Spinal Root Irritation
It is uncommon for shoulder pain to be caused by nerve irritation.
However, a suprascapular nerve can become entrapped and can
cause weakness or an inability to flex, abduct and externally rotate the shoulder.
Compression of a nerve(s) in the cervical spine (neck) can cause a radiating
pain in the arm or shoulder, making shoulder motion painful. Minor cases of
nerve entrapment may respond to a course of physical therapy and anti-inflammatory
medication. Patients generally respond well to moist heat on the affected area.
If symptoms persist or worsen, a physician may order electromyography (EMG)
or a magnetic resonance image (MRI) of the cervical spine. The EMG will help
assess neuromuscular activity.
The nerve root is a peripheral extension of the central nervous system (CNS)
that exits the spinal canal and terminates in the extremities. Its purpose
is to transmit sensory information from the extremity to the brain and motor
commands from the brain to the extremity.
Nerve root irritation is when some structure puts pressure upon the nerve
root either in the form of a tumor, a fracture, arthritis, a congenital deformation,
or herniated disc, a stenotic canal (narrowed spinal canal) or several other
diagnoses.
Symptoms include pain, numbness, tingling and weakness. The
diagnosis is made through a neurologic exam and confirmed through the use of
an MRI (magnetic resonance image), EMG (electromyography), a discogram (when
normal saline is injected into a disc to expand it and determine if this recreates
pain) or CT myelogram. An EMG is an electrical test which determines the ability
of a nerve to conduct an electrical charge. A myelogram is an injection of
contrast material (dye) into the cerebral spinal fluid (CSF) which occurs in
the sac surrounding the spinal cord.
Treatment may include a short period of rest (24-72 hours), anti-inflammatory
medications, bracing and a gradual return to exercise. Steroid injections into
the spinal canal may be helpful. Often, a back stabilization exercise program
is extremely helpful to the patient.
