A “pinched nerve” is the common term for radiculopathy, a condition where a nerve root is compressed or irritated. This compression typically happens when surrounding tissues, such as bone, cartilage, muscle, or tendon, exert pressure on the nerve. While the term suggests an issue at the site of the pain, discomfort felt in the shoulder blade is often a symptom of nerve compression originating elsewhere. It is entirely possible to feel sharp, aching, or burning pain in the scapular region because of a nerve compressed at its root in the neck. This phenomenon, where the source of the compression is distant from where the pain is perceived, is a defining characteristic of this condition.
The Anatomical Connection: Referred Pain to the Shoulder Blade
The pain felt around the shoulder blade, or scapula, is frequently a form of referred pain, meaning the actual injury site is located somewhere else along the nerve’s pathway. The spinal nerves that control sensation and movement in the shoulder blade and arm originate in the cervical spine, or neck. Specifically, the nerve roots exiting the cervical vertebrae (C5, C6, C7, and C8) are responsible for the function of the upper extremities and the area around the shoulder blade. When a nerve root in the neck is irritated or compressed, the brain interprets the resulting signals as coming from the nerve’s entire distribution area, including the shoulder blade. This is why discomfort is often felt deeply beneath the scapula, even though the source of the pressure is in the neck.
The location of the compression is most often where the nerve root exits the spinal column, a small opening called the foramen. Pressure on these nerve roots disrupts their normal signaling, leading to the varied symptoms felt far from the neck. Understanding this anatomical connection is the first step in correctly identifying and treating the underlying cause of shoulder blade discomfort.
Identifying the Specific Symptoms
A compressed nerve root produces a distinct set of symptoms that help distinguish it from common muscle strain. The pain is often described as sharp, electrical, or burning, and it may radiate from the neck down toward the shoulder blade and into the arm. This radiating pain is a hallmark sign of nerve root irritation.
Many individuals also experience sensory changes, such as numbness or tingling, often described as a “pins and needles” sensation (paresthesia). This altered sensation may follow a specific pattern down the arm and into the hand or fingers, depending on which particular cervical nerve root is affected. For example, compression of the C7 nerve root commonly causes symptoms that travel down the back of the arm and into the middle finger.
In more severe cases of nerve compression, muscle weakness can occur in the shoulder, arm, or hand. This happens because the nerve’s ability to transmit motor signals to the muscles is impaired. Patients may notice difficulty with tasks that require grip strength or struggle to lift their arm or perform certain movements.
Common Causes of Nerve Compression
The primary causes of nerve compression are often categorized into acute injuries and chronic degenerative changes within the cervical spine. A common cause in younger individuals is a cervical disc herniation, where the soft center of an intervertebral disc pushes out and directly presses against a nerve root. Acute trauma, such as a whiplash injury, can also precipitate a disc herniation, leading to sudden, sharp pain.
In older adults, chronic, age-related changes are the more frequent culprit. Cervical spondylosis, or osteoarthritis of the neck, involves the gradual deterioration of the discs and the formation of bone spurs (osteophytes). These bone spurs narrow the space where the nerve roots exit the spine, a condition called foraminal stenosis, causing irritation and compression over time.
Poor posture, especially prolonged forward head positioning associated with computer use, can contribute to chronic nerve irritation. This posture places added stress on the cervical vertebrae and discs, accelerating degenerative changes or causing chronic muscle tension.
Diagnosis and Treatment Options
Diagnosis
Diagnosing nerve compression that refers pain to the shoulder blade begins with a detailed physical examination. The clinician will test reflexes, muscle strength, and sensation in the arms and hands to determine which specific nerve root may be involved. Certain movements, such as tilting the head backward or toward the affected side, may be used to provoke symptoms and help pinpoint the area of compression.
Imaging studies are often necessary to confirm the diagnosis and identify the underlying cause of the nerve irritation. X-rays can show bone alignment and degenerative changes, such as bone spurs, while a Magnetic Resonance Imaging (MRI) scan provides detailed images of soft tissues, including the discs and nerve roots. In some situations, a nerve conduction study (NCS) or electromyography (EMG) may be performed to assess the severity of nerve damage or to rule out other conditions.
Treatment Options
The initial approach to treatment is generally conservative, focusing on non-surgical methods to relieve pain and inflammation. This often includes a period of rest or activity modification to avoid movements that aggravate the nerve. Nonsteroidal anti-inflammatory drugs (NSAIDs) may be recommended to reduce swelling around the compressed nerve root.
Physical therapy is a standard and effective component of conservative care. It utilizes exercises to strengthen the neck and shoulder muscles, improve posture, and increase the range of motion. Techniques like cervical traction may also be employed to gently stretch the neck and temporarily relieve pressure on the nerve.
If symptoms are severe or persistent, a doctor may recommend an epidural steroid injection, which delivers anti-inflammatory medication directly to the area around the irritated nerve root. In rare instances where pain is severe and neurological deficits worsen despite conservative treatment, surgical decompression may be considered to physically remove the pressure on the nerve.