View Full Version : Scapula abnormality and Scoliosis Physio

19-01-2011, 12:54 PM
Dr S,

I notice quite often when people are describing their childs scoliosis deformity, they mention about the Scapula sticking out oddly.
Can you tell me... is this a feature of scoliosis or is this another underlying issue? Since Elysia's 2nd surgery, there has been no improvement in the degree her scapula is protruding, in fact it looks worse to me than before.
I've read up on some "internet" blurbs that it can be caused from nerve damgage to the Thoracic area.. such as a severe knock to the back. Elysia did experience this back when she was 9 when she fell from a horse and severely grazed her back, this was when we first noticed the deformity, had never noticed it before. Viewing of MRI's taken during this accident viewed later by her Scoli surgeon, revealed the start of her Scoliosis back at that age.
I've also read that it can be caused from weak muscles in the back - true?
Does this sort of abnormality normally cause pain across the shoulder? Elysia has continual shoulder pain before and now still after surgery! Pain to what degree? No drugs, but she's learnt to live with it to an extent, but is feeling disappointed that it's still there after having surgey twice now!
Although, looking at her x-rays I feel the pain could be coming from her T4,T3 vertebrae, which are awfully tilted. Is that a possibility at all? I know, I know, you can't comment..... but Scoliosis is NOT supposed to cause pain, well so "they" keep saying on the blurbs you read about Scoliosis! Wish "they" would come live with us for a week!

Second question.... I'll be asking our surgeon the same tomorrow.... do you think attending Physio after surgery is a good idea or not? Elysia still seems very weak and I'm considering taking her off to see a physio to ask him for some advice on some gentle strengthening excercises for her to partake in to try and regain her strength and alleviate the nagging pain. Is this a waste, will only TIME allow full strength to return? I know a lot of other mums and adults alike are always surprised that there is no recommended physio program by our surgeons afte surgery, is this because really it's not going to speed recovery?

Lastly.... why are soooo many Scoliois kids so thin??? It seems everytime I'm shown a picture of a child with scoliosis they are skinny as?


Dr Scoliosis
25-01-2011, 04:25 PM
Thank you for your enquiry. When the spine bends sideways and starts to rotate the ribs follow because of their attachment to the spine. On the convex side of the curve the ribs rotate backwards and on the concave side the reverse. That is why with a right thoracic curve the left breast appears to be more prominent than the right. When the ribs on the right side rotate backwards they also move upwards and that is why there is often an unevenness of shoulder heights with a thoracic curvature. You will also note that because the ribs are rotating the medial or the inner margin of the scapula becomes more prominent and because of the rib movement it is further away from the mid line. All the changes in the position of the scapula are secondary events and have nothing whatsoever to do with the cause of the curve.

Yes, there is a condition called "winging" of the scapula which is due to a rare injury to the nerve to the muscle called serratus anterior which holds the scapula against the chest wall. That has nothing whatsoever to do with scoliosis.

With regard to the pain your daughter is having, that is something you need to discuss with your surgeon. Certainly when deformity is corrected that, in itself, results in the stretching of tissues and with the instrumentation now available it is not unusual for adolescent patients to have aching discomfort in the thoracic region after the surgery. This usually disappears in 4-6 weeks.

By and large, children and adolescents are their own best physiotherapists. The Dr Scoliosis on duty never referred a youngster for physiotherapy and had no cause to regret this. Every surgeon has a different post-operative regime. This is usually a rather rigid one as it makes life easier for all concerned. You should ask the surgeon the direct questions concerning activities and the time intervals before they can be commenced.

The Dr Scoliosis on duty had a routine which was followed for many years without cause for concern. This relates to when an adolescent may return to school after scoliosis surgery. My standard answer was when the mother thought her daughter/son was capable of doing so. The fact that there was never any serious consequences to this approach says a lot for maternal instinct.

You are absolutely correct. Girls with adolescent idiopathic scoliosis tend to be on the slender side but the reason for this is unclear. It is tempting to link this in some way with the causation but the mechanism defies the definition. If your daughter lost weight after her surgeries that might account for the scapula on the convex side looking a little more prominent than it did prior to the surgeries.

I trust these comments are helpful.

Dr Scoliosis

25-01-2011, 10:14 PM
thank you Dr S, that explains it nicely!

Last quick question.... my daughter has been having some pain running right down her right arm which doesn't seem to be dwindling! Today she has now also noticed pins and needles in her fingers of that arm. I did mention that at appointment and it wasn't commented on. 5 weeks post op... do I need to relax and not worry about this? Next appointment is not for another 4 months... seeing GP would do what?? I don't know what to tell my daughter when she complains to me about this... she didn't have that symptom before surgery! Could it be just a pinched nerve which would settle in time?

Any suggestions as to what could be causing this? I don't want to appear like a mother worrying about nothing... but pain running down the arm with pins and needles doesn't sound like a normal post op settling thing!

Thanks again

Dr Scoliosis
03-02-2011, 11:24 AM
The reported symptoms of pain and pins and needles in your daughter's right arm is something which should be brought to the attention of her surgeon. One way to do this is to leave a precise message with the surgeon's secretary with an enquiry whether the complaints warrant an early review.

Dr Scoliosis