Suprascapular Neuropathy: An Overlooked Cause Of Superior Shoulder Pain And Weakness
This article highlights a commonly missed diagnosis: suprascapular neuropathy. The condition accounts for approximately 2-4% of all shoulder pain but is present in up to 8% of patients with a full-thickness rotator cuff tear. Check out the following quick synopsis for up-to-date assessment and management considerations.
Introduction & Etiology
The suprascapular nerve arises from branches of the C5 and C6 spinal nerve roots, with a variable contribution from C4. The suprascapular nerve innervates the supraspinatus and infraspinatus muscles, providing shoulder abduction and external rotation, respectively. The suprascapular nerve supplies sensation to several shoulder structures, including the coracohumeral ligament, coracoacromial ligament, subacromial bursa, acromioclavicular joint, and glenohumeral joint. While early anatomical studies did not recognize a cutaneous branch, more recent dissections have identified sensory innervation to the lateral deltoid region.
Clinical evaluation may demonstrate tenderness to palpation over the suprascapular notch, i.e., deep and posterior to the AC joint, between the spine of the scapula and clavicle. Range of motion testing may demonstrate weakness upon resisted shoulder abduction and/or external rotation . Chronic cases may demonstrate palpable atrophy of the supraspinatus or infraspinatus muscles. Check out this demonstration of isolated strength testing for each rotator cuff muscle.
Shoulder Weakness When Lifting Your Arm To The Side Supraspinatus Muscle Test
This video shows you how to test for shoulder weakness in your rotator cuff supraspinatus muscle. The supraspinatus is the most common injured muscle of the rotator cuff. If you have pain lifting your arm to the side, overhead, or reaching out to grab something, the supraspinatus may be the affected muscle.
Shoulder Weakness When Rotating Your Arm Backwards Infraspinatus Muscle Test
This video will show you how to test your Infraspinatus rotator cuff muscle If your infraspinatus muscle is painful, you may have discomfort on your shoulder blade and in the back of your shoulder. If the infraspinatus muscle is weak, you may feel weakness when reaching behind your head or winding up to throw a football.
Shoulder Weakness When Rotating Your Arm Inwards Teres Minor Muscle Test
This video will show you how to look for weakness in the Teres Minor If this muscle is affected you may have pain in the back of your shoulder and at the outside edge of your scapula. If you have weakness, you may feel it when reaching across to touch the opposite shoulder or reaching behind you to touch your lower back.
When Might Nerve Injury Be The Source Of Your Shoulder Pain And Weakness
Sometimes the root cause of shoulder pain is not in the shoulder. In fact one of the more common conditions that causes shoulder weakness is a pinched nerve in the neck.
It is not uncommon for me to see patients who are mistakenly referred for a “shoulder problem” when in reality the problem is coming from their neck.
How Do You Know If A Nerve Injury Is Causing Your Shoulder Weakness
Injury can occur anywhere along the course of the nerve fibers from your spine to the tips of your fingers. A thorough history and physical performed by a knowledgeable specialist will help you better determine whether nerve damage is causing your weakness. A meticulous investigation is sometimes necessary to pinpoint where it may be.
Sometimes a physician will order a test called an EMG to determine whether you have had nerve damage. The EMG can help pinpoint nerve damage and nerve recovery. There are 2 catches to the test: 1) to get the best results, you should have the test performed by a doctor that performs them often 2) the test can be uncomfortable. It involves placing tiny needles into individual muscles in your arm and sending mild currents through them. I’ve had one myself and while I did not find it that painful, I did find it “strange” feeling.
What Can Cause Sharp Pain In Your Neck And Shoulder When Breathing
A couple of conditions can cause pain in the neck and/or shoulder when you take a deep breath, including:
- Pleurisy : Symptoms include sudden chest pain that may be felt only while coughing or breathing deeply, fever, cough, and shortness of breath.
- Pericarditis : Symptoms include rapid-onset stabbing chest pain, possibly pain in the shoulder, fever, weakness, and trouble breathing. It gets worse if you lie down or breathe deeply.
Pleurisy and pericarditis aren’t usually medical emergencies but you should treat any chest pain or breathing difficulty as an emergency until you know for sure what’s causing it.
Shoulder Weakness When Pressing Back Subscapularis Muscle Test
This video will show you how to test the subscapularis shoulder muscle Typically this will produce pain underneath the shoulder blade or in the armpit. If you’re reaching back like when putting your seatbelt on or reaching into the back of the car you may notice weakness in this rotator cuff muscle.
Is Your Shoulder Pain Related To Your Numb Hands Or Fingers
n some people, shoulder pain may be a symptom of a nerve being pinched where it originates in the upper spine. ReadBlood and Nerve Supply of the Shoulder
Consider these conditions:
A pinched nerve, also called cervical radiculopathy, can result in shoulder pain, along with numbness and weakness in your arm and hand.1 Some patients describe the numbing sensation in their hands and fingers as “pins and needles.” A pinched nerve can occur when a nerve in the neck is squeezed or aggravated.1>
Brachial plexus injuries can cause shoulder pain and numbness and weakness in your arm and hand, among other symptoms.2 The brachial plexus refers to a web of nerves that starts in your neck. It controls feeling and movement in your hand and arm.3,4
Thoracic outlet syndrome is a condition that may cause shoulder and neck pain, as well as numbness in your fingers.5 It occurs when blood vessels or nerves in your collarbone and first rib are squeezed.5
Most of us experience minor instances of shoulder pain and numbness from time to time, and occasionally these symptoms are the result of a more serious medical condition. When it comes to shoulder pain and hand numbness, there are many causes for your doctor to consider.
Some Shoulder Conditions May Become More Common As You Age
You probably don’t think about your shoulders much, until you suddenly experience pain in one of them. Shoulder pain can make a simple act — brushing and drying your hair, reaching behind your back to fasten a bra, or grabbing something overhead — seem like a monumental task.
As you age, you’re more likely to experience shoulder pain from a variety of common conditions. “Shoulder problems are very common,” says Dr. Arun Ramappa, associate professor of orthopedic surgery at Harvard Medical School. The pain can come on gradually or abruptly, and it may range from mild to excruciating.
Below are some of the most common conditions you may encounter, and some tips for how to address them.
What Causes Pain In Both Shoulders Your Symptoms Explained
Shoulder pain questionnaire
Causes of why both your shoulders hurt include strain and tension in the muscles from poor posture, overuse, or trauma from an injury that may also cause neck and shoulder pain. Read below for more information on causes and how to relieve shoulder pain on both arms.
How Might You Sustain A Nerve Injury Around The Shoulder
Nerve injury around the shoulder can be caused by trauma such as fractures, dislocations or blunt force. A history of trauma should prompt your doctor to remain aware for signs of nerve damage. Numbness, unusual weakness or electric shock-type pain might be a sign of nerve damage.
Not all nerve damage follows trauma. Some disorders such as “brachial neuritis” may occur without warning. “Brachial neuritis” or inflammation around the brachial plexus may present as pain alone or with weakness.
While rare, nerve injury from surgery can happen as well. Typically nerve injuries, even from surgery are stretch-type injuries and often recover on their own. Of course, prevention is always the best medicine. Employing a surgeon who is knowledgeable of the anatomy is critical. Repeat surgeries are often more high risk than first time surgeries because of the difficulty of dissecting through scar tissue, so if you are considering repeat surgery you want to remain especially conscious of this.
Things That Can Cause Pain Between Your Shoulder Blades
Whether it’s a dull ache or sharp spasm, pain between the shoulder blades can be a caused by a variety of things. It can be due to bad posture while staring at a computer screen all day, an exercise mishap, or an overuse injury.
Sometimes referred to as scapular pain—scapula is another name for your shoulder blade—it’s a common problem. According to a paper published in the Pain Research and Management, chronic shoulder pain affects about 19 percent of Canadian adults, with one half of those reporting chronic pain suffering for more than 10 years.
Here’s how to recognize this discomfort, know how to address it, and understand when to see a doctor.
Possible Reasons Behind Your Shoulder Pain And Weakness
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Shoulder pain and weakness happens more often than you might realize. In fact, somewhere between 4 and 26% of people experience shoulder pain in their lifetimes.
If you’re struggling with shoulder pain, it can impact your entire quality of life. Not knowing the root of your problem could cause it to persist. Instead, it can help to understand a few common causes that lead to shoulder pain.
Keep reading to discover the top five possible reasons behind your persisting shoulder pain.
What Shoulder Problems Can Cause Rotator Cuff Weakness
Most causes of shoulder weakness and pain aren’t traumatic and develop over time. You’re probably familiar with the big causes of weakness but less familiar with other causes. Here’s a list of the most common causes of shoulder weakness, keep in mind that it’s not an exhaustive list.
- Rotator cuff tendinitis or tendinosis
- Partial tears of the rotator cuff muscles
- Complete tears of the rotator cuff muscles
- Impingement syndrome of the supraspinatus muscle
- Scapular dyskinesia and poor shoulder movement patterns
- Moderate to severe shoulder arthritis
- Adhesive capsulitis
How To Test For Shoulder Weakness In The Rotator Cuff
Testing for rotator cuff weakness is an important part of identifying what’s wrong with your shoulder, and I’m going to show you how to do that here. But first, let’s do a quick review of the rotator cuff.
Your rotator cuff is made up of 4 muscles, easily remembered with the acronym SITS: Supraspinatus, Infraspinatus, Teres Minor, and Subscapularis.
The job of the rotator cuff is the stabilize the glenohumeral joint and normal rotator cuff muscles should be strong and your shoulder should feel supported.
To test your own rotator cuff muscle strength, you’re actually going to need one other person. It’s a fairly simple process in which your helper will be pushing your arm in one way while you’re resisting their pressure in the other direction. If you’re unable to resist at all, or maybe can’t provide the same resistance compared to the other shoulder you have weakness in that rotator cuff muscle.
It’s always a good idea to test your good shoulder so you can compare it to your suspected weak shoulder. Also, keep in mind that you may have pain or weakness in multiple muscles of the rotator cuff, this is not uncommon.
Maybe you’re not sure you have shoulder weakness but ARE sure you have shoulder tightness. Check out my content –>Dry Needling for Shoulder Tightness
If your rotator cuff IS weak, you may have a shoulder labrum tear Here’s some content I wrote about how to figure out if you have a torn shoulder labrum –>
When A Weak Shoulder May Be A Sign Of Deeper Problems
Weakness is often pain’s evil twin. When your shoulder is painful, weakness usually follows. This makes sense. The more painful your shoulder is, the less you want to move it. The less you move any muscle, the more it shrinks. The more the muscle shrinks, the weaker you get.
Remember also that weakness is a symptom, not a cause. Symptoms can have many causes. Discerning the true cause of your weakness will likely require investigation.
Commonly, rotator cuff muscles weaken when you have shoulder tendinitis or bursitis. This is why we often prescribe physical therapy for these conditions.
One of the most common causes of structural weakness in the shoulder is a rotator cuff tear. “Structural” weakness implies a physical disruption in the mechanical fibers of the tissues. I describe rotator cuff tears elsewhere. But I will address a few things here on weakness in the rotator cuff about which people often ask.
Briefly, the rotator cuff muscles help keep the humerus centered in the socket and are important for rotating your shoulder as well as elevating your arm. A full detachment of the muscle from the bone can lead to atrophy and weakness.
The goal of surgery to fix a torn rotator cuff tendon is to halt the atrophy and strengthen the cuff muscles back to their original state. This is not always possible. But restoring the tendon back to its original position after a tear may give you the best chance at this.
Which Nerves Are Commonly Injured Around The Shoulder
Commonly injured nerves around the shoulder include the axillary nerve which supplies sensation and strength around your deltoid muscle, the suprascapular nerve which supplies your rotator cuff muscles and the long thoracic nerve which powers a muscle around your chest wall.
*Injuries to the axillary nerve or the whole brachial plexus are not uncommon after shoulder dislocation or severe fractures.
*Suprascapular nerve injuries may occur in conjunction with SLAP tears or cysts around the socket. If you have a suprascapular nerve injury you may notice pain or weakness in your rotator cuff muscles.
*Long thoracic nerve injuries are rare and can lead to “winging” of the scapula. Winging is a condition in which the shoulder blade elevates abnormally off of the torso and creates unnatural movement of the shoulder. There’s also something called “pseudo-winging” which looks like winging but is not from nerve damage. It results from abnormal adaptation of the shoulder blade due to pain or weakness in another area.
Most people find the thought of a nerve injury frightening. When they hear the term “nerve injury” they probably visualize a severed nerve. They have a general understanding that nerve injuries can be permanent.
It’s very rare to sustain a severed nerve. Most nerve injuries are stretch injuries or bruises and recover on their own without the need for surgery.
How Long Is Rehabilitation After Rotator Cuff Repair
Rehabilitation usually begins the first week after arthroscopic surgery or an open rotator cuff repair. It is very important to follow the program that the surgeon recommends. The physical therapist will demonstrate how to do the exercises to increase range of motion and to build muscle strength. A typical program might start with stretching and some minor strengthening exercises with rubber bands and light weights. It might take up to several months before strength is back to normal, but with hard work and adherence to the recommended program, in most cases a full recovery is likely.
What Treatments Are Available For Shoulder Weakness
If a patient reports that their shoulder feels weak, and a proper assessment confirms the presence of shoulder weakness, there are a number of treatment options their healthcare provider can recommend.
Of course, the suggested plan of action will differ depending on the severity of the presenting symptoms, so it is always best to consult with a healthcare professional before attempting to treat your weak shoulder in any way.
Shoulder weakness treatment options include:
- Resting the arm in a sling
- Applying hot and cold therapies
- Cortisone injections
- Shoulder replacement surgery
When Is Surgery Required To Treat Shoulder Weakness
As always, surgery is a last resort for treating medical conditions. Thus, a healthcare professional will likely recommend shoulder surgery when all other forms of treatment have failed to produce the desired results.
Some common signs that shoulder surgery may be necessary include:
- Pain continues to persist despite medicinal treatments like painkillers or cortisone shots
- An X-ray, ultrasound and/or MRI has shown a severe fracture, or the presence of bursitis or tendinitis
- A degenerative condition like arthritis has resulted in significant retrogression of the joints, cartilage, and/or bones
- Physiotherapy has failed to provide adequate relief
- Symptoms have persisted for longer than 6-12 months
Shoulder Weakness And How To Test Your Rotator Cuff
Shoulder weakness is probably the most concerning shoulder symptoms to have, and here I’m going to show you how to test your rotator cuff muscles on your own. Other symptoms and signs like shoulder pain, loss of range of motion, and loss of function are things you might notice as well, but testing your rotator cuff for muscle weakness will give you a good idea what’s wrong with your shoulder.
Since we’re all about providing value to patients and educating them on what’s going on in their body, in this content we’re going to:
- Show you how to test your own shoulder muscles for rotator cuff muscle weakness
- Explain different reasons shoulder muscles get weak
- Cover some of the shoulder problems that cause shoulder weakness
Things You Can Do If You Have Shoulder Impingement
- Avoid things that make the pain worse – avoid activities that involve repeatedly lifting your arm above your head for a few days or weeks. Ask a GP or physiotherapist when you can restart these activities.
- Do not stop moving your arm completely – try to carry on with your normal daily activities as much as possible so your shoulder does not become weak or stiff. It’s usually best to avoid using a sling.
- Gently hold an ice pack wrapped in a towel on your shoulder for 15 to 20 minutes a few times a day.
- Take painkillers – anti-inflammatory painkillers or paracetamol may help. A GP can prescribe stronger painkillers if needed.
Causes And Symptoms Of Right Shoulder And Arm Pain
If you have ever suffered with shoulder pain, you know it can range from simply annoying to severe, and it sometimes moves down your arm towards the elbow. Your shoulder joint is complicated, and pain can emanate from multiple problem areas. Let’s discover 7 causes and symptoms of right shoulder and arm pain…but there are many more.
Most Common Reasons You Cannot Lift Your Shoulder
Here are the most common reasons why you may not be able to move your arm. While there can be neurological reasons, like Parsonage-Turner Syndrome, most of you cannot move the arm or shoulder because of pain. The most common causes of shoulder pain and loss of motion are:
- rotator cuff tendonitis
- calcific tendonitis
- adhesive capsulitis or a frozen shoulder
The cause of your shoulder pain and the reason why it hurts will vary by age. Some problems are more common in different age groups. In younger athletes, tendonitis, or inflammation of the rotator cuff is more common.
Let’s run through each of these individually.
Common Characteristics Of Pain In Both Shoulders
If you are experiencing pain in both shoulders, it can likely present with:
- Shoulder pain, heat, and redness over the joints
- Pain that is deep, aching, and/or burning
- Pressure or tightness in both shoulders and both arms: Especially when walking or otherwise exercising
- Pain with tingling in the arm and hand
Weakness In One Upper Arm Treatments And Relief
Treatment for weakness in the upper arm is largely focused on physical rehabilitation and therapy. Some causes of upper arm weakness discussed above may require specific treatments, such as antibiotics for certain infections or steroids for inflammation. However, once the upper arm weakness results, treatment must be based on physical therapy in order to restore strength, function, and mobility to the arm.
Types Of Deltoid Muscle Pain And Their Symptoms
There are three different grades of deltoid pain, ranging from one to three. The deltoid pain is classified according to the severity of the injury.
Grade 1: At this level, there is mild tightness and pain in the shoulders. Individuals can still utilize their shoulders for movement and activities. There is minimal swelling of the deltoid muscle. Lifting the arm up, sideways, or front and back of body will not be much painful.
Grade 2: Major injury to the deltoid muscle is the indicator of this level. A partial rupture could be present in the tissue. Individuals experience increased pain and complications using their shoulders; for example, a person may not be able to do a press up. Swelling in the deltoid region might be noticeable. Lifting and moving the arm in different directions as well as pressing up creates a significant amount of pain.
Grade 3: A complete rupture is most likely in the case of level three pain. Severe pain is known, and individuals cannot use their shoulders. Significant swelling of the deltoid is also present, and a bulge or gap in the muscle might be noticeable. An individual can expect to be out of athletics or activities for up to 12 weeks.
Shoulder Pain Without Injury: 6 Common Causes
Joshua M. Zimmerman, M.D. contributes to topics such as Orthopedics.
Your shoulder is killing you, but you can’t think of anything you did to make it hurt.
…I didn’t fall.
…I didn’t get into a fight.
…I didn’t go all out at the gym.
Well, there are several conditions that cause discomfort but aren’t caused by a traumatic activity. How can you identify what’s wrong and how to make your shoulder feel better?
Joshua Zimmerman, M.D., an orthopedic surgeon with Hackensack Meridian Health Medical Group, helps by sharing six of the most common causes of shoulder pain without injury that he sees in his patients regularly.
What Are The Symptoms Of Shoulder Problems
Shoulder pain may be only in 1 area. Or it may spread to areas around the shoulder or down the arm. The location and type of symptoms depend on the injury or the location of the inflammation. Below are symptoms of some common shoulder problems.
A rotator cuff injury will often cause pain in the front or outside of the shoulder. The pain gets worse when you raise your arm or try to lift an object over your head. Rotator cuff pain can be severe. It can make even simple tasks impossible and wake you up at night.
If you have shoulder instability, pain can start suddenly, for example, just as you throw a ball. You may have numbness all the way down your arm. If the instability happens slowly, you may have mild pain only at certain times. Your shoulder might feel weak, sore when you move it, or “loose” in your joint. Shoulder instability is different than a shoulder dislocation.
The symptoms of a dislocated shoulder include intense pain, inability to move the joint, a visibly out of place shoulder, and swelling or bruising. The dislocation can cause numbness, tingling, or weakness near the injury or down your arm. A dislocated shoulder requires immediate medical care.
If shoulder pain is caused by inflammation, such as bursitis, it may feel stiff, achy, and hurt more when you move it. Sometimes it can look swollen or red.