Nerve entrapment on the back of the shoulder blade

Anatomy: Behind the upper edge of the shoulder blade in a small channel (incisura scapulae) closed by a ligament (ligamentus transversum), runs a nerve (N suprascapularis) that distributes nerve fibres to parts of the shoulder joint-capsule and the upper and lower shoulder blade muscle (M supraspinatus and M infraspinatus)

Symptoms: Usually a burning or cutting pain in the shoulder. Possibly a sense of weakness in the shoulder. In case of long-term symptoms degradation of the shoulder blade muscles will occur.

Examination: Uncharacteristic shoulder symptoms, not improved by relief, should be examined by a physician. If the results of the examination indicate nerve entrapment the diagnosis is made by a nerve conduction velocity test (EMG).

Treatment: The treatment involves relief from the pain inducing activity, stretching and rehabilitation of the muscles around the shoulder. If no progress is made with relief and rehabilitation, surgical intervention may be attempted (article-1) (article-2).

Relief is the primary element, and it is particularly important that the rehabilitation does not cause any discomfort. Fitness training should not be resumed until the pain has stopped

Complications: If satisfactory progress is not made, a physician should be consulted to ensure that the diagnosis is correct and that no complications have arisen. Amongst others the following should be considered:

• Slipped disc in the neck
• Frozen shoulder
• Rupture of the upper shoulder blade muscle
• Inflammation of the tendon sheath of the upper shoulder blade muscle
• Inflammation of the bursa
• Rupture of the deltoid muscle
• Rupture of the biceps muscle
• Tendon sheath inflammation of the biceps muscle
• Partial luxation in the shoulder joint
• Luxation in the joint between the shoulder blade and the collar bone
• Muscle infiltrations
• Sprained shoulder
• Meniscus lesion in the shoulder (laesio labrum glenoidale)
• Impingement