Thoracic outlet and rotator cuff problems

Our user asked: "Hi, I'm wondering if you might be able to help me with a question I have regarding thoracic outlet syndrome and problems with the upper trapezious and serratus anterior. I have been having problems in my left shoulder for around five years. I went to a PT and we worked on strengthening my rotator cuff muscles. Anyway, that seemed to help for a little while, but Im still unable to lift heavy weights without getting diffuse dull pain on the anterior part of my shoulder. Anyway, I have been lifting a bit again and am having some shoulder pain, but the main thing I noticed is that my left shoulder is sitting higher than my right. I should also state that I get sharp nerve pains in my neck and in the thoracic outlet when things are particularly inflammed in my shoulder. Anyway, I'm wondering if its possible that my thoracic outlet issues are causing some neropathy in my serrratus anterior, which is causing my upper trapezius to dominate my scapulothoracic rhythym. Is there anything else I can do, besides plus push-ups to help strengthen my serratus anterior as well as help with entrapment issues in my thoracic outlet? Thanks, PS- Im a 24 year old male, weight=156lbs height=6 feet"

Ask a PT Response: "It is not uncommon to have one shoulder lower than the other. In fact the dominant shoulder is usually lower for most people. First of all, since you have been experiencing this condition for so long, have you had any medical imaging performed on the shoulder? Medical imaging such as a MRI would be able to determine if there is an injury in most cases. The serratus anterior and trapezius are the prime movers for scapulothoracic upward rotation. In abduction of the arm,  the force of the trapezius is more critical to the production of upward rotation of the scapula, while flexion of the arm involves more the serratus anterior for upward rotation of the scapula. Without being able to observe your movement patterns at the arm and perform various tests, it would be very difficult to determine what is going on. My recommendation would be for you to seek additional medical attention and possibly revisit a physical therapist to obtain further direction with your condition."