The most common nerves to be pinched in your shoulder blade are the upper and lower subscapular nerves, dorsal scapular nerves, and the long thoracic nerve.
Pinching is the same thing as compression and can often be blamed for numbness, tingling, and weakness that occurs at the shoulder blade.
Not all compression causes nerve issues as each individual’s body is different and responds to these compressive forces uniquely.
In this article we will discuss which nerve might be compressed, what could have caused that, and a few things you can do about it. For extensive rehab suggestions for shoulder blade pain, I would recommend reading this article if you’re having a sharp type of pain that you haven’t been able to shake or this one detailing how to do it quickly.
- If you have weakness, numbness, or tingling you’ll want to check with your doctor or physical therapist ASAP.
- If you are primarily having pain but no associated weakness, then you likely will benefit from a rehabilitation program
- Trauma, disc herniations, and disc degeneration or osteoarthritis are some of the most common causes of nerve compression
- Scapular winging is the most common with dorsal scapular and long thoracic nerve injuries
- Common symptoms of nerve compression are numbness, tingling, weakness, and pain. All of these can be present or only one can be present.
Which nerve could be compressed?
Below, I’m going to share what symptoms you might experience that could be different with different nerves being compressed. Remember, not all compression causes symptoms, and just because it is compressed doesn’t mean that symptoms can’t get better with some basic rehabilitation movements and other interventions.
Upper and Lower Subscapular Nerve
These nerves innervate the subscapularis muscle providing it with the electrical “juice,” to perform its actions.
If this nerve is damaged, you may have trouble internally rotating your shoulder and you may experience some winging of your scapula. It’s not a slam dunk that you’ll have winging though, as you have many other muscles that are involved in controlling protraction, retraction, and all other motions of your scapula.
This is not a sensory nerve so you wouldn’t necessarily experience any numbness or tingling with this issue. Unilateral weakness would be the primary finding.
Dorsal Scapular Nerve
The dorsal scapular nerve innervates the levator scapulae and the rhomboid muscles. Both of these muscles assist with stabilizing the shoulder blade and assist with rotation.
If this nerve is damaged the following may occur:
“Dorsal scapular nerve syndrome can be caused by nerve compression syndrome. A winged scapula is the most common symptom. Shoulder pain may occur. It causes weakness in rhomboid major muscle, rhomboid minor muscle, and levator scapulae muscle. The range of motion of the shoulder may be limited. Treatment is usually conservative.” (source – wikipedia)
Long Thoracic Nerve
The long thoracic nerve innervates the serratus anterior muscle and runs along the lateral aspect (side) of the thorax or upper trunk.
If this nerve is damaged you can also experience a winged scapula and have great difficulty doing push-ups (if you were already able to do them).
Protraction of the scapula becomes nearly impossible as this the serratus anterior is the primary mover for this motion.
You may also have pain, numbness, and tingling around the shoulder blade with this condition in addition to motor control issues.
What Can Cause Nerve Compression and/or Damage Between the Shoulder Blades?
Below I will discuss a few different causes of compression and or damage of the nerves that can affect how your shoulder blade functions.
This one is pretty clear. If you’ve experienced trauma like a car accident, fall, or some other blunt force trauma or laceration (deep cut), it’s possible you could have experienced a nerve injury.
Generally, after any trauma, you will head to the hospital where you’ll be evaluated. The only problem is that if you had a larger injury somewhere else, like a broken femur or neck or something like that, it’s very possible (and common) that they missed a different injury that occurred.
This is normal as they were trying to save your life vs. prevent shoulder blade pain.
In any case, if there was trauma you’ll want to work with a healthcare professional to help you through this process of rehabbing.
Cervical disc herniations are much more common than thoracic disc herniations.
Cervical disc herniations would produce more of the motor weakness that you could experience as much of the shoulder blade muscles are innervated by the cervical nerve roots and the brachial plexus.
If you have a thoracic disc herniation this would likely produce more sensation loss and numbness than weakness.
Keep in mind that it is possible to have asymptomatic (no symptoms) disc herniations as well.
Osteoarthritis or Disc degeneration
As we get older and also depending on our genetics, we will experience osteoarthritis and disc degeneration. It’s inevitable.
While many people do have these structural changes and have symptoms, many people also have these structural changes WITHOUT symptoms.
This is why it’s so important to consult with your healthcare provider and to make sure they do a detailed physical exam to see if this is causative or not.
In most cases it’s very difficult, if not impossible, to determine what the exact cause of pain or discomfort.
It’s a little bit easier to determine where weakness or numbness is coming from as we know that certain nerves innervate certain muscles and skin.
When it comes to diagnosis, prognosis, and treatment options, the thing that matters most is not what specific tissue is affected (when related to pain), but what movements and interventions help you to feel better.
If it’s nerve damage that is causing numbness, tingling, and weakness then this may need to be addressed in other manners that require more medical involvement including medications and other methods.
What should you do if you have nerve compression affecting your strength and causing pain?
It’s important that if this has been going on for longer than a week or two without resolving on its own to set up an appointment with your physician or physical therapist.
My recommendation (biased) is to see a physical therapist first as we are the experts when it comes to screening and treatment options for musculoskeletal rehab.
I always recommend (almost always), that you try non-surgical, conservative treatment methods first as even with nerve compression it is possible to get back to normal.
If you want to try to give it a go on your own I recommend going through the exercises that I’ve detailed in this article about shoulder blade pain.
However, if you are having severe weakness, scapular winging (shoulder blade is sticking out), or pain that is horrible and not getting better I recommend that instead of reading that article you get seen immediately by a healthcare professional.
I hope this helps!