The scalene was just a thought as a potential source of the 'lev scap' pain. If the lev scap pain is located directly on the superomedial scapular border where the fibrous tendon is located then you are most likely on the right track with that being your original source of pain. If the pain was more focused in the belly and particularly anteriorly, then it might be easy to confuse the lev scap with the post scalene.

It sounds like what you have now developed - ulnar distribution pain etc.. would then point the finger at the lower cervical levels C6-T1 and rib dysfunctions.

Out of interest do you have any tricep or pec pain/weakness? This would then signify a C7/T1 disc type issue.

Back to the original lev scap problem. Chronic fibrosis in the tendon insertion with subsequent 'trigger points' in the muscle belly is reasonably common. Whether it is developmental due to posture (constant neck flexion, contralateral side flexion type posture), due to overuse (i get a problem with mine if i deadlift too heavy - the traction on my scapular must place a lot of strain on the lev scap and i feel a transient burning pain) or due to cervical spine pathology which drives the tone through the muscle.

The question about the head down posture is intersting as i am currently treating a guy at the moment who is a professional MMA (UFC ) fighter. He trains twice per day for a least 2 hours (much of it grappling and in head locks) but he does not feel it then. He feels it the most when he sits at the computer for too long or if he drives long distances. We get great relief by really hammering the insertion of the tendon on the border of the scapular, however the relief only lasts 3-4 days. He is now about to see a musculoskeletal physician who specialises in trigger point injections into chronically fibrosed muscle. What he does is very invasive and extraordinarily painful whereby he needs to sedate patients to do this. He also inject a whole cocktail of natural bits and pieces such as traumeel and vit C into it when he is done. This would be step on from simple dry needling.

I will let you know how this goes when he is done.

Other than that i feel for you and your physio, as these little suckers can be recalcitrant.