A pinched nerve in the scapula

Back pain is an extremely common phenomenon that periodically bothers 85% of the world's population. Unpleasant sensations are not always caused by any pathology and can appear as a result of an unfortunate movement or prolonged stay in an uncomfortable position. If we are talking about such a problem as a pinched nerve in the scapula, then it makes sense not to wait for the pain to disappear on its own, but to be examined by a specialist. Such discomfort can be related to trauma, musculoskeletal disease, and even cardiologic and digestive disorders. Diagnosis can be performed by a vertebrologist, orthopedist or therapist.

Epidemiology

A pinched nerve in the scapula is a common disorder that almost every second or third person on the planet experiences from time to time. According to statistical information, the average annual prevalence of this phenomenon is between 15 and 30%, and the prevalence during the entire life period is between 15 and 80%, depending on the region of residence.

In most patients, the intensity of the pain syndrome decreases during the first weeks after its onset. However, many people experience recurrences thereafter, causing reduced ability to work.

A pinched nerve in the scapula is a frequent cause of chronic pain, which is what makes the patient seek help from doctors.

If there are abnormalities in other parts of the spinal column and/or associated nerve pathways, the pain syndrome may "migrate". In most cases in the acute period, there is intense pain accompanied by neurologic signs.

Pinched nerve in the scapula is predominantly a problem of adult male patients from 30 years of age. In childhood, the problem is almost never encountered. Women note the occurrence of the disorder more often during pregnancy.

Causes of the pinched nerve in the scapula

Pathologies of the spine are the most frequent root causes of a pinched nerve in the scapula. In particular, we can talk about the following pathologies:

• osteochondrosis of the thoracic spine;
• traumatic injury to the ribs;
• congenital anatomical defect, improper localization of the scapular bone;
• spasticity of the muscles due to trauma, inflammation, etc.;
• herniated or protruding discs;
• pathologic curvature of the spinal column;
• thoracic radiculitis (intercostal neuralgia); [1]
• Shoulder periarthritis (degenerative and inflammatory lesion). [2]

Secondary causes can be hypothermia, lifting and carrying heavy objects, unusual physical activity, performing exercises with a wide range of motion, sleeping on an uncomfortable bed.

The most common cause of the disorder is considered to be progressive osteochondrosis, which is characterized by changes in the contours of the spine, resulting in compression of nearby structures and impaired nerve conduction. Among the rare causes are spinal tumors, autoimmune, digestive and endocrine diseases.

Risk factors

Pinched nerve in the scapula may be due to changes in the vertebral column (in particular, vertebral bodies, intervertebral discs, joints, ligamentous mechanism), damage or pathologies of the musculature, lesions of peripheral nerves or roots, diseases of internal thoracic and abdominal organs, and even mental disorders. Practitioners point to the leading role in nerve entrapment of musculoskeletal changes associated with stretching, traumatization, excessive strain on muscles, ligaments, or joints.

The main potentially dangerous vertebrogenic factors are noted in about 1% of cases and are expressed in the development of primary and meastatic tumors of the vertebral column, spondyloarthritis, infectious lesions (discitis, tuberculosis).

Nonvertebrogenic factors, caused by somatic disorders, are found in 2% of cases and consist of pathologies of the thoracic and abdominal cavity and retroperitoneum.

Risk factors for pinched nerve in the scapula include lifting heavy objects, prolonged static overload, vibration, uncomfortable position of the arms and back during work, prolonged sitting. Pain in the area of the scapula often appears in office workers, machine operators, farmers, construction workers. The risk zone also includes pregnant women and obese people (due to the increased load on the spine).

The frequency of pinched nerve in the scapula increases when practicing certain sports (skiing, rowing).

Pathogenesis

Inflammation, pinched nerve in the scapula is not a separate pathology, but a symptom. As we have already said, there are many reasons for its appearance, but in the vast majority of cases, these are disorders of the spinal column - in particular, its thoracic section.

• Protrusions and herniated discs of the thoracic spine are the most common mechanism of nerve entrapment. With any deformation of the fibrous ring, there is compression of the root, which forms the nerve branch. As a result, its function is impaired and, as a result, there is severe pain. [3]
• With the displacement of vertebrae, spinal misalignment, there is a mechanical compression of the nerve fiber.
• Stenosis of the cerebrospinal canal is accompanied by narrowing of its lumen, which also affects the sensitivity of nerve roots. [4]
• Osteochondrosis is accompanied by degenerative changes in the intervertebral discs, which bulge out of the spinal contour and are covered with bony growths, while exerting pressure and pinching nerve endings. [5]
• Spasm of nearby muscles due to hypothermia, heavy physical activity or trauma also contributes to pinched nerve in the scapula. This situation can also lead to the development of inflammation.

Many structures of the spinal column have nerve endings and can become a source of pain syndrome. The development of biomechanical imbalances that increase the load on individual structures can be associated with congenital anatomical discrepancies: asymmetry of limbs and joints, dysfunctional joint conditions, bone and tendon defects.

Symptoms of the pinched nerve in the scapula

Pinched nerve in the scapula is a common neurological phenomenon, which is accompanied by a number of unpleasant sensations, the main of which is sharp pain. It occurs more often suddenly, intensifies with movements, coughing, sneezing. [6] In general, the symptoms are as follows:

• burning, tingling in the thoracic spine and one of the shoulder blades, sometimes in the arm on the side of the affected shoulder blade;
• in some cases - redness, swelling of the skin in the affected area;
• increased sweating;
• numbness of muscles in the area of the scapula, neck, thoracic spine;
• increased pain when trying to move the arm on the affected side;
• a sense of stiffness;
• numbness in the upper extremities (or one of them);
• pain behind the sternum.

There may be twitching of periolopathic muscles, sensation of a foreign object in the back. The patient becomes irritable, there is increased fatigue, impaired performance, deterioration of sleep. Headache, increased blood pressure may be bothersome. [7]

The initial symptomatology has its own specific characteristics due to the location of the pinched nerve fiber. In most cases, patients voice the following complaints:

• sudden onset of sharp, burning pain in the back or shoulder blade with irradiation to the shoulder, upper extremity, chest;
• tension, muscle soreness in the affected area;
• Limitation of arm mobility on the affected side;
• swelling in the peri-pelvic area;
• tingling sensations, goosebumps;
• muscle twitching.

When trying to move the arm, when touching the injured area, the pain usually increases. The patient tries to maintain a forced posture in which the discomfort is felt least intensely.

Additional signs are sometimes:

• pain in the head;
• pain in the scapula or thoracic spinal column when taking a deep breath, coughing, sneezing;
• dizziness.

Many people whose work is associated with prolonged stay in a forced body position, complain of regular pinching of the nerve in the scapula: sometimes it happens on the left, sometimes - on the right, or above or below the scapular bone.

A pinched nerve in the left scapula

A pinched nerve on the left side of the spine in the scapula area is no less common than on the right side. However, in some cases, the pain is not at all related to the pinched nerve: such a sign is characteristic of diseases of the cardiovascular system - in particular, myocardial infarction, angina pectoris, aortic aneurysm, pericarditis. In these pathologies, pain is often noted not only in the left scapula, but also in the left shoulder, or throughout the chest.

It is strongly recommended to consult a doctor if such a problem is detected. Self-treatment can only worsen the situation without knowing the causes of its origin. Especially those people who allegedly have a pinched nerve in the left scapula accompanied by pain behind the sternum, dizziness, coughing, general malaise should be wary.

In addition to the cardiovascular system, the "culprits" of similar symptoms can be respiratory organs and gastrointestinal tract.

Pinched nerve in the right scapula

Often right-sided impingement occurs when the spine is curved, especially with scoliosis or regular incorrect positioning during work. In such a situation, the spinal musculature receives an uneven load. However, in many cases, we are talking about more serious pathologies - in particular, the displacement of intervertebral discs.

Another common cause of right-sided pain in the scapula is various diseases of the respiratory and digestive systems. In this situation, the pain does not appear directly in the scapular region, but irradiates from other organs and innervated areas. Such situations are particularly dangerous: the patient believes that he or she has a pinched nerve in the scapula due to lifting heavy objects or incorrect posture, but in fact the real problem remains unnoticed and unresolved.

Like most diseases of the musculoskeletal system, pain in the scapula can be associated with obesity: the condition of such patients improves with normalization of body weight.

Pinched nerve in the back under the shoulder blade

Pain under the shoulder blade is not always a sign of a pinched nerve either. Meanwhile, it can indicate a variety of diseases of internal organs and musculoskeletal mechanism.

For example, common causes are considered to be:

• Intercostal neuralgia, which develops as a result of compression of the intercostal nerves, and the provoking factor is often osteochondrosis;
• pathologies of internal organs, including gastritis, gastric and 12-acid ulcers, liver cirrhosis, hepatitis, spleen diseases, myocardial infarction, pulmonary disorders.

Shingling pain under the shoulder blades may indicate the development of pancreatitis, and right-sided pain radiating not only to the scapular bone, but also to the shoulder and neck, is a sign of acute cholecystitis or hepatic colic (in colic, nausea and vomiting are also present at the same time).

In any of the above cases, it is better to visit a doctor and undergo an examination to avoid the development of adverse effects and complications.

Complications and consequences

Pinched nerve in the scapula is rarely complicated by other pathologies. Only in rare cases, untreated, neglected, complex form of the disease leads to the development of dangerous complications:

• the pinched nerve dies;
• paralysis of the affected limb;
• disruption of trophics of innervated internal organs;
• Spinal instability (thoracic spine);
• aggravation of pain syndrome, lack of response to the use of analgesic procedures;
• disorders of the cardiovascular system, central nervous system (appearance of neuroses, insomnia);
• exacerbation of chronic cardiovascular, pulmonary or digestive diseases.

These complications are noted only in rare cases, if the duration of nerve entrapment in the scapula is more than 3 months. For most patients, even recurrent impingement has a relatively favorable prognosis, although each subsequent recurrence may be somewhat more severe and prolonged.

Diagnostics of the pinched nerve in the scapula

Diagnosis of a pinched nerve in the scapula requires a full-dimensional examination of the patient. The specialist needs to find out what caused the compression of the nerve, at what level it occurred. For this purpose, the following diagnostic techniques are used:

• collection of anamnesis, listening to the patient's complaints with assessment of the nature of pain, its intensity, identification of additional pathologic symptoms;
• clarification of the time of pathology start, search for possible connection of the disorder with chronic diseases or traumas;
• external examination with assessment of reflex capabilities, condition of the spinal column;
• palpation of the affected area, identifying the most painful, swollen, spasmodic areas;
• instrumental diagnostics in the form of X-rays, CT or MRI of the cervicothoracic and thoracic spine to determine the symptoms of osteochondrosis, protrusion or herniation of intervertebral discs, narrowing of the spinal canal;
• Ultrasound of the affected area to detect muscle spasms;
• duplex scanning of the upper extremity vessels to assess the likelihood of blood flow disorders, deformity, narrowing of the lumen of arterial or venous vessels, to exclude a vascular cause of pinched nerve in the scapula.

If indicated, it is possible to appoint laboratory tests in the form of a general blood and urine analysis, biochemical analysis of blood.

If the pinched nerve in the scapula appeared against the background of pathology of the cardiovascular or respiratory system, then an additional consultation with a cardiologist, pulmonologist, as well as appropriate examinations (ultrasound, smears, sputum culture, etc.) is required.

Differential diagnosis

Pain simulating a pinched nerve in the scapula can also occur for other reasons, including non-vertebrogenic. It can be vascular lesions, neurological diseases, pathologies from internal organs with pain irradiation.

Conditions that can cause such irradiating pain include:

• Rheumatic pathologies associated with immune disorders, joint and vascular damage;
• diseases of the digestive tract (pancreatitis, cholecystitis, 12-prong ulcer);
• cardiovascular pathologies (myocardial infarction, ischemic heart disease);
• infectious pathologies (herpes, tuberculosis);
• diseases of the respiratory system (inflammation of the lungs).

Doctors distinguish characteristic signs that indicate that the pain is not caused by a pinched nerve in the scapula, but by diseases that have nothing to do with the spine:

• The onset of pain during childhood and adolescence;
• Lack of pain relief at rest, while lying down, in a certain posture;
• a gradual increase in pain syndrome;
• the presence of oncopathologies in the anamnestic data;
• The appearance of pain on the background of hyperthermia, cachexia;
• presence of signs of spinal lesions (paralysis, sensory disturbances);
• obvious abnormalities detected by blood, urine.

It is equally important to distinguish muscle pain syndrome (myositis) from vertebrogenic pain, which occurs as a result of disorders of the musculoskeletal and nervous system of the spinal column. Myositis is accompanied by a dull pain that increases during pressure on the muscles and does not go away at rest.

Skeletal pain is more often shooting pain, involving several muscles of the back, increasing with exertion and subsiding at rest, with limitation of spinal mobility.

The main instrumental examination for patients with osteochondrosis is radiography, which helps to detect narrowing of the intervertebral gap, the presence of osteophytes, degenerative processes in the vertebrae, herniated discs. In addition, radiography can diagnose vertebral fractures caused by osteoporosis, tumor metastases, etc.

Magnetic resonance imaging is prescribed to diagnose radicular pain.

Treatment of the pinched nerve in the scapula

Treatment of pinched nerve in the scapula is carried out using a comprehensive approach: combine drug therapy, physiotherapy, massage, physical therapy, physical therapy, etc.

Depending on the intensity of symptoms, medications from the following categories may be prescribed:

• Analgesics and non-steroidal anti-inflammatory drugs such as Ketanov, Diclofenac, Meloxicam, Nimesulide inhibit the development of inflammatory reaction and relieve pain. These drugs can be used in the form of tablets or injections, as well as external ointments and gels.
• Anesthetic agents (Novocaine, Lidocaine) reduce the sensitivity of pain receptors, so they are used for local action (applicator application, compresses, patches), as well as for electrophoresis or phonophoresis procedures.
• Corticosteroid drugs based on dexamethasone, hydrocortisone, prednisolone stop the development of the inflammatory process, eliminate tissue edema. They can be used in the absence of effect from analgesics and non-steroidal anti-inflammatory drugs.
• Myorelaxants (e.g., Midocalm) eliminate muscle spasm by stopping nerve compression in the scapula.
• B vitamins (e.g., Neuromultivit, Milgamma) improve nerve conduction, quickly relieve numbness, excessive sensitivity and other painful symptoms.

In complex cases and with intense pain syndrome, a paravertebral blockade is indicated, which consists in injecting an anesthetic or corticosteroid drug directly into the periorbital structures. Such an injection can be a single or multiple injections, which depends on the specifics of the pathology. Most often Novocaine, Lidocaine, Dexamethasone, Diprospan, or vitamin _B12 are used for blockade.

In addition to drug therapy, supportive treatment is prescribed:

• physiotherapy procedures such as magnetotherapy, laser therapy, phono and electrophoresis, UHF and other methods to relieve spasm, improve tissue trophism, enhance the effect of anti-inflammatory drugs;
• Massage - used after the elimination of acute pain, relaxes the muscles, prevents recurrence of pinched nerve in the scapula;
• acupuncture - involves exposure to bioactive points using special needles or finger pressure;
• Therapeutic exercise - prescribed after the acute period of the disorder to strengthen the musculature, increasing the endurance of the body.

Additionally recommended spa treatment, mud treatment and other balneological procedures.

Surgical intervention for pinched nerve in the scapula is very rarely prescribed. Indications for surgery may be voluminous neoplasms in the affected area (tumor processes, abscesses), or advanced forms of osteochondrosis, in which conservative therapy is ineffective.

Medicines that your doctor can prescribe

Diclofenac	Tablets are taken in 100-150 mg/day, in 2-3 doses. Injection (intramuscular) the drug is administered by 1 ampoule daily, for 2-3 days. Longer use is undesirable due to the negative effect of the drug on the gastrointestinal tract.
Meloxicam	The daily dosage for internal administration ranges from 7.5 to 15 mg. Possible side effects: dyspepsia, abdominal pain, bloating, constipation, headache. The drug is administered with caution to people who have been treated for gastric or 12-rectal ulcers, as well as to patients taking anticoagulants.
Midocalm	It is taken orally after meals, without chewing, in a daily amount of 150-450 mg, divided into three doses. Among the side effects, the most frequently reported are skin rashes, general weakness, dyspeptic disorders. The drug is prescribed with caution if the patient has hypersensitivity to lidocaine.
Nimesulide	It is taken orally at 100 mg twice a day, drinking enough water. If there are any digestive pathologies, the drug is taken after meals. Patients with chronic renal failure should not take Nimesulide in an amount of more than 100 mg per day. In general, the duration of treatment for all categories of patients should not exceed 2 weeks.
Milgamma	Injections are carried out intramuscularly deep 2 ml daily for one week. Further injections are performed every other day for 2-3 weeks, or switch to taking the tablet form of the drug Milgamma Compositum. Side effects rarely develop. Among the contraindications: pregnancy and lactation, tendency to allergies, decompensation of cardiac activity.

Prevention

Since a pinched nerve in the scapula is an extremely unpleasant condition that sharply limits a person's ability to work, it is better to prevent it in advance. Experts-vertebrologists and neurologists advise to heed the following recommendations:

• do not lift or carry heavy objects, avoid physical overexertion;
• adhere to a healthy lifestyle, provide a nutritious, quality and varied diet, be physically active (moderate, thoughtful physical activity is preferable);
• observing breaks in case of prolonged stay in forced postures, prolonged sitting or standing, and vibration;
• avoiding hypothermia, drafts;
• maintaining proper posture.

A pinched nerve in the scapula is a common and familiar problem for many people. Lifting a heavy bag, an awkward turn, a sudden movement can lead to severe pain and stiffness. Most often it is enough to rest the back and limbs for a few days, so that the pain syndrome recedes. However, if the pinching continues to bother you or the pain increases, you should immediately consult a specialist.

Forecast

The prognosis of pinched nerve in the scapula is most often favorable. In many patients, the disorder resolves on its own within a few days (usually 3-4 days). In more complex cases with appropriate medication and physiotherapeutic treatment, the problem is overcome in 2-3 weeks. There is no need for surgical intervention in the vast majority of cases.

In general, the outcome of the pathology depends largely on the root cause of the disorder. In cases where it is possible to eliminate the cause by medication or other means, then the prognosis for recovery is considered positive. If the nerve is affected by pathological processes, requires time and effort to recover even after the elimination of the root cause, then in such cases a favorable outcome is questionable. Genetic and anatomically inherited pinching of the nerve in the scapula is impossible to prevent. Severe nerve fiber injuries do not regenerate.