.

He gave Heather her life back again. The man is truly amazing.

Good luck and feel free to call me any time.

Best,
Susan

We've gradually come to realize that Joshua wings (not tremendously but moreso in certain positions) because of his subscapularis weakness. It is his body's accomodation of a weak and/or fibrotic subscapularis. We know his subscap didn't recover very well and got very contracted sometime in the first few months of his life because his shoulder joint was already showing significant malformation in his 3-month MRI.

His subscapularis was further weakened when it was partially released during ACR. Tendon lengthenings effectively weaken a muscle by making it have to contract more for the same "pull"; sometimes a muscle can recover, but not always. We had to choose the shoulder joint over the subscapularis, as the shortened muscle was not allowing the shoulder joint to form correctly.

Now, if Joshua wants to get to midline, he has to do it by basically letting go of his scapula stabilizers and allowing his pec major and minor to pull his scapula around and forward. As a result, it wings out in the back. He can't stabilize his shoulder AND internally rotate because his subscapularis is incapable of rotating the ball in the joint very effectively.

The only way to improve winging in his case would be to somehow bring the subcapularis back to life and get it working properly. It is not accessible via surface e-stim (perhaps I need to get my old colleages to implant a stimulator??) We have been trying various different things in therapy to try to help it along, but so far have not had not much success. It is possible that he just learned different motor patterns and if we could just figure out how to get him to try something "new", he might start using it. Along those lines, we are thinking about botoxing his pecs - temporarily paralyzing them - so that he can't use them as a crutch and might "rediscover" his subscapularis. We still haven't decided on anything.

But one thing I would never consider is any permanent release of his pecs, as it might turn out using his pecs is the only way he'll ever have midline ability! I also really don't see how anything else that has been proposed would address his weak subscapularis, the fundamental cause of his winging. So we are still waiting for "the answer" on this topic...

Winging can also be caused, BTW, by an external rotation contracture. Don't dismiss that thought because your child is weak in external rotation (see my post on biceps contractures). Weak but working external rotators might just not be strong enough to be able to pull the arm back from full internal rotation, and so might tend to "stay on" all the time. If they become contracted or cannot "turn off", the child will need to compensate by winging to get to midline or into internal rotation.

Kate