Left Shoulder Blade Numbness and Facial Asymmetry

Numbness in the left shoulder blade?

Hello, doctor.
I have been experiencing occasional numbness near my left scapula close to the armpit, and it can even be painful when pressed.
This symptom has persisted for over a year.
I would like to know if I need to go to the hospital.
Although it does not interfere with my daily life, I am still quite concerned.
Additionally, I have another issue: when I smile in the mirror, I notice that the corners of my mouth are asymmetrical (the left side is higher than the right).
Could this indicate a problem with the facial nerve or cranial nerves? I would appreciate your advice.
Thank you.

Rick, 10~19 year old female. Ask Date: 2015/04/22

Dr. Lan Shengxing reply Neurology

Hello Rick, the issue with your left scapula may be related to an old injury causing nerve regeneration entrapment, or there could be other lesions causing compression, depending on your past medical history and whether your current symptoms have progressed.
If the symptoms are worsening or if there was no prior injury, you should consider visiting a neurology clinic for evaluation.

Additionally, while the body is generally symmetrical, there may not be "absolute" symmetry; features such as ears, eyes, and mouth corners may not be perfectly aligned.
At your age, you might have higher expectations regarding your appearance, but others often do not notice these differences.
If the lower side becomes increasingly pronounced or if you experience functional impairments, such as difficulty closing your eye, drooling, or slurred speech, it is important to seek medical attention promptly.

Reply Date: 2015/04/22

More Info

Understanding the symptoms of left shoulder blade numbness and facial asymmetry can be complex, as they may stem from various underlying conditions. Your description of numbness near the left shoulder blade, particularly close to the armpit, accompanied by pain upon pressure, raises several considerations. This symptom has persisted for over a year, which is significant and warrants further evaluation.

Numbness and Pain in the Left Shoulder Blade
The numbness and pain you are experiencing could be related to several potential causes:
1. Nerve Compression or Irritation: The brachial plexus, a network of nerves that originates from the spinal cord in the neck and extends into the arm, could be compressed or irritated. This can happen due to poor posture, repetitive movements, or even trauma. Conditions like thoracic outlet syndrome, where nerves or blood vessels are compressed as they pass from the neck to the arm, could also be a factor.

2. Cervical Spine Issues: Problems in the cervical spine, such as herniated discs or degenerative disc disease, can lead to nerve root compression. This can cause symptoms that radiate into the shoulder blade area and may also affect the arm.

3. Muscle Strain: Overuse or strain of the muscles around the shoulder blade can lead to localized pain and numbness. This is particularly common in individuals who perform repetitive overhead activities or have poor ergonomic setups at work.

4. Referred Pain: Sometimes, pain in the shoulder blade area can be referred from other areas, such as the heart or lungs, especially if there are accompanying symptoms like shortness of breath or chest pain. However, this is less likely given your description.

Facial Asymmetry
Regarding the asymmetry you notice when smiling, where the left corner of your mouth is higher than the right, this could be indicative of several conditions:
1. Facial Nerve Dysfunction: The facial nerve (cranial nerve VII) controls the muscles of facial expression. If there is any dysfunction, it can lead to asymmetry. This could be due to Bell's palsy, which is a temporary weakness or paralysis of the facial muscles, or other neurological conditions.

2. Structural Issues: Sometimes, structural issues such as previous trauma, dental problems, or even congenital conditions can lead to facial asymmetry.

3. Muscle Imbalance: Over time, if one side of the face is used more than the other, it can lead to muscle imbalances that cause asymmetry.

Recommendations
Given the duration and nature of your symptoms, it is advisable to seek a comprehensive evaluation from a healthcare professional. Here are some steps you can take:
1. Consult a Neurologist: A neurologist can perform a thorough examination to assess the function of your facial nerve and determine if there are any underlying neurological issues contributing to your symptoms.

2. Physical Examination: A physical examination, including a neurological assessment, can help identify any signs of nerve compression or other musculoskeletal issues related to your shoulder blade pain.

3. Imaging Studies: Depending on the findings from your examination, imaging studies such as an MRI or CT scan of the cervical spine may be warranted to rule out any structural abnormalities.

4. Physical Therapy: If nerve compression or muscle strain is suspected, physical therapy may be beneficial. A physical therapist can provide exercises to strengthen the muscles around the shoulder and improve posture, which may alleviate symptoms.

5. Monitor Symptoms: Keep track of any changes in your symptoms, including the frequency and intensity of the numbness and pain, as well as any changes in facial asymmetry. This information will be valuable for your healthcare provider.

In conclusion, while your symptoms may not currently interfere with daily life, they are significant enough to warrant medical attention. Early intervention can lead to better outcomes and prevent potential complications. Please consider scheduling an appointment with a healthcare professional to discuss your symptoms in detail.

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