UnderstandingNeck and Shoulder
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 spacial positioning, muscular contraction and sensory information. When nerves become impinged or pinched, the result is not only pain at the nerve root and along the associated muscles, but also impaired movement and deficient motor responses that can interfere with performance.
Because the nerves that exit from the intervertebral spaces in the cervical spine of your neck govern the muscles of your upper back, chest, shoulders and arms, impingement of those nerves can cause pain and movement dysfunction of your upper body. When nerves that innervate your rotator cuff muscles, such as the suprascapular nerve, become impinged, you may experience pain and weakness in your shoulders and scapular region that makes overhead arm movements difficult.
Nerve impingement is nothing more than pressure on a nerve root by another body. It can be caused by inflammation of soft tissue surrounding the nerve, or by pressure from a bone, cyst or connective tissue. It can also originate within the vertebral space, when intervertebral discs become compressed, causing them to bulge or herniate, and placing pressure on the nerves.
Nerve entrapment is related to, yet distinct from nerve impingement. Entrapment can occur when a nerve adheres to a bone by fibrous tissue, when a bone is fractured, or when a cyst or large vein inhibits the nerve from moving as the body moves.
When a nerve is impinged or entrapped, blood flow to the nerve is restricted, interfering with its ability to transmit action potentials to the muscles. Over time, reduced blood flow can lead to permanent nerve damage that impairs muscle activity, creating a cascade of movement and postural deficiencies that can become debilitating.
The source of nerve impingement in older adults is often associated with age-related normal wear and tear, postural deficiencies or joint conditions like arthritis. However, in younger people, nerves most often become impinged as a result of physical activity overuse, or from injury resulting in herniated discs.
Suprascapular neuropathy occurs when the nerve running along the back of the shoulder beneath the trapezius is compressed or stretched. While rare, this type of nerve impingement is most often seen in athletes whose sport or event requires overhead movement. Athletes likely to present with suprascapular neuropathy include:
Compression or entrapment of the suprascapular nerve sometimes presents as vague posterior shoulder pain, although distal nerve injuries (located away from the spine) can be relatively painless. Symptoms are typically unilateral, involving the nerve and muscles on the dominant side.
The most common site of suprascapular nerve entrapment is the suprascapular notch. Shoulder pain may be prominent In such cases, and an athlete may report weakness, impaired mobility and a decline in performance.
If suprasternal neuropathy is not diagnosed and treated, the external rotator cuff muscles may become atrophied over time, and the shoulder girdle may become unstable.
Cervical nerves exit the cervical vertebrae and then branch out to innervate muscles of the upper extremities, including the shoulders, arms, hands, fingers, upper chest and upper back. If the nerve roots become irritated by inflammation or compression, pain, tingling and numbness can radiate along the nerve pathway, affecting any or all of the associated muscles.
Compression of cervical nerves can arise from a number of causes, including:
Acute Injury: Injuries arising from automobile accidents, sports or high impact collisions can cause inflammation, damage to soft tissue, nerve compression and pain.
Cervical Herniated Disc: When cervical discs are compressed to the point where the inner material of the disc leaks out, inflammation and impingement of the adjacent nerve can occur. In younger people, cervical nerve pain is most often caused by a herniated disc.
Cervical Spinal Stenosis: Most commonly seen in adults over age 60, stenosis is a degenerative process where the space for the spinal canal becomes tightened due to age-related changes in spinal joints, and nerves become compressed in the process.
Cervical Degenerative Disc Disease: Seen in individuals over 50, spinal discs degenerate, becoming stiffer and flatter, providing less support to the cervical spine. This sometimes leads to inflammation and the impingement of nearby nerves.
Text Neck: An affliction of the 21st Century, text neck results from too frequent and too long bouts of bending the neck forward to text or otherwise interact with mobile electronic devices. The syndrome manifests as severe upper back muscle strain and muscle spasms. If a nerve is pinched in the neck, you may experience shoulder pain that can radiate down the arm and to the hand.
Because symptoms of pain, tingling, weakness and numbness associated with pinched nerves in the neck and shoulder can also have other origins, an accurate diagnosis is fundamental to developing a treatment strategy. Diagnosis will most likely include the following steps:
Patient History: Factors like medical conditions, lifestyle, previous episodes, injuries, physical activities and other information will be given careful consideration.
Physical Exam: The practitioner will palpate the neck and shoulder area for abnormalities, and will evaluate range of motion.
Spurling’s Test: This simple evaluation aims to reproduce the patient’s pain through manipulation of the cervical spine, to identify the origins of the symptoms.
Ultrasound Imaging or MRI: Imaging technology enables the practitioner to get a close-up view of the source of your pain.
While treatment for your neck and shoulder pain will vary, depending on the source and severity, treatment protocols frequently entail any or all of the following:
The sports medicine professionals at NYDNRehab use their combined experience and expertise to accurately diagnose and treat neck and shoulder pinched nerve pain. Employing innovative cutting edge technology and unique state-of-the-art treatment strategies, the professional staff at NYDNRehab is equipped and ready to get to the source of your pain and treat it, so you can get back to your busy life.
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