Diagnosis of scapula winging, but MRI shows no signs of nerve damage, no pain, no traumatic injury, just gradual and consistent loss of strength on left side, back muscles asymmetric

[Narcissus]

About 2 months ago, I noticed that every week I went to the gym, I was getting weaker and weaker in my upper body (lower body seemed fine). It was most noticeable on the bench press, I would lose 2.5 - 5 kgs off my bench press each week. It was much worse for any pushing exercises (bench press, shoulder press), than for pulling exercises (chin ups, upright rows). This continued for almost 6 weeks (at which my bench press had dropped from 75 kgs to 45 kgs), at which point I noticed that I was tilting on chin ups and I suspected one side of my body had become weaker than the other. I tested this by isolating the left and right sides and I discovered that indeed, my left side was much, much weaker than my right, especially for pushing exercises, much less difference for pulling exercises. There was no traumatic injury that I can remember (although I do practice brazilian ju jitsu and I am constantly getting shoulder locked), I have done the same weights program from 10 years with no problems, I didn't change anything recently. And there is no pain in my shoulder really, the only symptom has been a constant and progressive loss of strength.

I went to see a Doctor who referred me to a kinésithérapeute (kiné), which is what we call a physical therapist in France. Since my French is adequate but not perfect, this has made it more difficult to understand the diagnoses given.

The kiné (physical therapist) diagnosed scapula winging (with some uncertainty), and sent me to get an MRI. I did this, and it showed no sign of nerve damage, including the long thoracic nerve. I was sent back to the kiné and we began a program of muscular re-education for the serratus anterior. He tells me that he isn't sure it will have any effect and in 3 weeks if there is no change then I will have to get an ECG (which I believe is French for EMG). I'm usually very proactive with my own health, and it's frustrating not being able to understand exactly what my health care providers are telling me. I also had an accident several years ago where I didn't seek a second surgical opinion and I am now paying for that with a non functioning right thumb, so I am just aiming to seek a second opinion. After some extensive research on scapula winging, I'm still uncertain. Things of note include:

1. No pain, no one-off traumatic injury, just a constant and continuing loss of strength in my left upper body, especially pulling exercises. Outside of the gym I barely even notice anything.
2. MRI indicates no nerve damage.
3. When doing a test where I lift my arms from my side, straight in front of me, then above my head, then lower them in the same way, I did notice what could be consider minor scapula winging when lowering (see pic 1).
4. On raising them during the same test, my back muscles look really asymmetrical (see pic 2), the left side look longer and thinner. I'm wondering if this is either a symptom of the scapula winging, or indicates another condition that could cause the weakness.
5. From a side view, the left and right sides look fairly similar, it's possible that the left shoulder is rolled forward slightly, though I might be reading too much into this (see pic 4, left picture is left side, right picture is right side flipped horizontally for better comparison).

Any insight that anyone could offer would be very much appreciated!

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[physiobob]

Hi Narcissus

Thanks for reaching out via the forum. It sounds like you have a lot of experience in the gym and with weights so I feel your frustration with this issue. A winged scapula is due usually to an issue with the long thoracic nerve of the shoulder and/or weakness in the Serratus Anterior muscle. If the long thoracic nerve is damaged or bruised it can cause paralysis of the serratus anterior muscle and wing of the scapular or shoulder blade.

It could well be the case that your scapula on the left (like mine) has been a little compromised for a long time and only now that you are having an issue are you noticing it. Often this would not show up on a scan and actually if an MRI is pretty clean then that's great as there should not be anything to major going on. If the serratus anterior muscle is having an issue then this will affect your pushing (bench) movements. But a true long thoracic nerve issue would also cause some pulling issues too as the scapula would be having a hard time to hold itself in a stable position while you recruit the muscles attached to it. So your presentation might not really be a true winging issue but that the winging is a sign of some asymmetry that has been creeping in over time and now is proving to be symptomatic.

One thought also is that if your AC Joint (Acromioclavicular joint) is a little out of place then the body will not be pulling or pushing with normal strength. It's easy to upset that joint at the scapular end (and also at the sternal end) with pull ups etc. and you might not even know it.

My approach to this would be to back off the weight for now until you feel both sides are contributing equally to the exercise. Be strict with your form on that. And as the nerve might be a little trapped in the neck musculature perhaps get some deep tissue massage for a few sessions to release the area. I'd think something 1-2 times a week for a couple of weeks in combination with the reduction in weight on the bar etc. Lay off the chins etc unless you're using a machine assisted version.

These things can be frustrating which is rather annoying but in my experience that have often been a long time coming and only towards the later stages do they become symptomatic. Let us know how you get on and I can provide some more feedback.

regards

PB