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Nerve Entrapment Leading to Shoulder Blade Discomfort

Do you ever feel discomfort on the inside of the shoulder blade? There can be many causes of pain on the inside of the shoulder blade but one that often can be missed is entrapment of the Dorsal Scapular nerve.

The Dorsal Scapular Nerve Exits C5 as part of the brachial plexus and innervates the Rhomboids and Levator Scapula.

What are symptoms of Dorsal Scapular Nerve Entrapment?

  • Pain along medial border of Scapula

  • Atrophy of the rhomboids and levator muscles

  • Tight neck muscles

  • Winged Scapulas

Muscles innervated by Dorsal Scapular Nerve
Dorsal Scapular Nerve Inneravation

Root Cause of this Issue

This nerve can commonly get impinged as part of a larger problem of the vertebral segments not moving properly but more commonly can occur when someone exhibits problems with the anterior and posterior scalenes.

Dorsal Scapular Nerve Impingment
Nerve Impingment by Scalenes

When the scalenes become too tight, or neurologically speaking what we call Hypertonic, these muscles can pinch down and decrease conductivity of the dorsal scapular nerve and any veins/arteries that also pass though this area.

Positionally dysfunctional:

If someone has an overhead job like a painter or electrician this can occur positionally with the arms above the head. This means symptoms may only occur when the arms reach above the head.

Muscles of the neck
Anatomy of Neck and Brachial Plexus

How can you relieve the nerves of this entrapment?

The first test to see if there is nerve entrapment is simply test the muscles. If the body can utilize the rhomboids and levator scapula without compensating then there is no nerve entrapment since there is conductivity to the muscle. This means the problem is being caused by something else. Remember that this can be positionally based though so you may have to experiment with the neck, sacrum (seated vs standing) and see if the problems come out that way.

Massage Only Method:

Try massaging the middle/posterior scalenes to help relieve tension and create more space for the muscles. After working on them go back and retest the rhomboids and levator scapula and see if they are back online. If so the client will likely want to work on massaging the neck muscles followed by muscle strengthening (thereby strengthening the nerve connection) of the rhomboids/levator scapula.

Neck Massage

Level Up Approach using: P-DTR, Massage, and Photobiomodulation

Unloading: If the rhomboids and levator scapula are weak then you can try putting the neck into different positions and see if it brings the neck back online as it may temporarily relieve. This helps us to know if the neck is the contributing factor for the muscles innervated by the dorsal scapular nerve.

Next we can use P-DTR to help relieve the hypertonicity of the muscles causing the entrapment. Be sure to check the rhomboids and levator in a variety of positions to ensure that the muscles are operating properly in the clients daily life.

Follow with massage therapy and photobiomodulation over the neck to help the scalenes recover more efficiently and bring in proper blood-flow. follow with corrective exercise of the rhomboids to help strengthen the nerve connection to the muscles.

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