Understanding

Neck and Shoulder Pinched Nerve Pain

Neck and shoulder pinched nerve pain

Your neuromuscular system represents the critical connection between your brain and your muscles, governing and coordinating movement and sending messages to and from the brain about your body’s position in space, muscle contractions and sensory information. When nerves become impinged, or pinched, neural messaging is impeded, and you experience pain at the nerve root, along with motor deficiencies and reduced performance in the muscles associated with the nerve.

Nerves that exit from the intervertebral spaces in your neck govern your upper back, chest, shoulder and arm muscles, and those nerves can restrict movement and cause pain throughout your upper body. When nerves that innervate your rotator cuff muscles are impinged, you may feel pain and weakness in your shoulders and shoulder blades that inhibits overhead arm movement.

Neuromuscular system
Causes of Nerve Impingement

Nerve impingement is pressure on a nerve root imposed by another body structure. Inflammation of soft tissues surrounding the nerve, or pressure from a bone, cyst or connective tissue can cause impingement. Pressure can also originate within the vertebral space from a bulging or herniated disc that puts pressure on an adjacent nerve.

Nerve entrapment is related to but distinct from nerve impingement. It occurs when a nerve adheres to bone by fibrous tissue, when a bone is fractured, or when a cyst or large vein entraps the nerve, keeping it from gliding within the body as it moves.

When nerves are impinged or entrapped, blood flow to the nerve is restricted, interfering with its ability to transmit action potentials to the muscles. Over time, restricted blood flow can cause permanent damage to the nerve, limiting muscle activity and creating a cascade of movement and postural deficiencies that can become debilitating.

In older adults, normal wear and tear over time combined with postural deficiencies and joint conditions like arthritis can cause pinched nerves. In younger people, overuse from physical activity or injury are the most common causes of nerve impingement.

Nerve Impingements Affecting the Neck and Shoulder
The location and nature of nerve impingement dictates which muscles are affected, and what treatment strategies are appropriate.
  • Suprascapular neuropathyoccurs when the nerve that runs along the back of the shoulder beneath the trapezius muscle is overstretched or compressed. The condition, while rare, is most often seen in athletes whose sports require overhead movements, like swimmers, tennis players, shot putters and baseball pitchers. Compression or entrapment of the suprascapular nerve may present as mild shoulder pain, with symptoms most prominent on the athlete’s dominant side. The athlete may experience weakness, impaired mobility and reduced performance.
  • Cervical spine impingementoccurs in the nerves where they exit the spinal column at the neck and branch out to innervate the upper body muscles. Compressed or irritated nerves can cause pain, tingling and numbness to radiate along the nerve’s pathway, affecting associated muscles. The cause is often trauma from an automobile accident or sports collision, where inflammation and soft tissue damage exerts pressure on the nerves.
  • Cervical herniated discsarise when they are compressed to the point where the inner disc material bulges and leaks out, causing inflammation, and pressing on adjacent nerves.
  • Cervical spinal stenosisis most often seen in adults over age 60, and is due to degeneration of the space within the spinal canal, which can cause nerves to become compressed.
  • Cervical degenerative disc diseaseis most common in adults over age 50, where the spinal discs stiffen and become flatter, reducing support to the spine, and causing inflammation that impinges nearby nerves.
  • Text neckis a 21st Century affliction resulting from frequent long bouts of electronic devise use. The weight of the head shifts forward, causing severe strain of the upper back muscles, which can lead to nerve compression.
Diagnosis for Pinched Nerves in the Neck and Shoulder

Symptoms of neck and shoulder pain may also stem from other sources, making accurate diagnosis a critical factor for treatment. A patient history and physical exam will precede and be confirmed by real time diagnostic ultrasound, which gives a close up view of the structures of the neck.

Diagnosis for pinched nerves in the neck and shoulder
Treatment for Neck and Shoulder Pinched Nerve Pain

Traditional treatment for pinched nerve pain targets the locus of pain with the aim of reducing inflammation and decreasing pressure on the nerve. Treatment may include:

  • Ice and NSAIDs to treat pain and inflammation
  • Rest and activity modification
  • Corticosteroid shots
  • Chiropractic manipulation
  • Physical therapy
Pinched Nerve Therapy at NYDNR

The sports medicine professionals at NYDNRehab use state-of-the art technologies and innovative treatment methods to identify and correct compressed and entrapped nerves.

Some of our treatment methods include:

  • Real time dynamic ultrasound
  • DNS (dynamic neuromuscular stabilization)
  • Exercises for upper body motor control
  • Range of motion exercises
  • Acupuncture
  • Postural correction
  • Gait analysis and retraining
  • ESWT (extracorporeal shock wave therapy)

Many of our technologies and treatment approaches are unique to our midtown Manhattan clinic, and cannot be found at other clinics. Our end goal is to go beyond treating pain, to getting to its source, eliminating it, and restoring optimal function to the patient.

Pinched nerve therapy at NYDNR
130 West 42 Street Suite 1055, New York NY 10036
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In this instance, an athlete was originally diagnosed with minor quadriceps muscle strain and was treated for four weeks, with unsatisfactory results. When he came to our clinic, the muscle was not healing, and the patients’ muscle tissue had already begun to atrophy.

Upon examination using MSUS, we discovered that he had a full muscle thickness tear that had been overlooked by his previous provider. To mitigate damage and promote healing, surgery should have been performed immediately after the injury occurred. Because of misdiagnosis and inappropriate treatment, the patient now has permanent damage that cannot be corrected.

The most important advantage of Ultrasound over MRI imaging is its ability to zero in on the symptomatic region and obtain imaging, with active participation and feedback from the patient. Using dynamic MSUS, we can see what happens when patients contract their muscles, something that cannot be done with MRI. From a diagnostic perspective, this interaction is invaluable.

Dynamic ultrasonography examination demonstrating
the full thickness tear and already occurring muscle atrophy
due to misdiagnosis and not referring the patient
to proper diagnostic workup

Demonstration of how very small muscle defect is made and revealed
to be a complete tear with muscle contraction
under diagnostic sonography (not possible with MRI)

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Complete tear of rectus femoris
with large hematoma (blood)

image

Separation of muscle ends due to tear elicited
on dynamic sonography examination

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