Pterygoid scapula and back pain

Pterygoid scapula syndrome is a rare cause of musculoskeletal pain in the shoulder and posterior thoracic wall. The pterygoid paralysis caused by the pterygoid scapular syndrome begins as a painless weakness in the muscle with the pathognomonic shape of the scapula developing at the same time.

Muscle pain occurs as a result of a secondary impairment of function due to paralysis of this muscle. In the beginning, the pterygoid shoulder syndrome is often mistaken for stretching the muscles of the shoulder group and the posterior thoracic wall, since the onset of the syndrome is often associated with severe stress, often with the wearing of a heavy backpack. At the same time, there may exist tunnel suprapatant neuropathy.

The development of the pterygoid shoulder syndrome often causes trauma to the long thoracic nerve of Bel. The nerve is formed from 5, 6, 7th cervical nerves, it should be borne in mind the possibility of its damage during stretching and direct injuries. The nerve is also often damaged by resection of the first rib with the syndrome of the upper thoracic outlet. Damage to the brachial plexus or cervical roots can also cause the pterygoid scapula, but often in combination with other neurological symptoms.

Pain in the pterygoid scapular syndrome is aching in nature, localized in the muscular mass of the posterior thoracic wall and scapula. Pain can extend to the shoulder and upper arm. The intensity of pain from mild to moderate, but can cause a significant limitation of the function, which, without treatment, continues to strengthen the muscle component of pain.

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Symptoms of the pterygoid syndrome

Despite the mechanism of damage to the long thoracic nerve of Bel, a common clinical sign of the syndrome of the pterygoid scapula is the paralysis of the scapula due to weakness of the anterior dentate muscle. Pain usually develops after the onset of sudden muscle weakness, but is often erroneously attributed to overexertion during excessive stress. At physical examination, a restriction of extension to the last 30 degrees in the upper part of the arm and a violation of the shoulder-shoulder rhythm are detected.

Pterygoids are easy to detect, while the patient presses against the wall with arms outstretched, being behind his back. Other neurologic symptoms should be within normal limits.

Examination Ambiguity and confusion around the clinical syndrome determines the importance of the examination to confirm the diagnosis. Electromyography helps to distinguish the isolated lesion of the long thoracic nerve associated with the pterygoid scapula and shoulder radiculopathy. A review radiography is shown to all patients with pterygoid scapular syndrome to exclude a hidden pathology of bones. Additional clinical studies can be shown that include a general blood test for uric acid, ESR, antinuclear antibodies. MRI of the brachial plexus or cervical spinal cord can be indicated if the patient exhibits other neurological deficits.

Differential diagnosis Damage to the cervical spinal cord, brachial plexus and cervical nerve roots can cause clinical symptoms, including the pterygoid scapula. Such lesions always cause other neurological symptoms, which in any case help the clinician to distinguish such pathological conditions from isolated clinical signs observed in the syndrome of the scapular scapula. The pathology of the shoulder blade or shoulder area can make the clinical diagnosis more difficult.

Treatment of pterygoid syndrome

There is no specific treatment for pterygoid scapular syndrome, except to prevent the causes of nerve compression (wearing heavy backpacks or swelling of the nerve) and wearing orthopedic devices to stabilize the shoulder blade and normal functioning of the shoulder. Pain management and function limitations associated with pterygoid scapula syndrome should be initiated with a combination of NSAIDs (eg diclofenac, lornoxicam) and physiotherapy. Local thermal and cold applications can also be effective. Avoid repetitive movements or movements that cause the syndrome.

Side effects and complications

The main complications associated with the pterygoid scapular syndrome can be divided into 2 categories: shoulder damage due to function limitation associated with the syndrome and failure to recognize that the cause of the pterygoid scapula is not the isolated lesion of the long thoracic nerve but another, more significant, neurological problem .

The pterygoid syndrome is a separate clinical unit that is difficult to treat. Early elimination of the cause of nerve compression should lead to the restoration of nerve function and as a result of pain relief and restoration of shoulder function. Before attributing the neurological symptoms of pterygoid scapular syndrome, it is necessary to carefully investigate other possible causes.