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Pinched Nerve In Your Shoulders

If you googled “pinched nerve in shoulder,” you have come to the right place. A pinched nerve in your shoulder can not only cause excruciating pain but it can prevent the movement of your shoulder.

It is important to find the cause of the pinched nerve. Is it because of shoulder pathology or cervical spinal nerves? The cause of the pinched nerve in your shoulder will dictate your treatment.

We discuss the symptoms of a pinched nerve in the shoulder, the treatment options, and the alternative remedies for those who do not want invasive treatment.

What Is A Pinched Nerve In The Shoulder?

A pinched nerve in the shoulder occurs when a spinal nerve is compressed and inflamed. This can occur anywhere along the path of the nerve, from its origin at the spinal root right up to the muscles, ligaments, and tendons it supplies. 

A pinched nerve in the shoulder occurs when surrounding tissues, such as muscles, bones, disc, facet joints or tendons, apply excessive pressure to a nerve. This can occur anywhere along the path of the nerve, from its origin at the spinal root right up to the muscles, ligaments, and tendons it supplies. The pressure can disrupt the nerve’s function, causing pain, tingling, numbness, or weakness in the shoulder and arm.

Pressure On Nerves

Nerves exit the neck at each level of the cervical spine and travel to their final destination. Their path traverses muscles, tendons, ligaments, and bones. Pressure on a nerve can occur at multiple sites due to inflammation, swelling, instability, bone spurs, and disc or facet injuries.  This pressure can result in pain and or pinched nerve symptoms. 

Cervical Radiculopathy

Cervical radiculopathy is a medical condition where a nerve or nerves in the neck are pinched or compressed.  Nerve compression or irritation can occur due to a number of cervical spine conditions such as disc herniations, extrusion, stenosis, facet overgrowth and instability. 

There are seven cervical vertebrae with intervertebral discs in between. Over time, with increased wear and tear, these spinal vertebrae can become stiff and lose height. This can lead to compression of the nerves as they emerge from the spinal canal.

Repetitive activities, like heavy lifting and sports, can also hasten the degenerative changes in the spine.

Cervical radiculopathy can cause localized pain or may cause sharp radicular pain, electrical pain that radiates down the arms and in many cases into the fingers.

Symptoms Of A Pinched Nerve In The Shoulder

Symptoms of a pinched nerve in the shoulder may be local and limited only to the neck. Or, symptoms can be more widespread and cause pain along the neck and arm, and in some cases to the wrist, depending on how much pressure the nerve experiences. 

Here are some signs and symptoms of pinched nerves in the shoulder:

Pain In The Shoulder And Neck

When it comes to pain due to pinched nerves, the pain is oftentimes very sharp and described as a “burning pain.” In the initial stages, it may be a dull ache, but this can worsen if the nerves are compressed chronically.

Sensory Changes In The Shoulder

The nerves are responsible for carrying sensations from the shoulder area to the brain. Examples include hot, cold, and light touch.  The transmission of sensory information can be compromised when one or more nerves is irritated or compressed.  If the nerves are compressed, it may result in reduced or even loss of sensation in the shoulder and neck region.

Muscle Weakness In Arm, Neck, And Shoulder

The spinal nerves also innervate the muscles of the arm, neck, and shoulder. If these nerves are compressed, patients may experience muscle weakness or lack of strength in the arms.

This can also limit the active range of motion of the shoulder joint. As a result, patients may be unable to lift their arm overhead or carry out their usual daily activities.

 Numbness And Tingling

It is quite common for patients to experience a “pins and needles” sensation along the neck and shoulder area from a pinched nerve. This may extend from the neck all the way down to the fingers. Patients may even feel like their arm is falling asleep or becoming numb.

Difficulty Turning Or Extending The Neck

Pinched nerves can also lead to pain while turning the neck from side to side or up and down. If the nerves are compressed, it can be difficult to extend the neck or turn it without pain.

Common Causes Of Pinched Nerves

There are many causes of pinched nerves, which include:

  • Cervical disc injuries:  protrusion, extrusion, herniations
  • Cervical facet arthritis
  • Cervical instability:  examples include anterolisthesis or retrolisthesis.
  • Bone Spurs
  • Cervical Stenosis
  • Thoracic Outlet Syndrome

Disc Herniation or Bulging Disc

A disc herniation, also known as a ruptured disc, occurs when the soft, gel-like center of an intervertebral disc (the nucleus pulposus) pushes through a tear or weakness in the outer layer (the annulus fibrosus) of the disc. This can result in the displaced disc material pressing on nearby spinal nerves or the spinal cord.

Disc Degeneration

The discs are important shock absorbers in the spine. They are sandwiched between the vertebral building blocks. With age, the discs become stiffer due to a reduction in their water content. The discs are about 85% water and by the age of 70, this reduces to about 70%. The discs also experience degeneration over time.

As the disc loses height the bony doorway through which the nerve exits becomes narrower.  Over time, there can be compression or irritation of the nerves resulting in pinched nerve symptoms. 

Bone Spurs

A bone spur, or osteophyte, is an abnormal bony growth that develops along the edges of bones typically occurring in joints or where bones meet each other.  Bone spurs form as a result of the body’s attempt to repair itself by adding extra bone, often in response to continuous stress, instability, friction, or pressure over time.

A bone spur can irritate or compress exiting nerves causing shoulder pinched nerve symptoms.

Cervical Facet Injuries

The cervical facet joints are small, paired joints located on the back of the spine in the neck. They provide stability and flexibility to the spine, allowing for a range of motions such as bending and twisting. Each cervical vertebra has two facet joints: one on the left and one on the right side.

Facet joints can be injured through trauma or degeneration resulting in arthritis and joint overgrowth.  Both can narrow the bony doorway through which the nerves exit resulting in pinched nerves symptoms. 

Inflammatory Conditions

Inflammatory conditions can lead to shoulder pinched nerve symptoms through swelling and inflammation that compress nearby nerves. Here are some simple examples:

Arthritis:  

Inflammation of the joints, including osteoarthritis (degenerative) and rheumatoid arthritis (autoimmune). Inflammation in the shoulder joint can cause swelling, leading to compression of the nerves that pass through or near the joint.

Bursitis:

Inflammation of the bursa, a small fluid-filled sac that reduces friction between moving parts in the joints.

-welling of the bursa in the shoulder can put pressure on nearby nerves

Tendinitis:

Inflammation of the tendons, which connect muscles to bones.

-Inflammation and swelling of the shoulder tendons can press on adjacent nerves.

Acute Injury

An acute injury like an accident or trauma can damage the nerve. A brachial plexus injury can forcefully stretch, compress, or even rip the axillary nerve and its branches that supply the shoulder joint and its muscles from the spinal cord. 

This is a serious injury that affects the shoulder and may even render the arm useless. Pinched nerves can occur due to compression or stretching secondary to brachial plexus injuries during a fight, a fall, or and an accident. 

Poor Posture 

Poor posture is everywhere due to our dependence on mobile phones, tablets, and monitors.  Over time poor posture can lead to head forward posture, rounding of the shoulder, and excessive thoracic curvature (kyphosis). This in turn can lead to muscle imbalance, spinal misalignment, and irritation of nerves as they exit the cervical spine. 

Inflammatory Conditions

Inflammatory conditions can lead to shoulder-pinched nerve symptoms through swelling and inflammation that compress nearby nerves. Common examples include:

  • Arthritis: Inflammation in the shoulder joint can cause swelling, leading to compression of the nerves that pass through or near the joint.
  • Bursitis: Inflammation of the bursa, a small fluid-filled sac that reduces friction between moving parts in the joints.Swelling of the bursa in the shoulder can put pressure on nearby nerves.
  • Tendinitis: Inflammation of the tendons, which connect muscles to bones. Inflammation and swelling of the shoulder tendons can press on adjacent nerves.
  • Thoracic Outlet Syndrome: Thoracic Outlet Syndrome (TOS) is a medical condition where the nerves or blood vessels that pass through a narrow space near your shoulder, called the thoracic outlet, are compressed or squeezed. This space is located between your collarbone (clavicle) and your first rib. Compression of the nerves can cause pain, numbness and pinched nerve symptoms.

Common Treatment Options For Pinched Nerves In The Shoulder

There are many different treatment options for the symptoms of a pinched shoulder nerve. The treatment depends on multiple variables including the severity of pain, location, current medication, and past medical history. When appropriate conservative care should always be the first line of treatment. The most common treatment options include:

Pain Relievers

Pain relievers are a type of medication that can reduce pain. For pinched shoulder nerve symptoms, non-steroidal anti-inflammatory drugs (NSAIDs) like Aspirin, naproxen (Aleve), and ibuprofen (Advil, Motrin) can help relieve pain by reducing inflammation. They have significant side effects which have been previously discussed and therefore should be avoided.

When NSAIDs medications fail, some patients are prescribed narcotics such as Percocet or Vicodin. Neither medication addresses the underlying problem and has the risk of dependence. 

Painkilling anesthetic gels with lidocaine can also relieve pain.Lidocaine and most anesthetics block pain at the source and also halt their transmission via the nerves. However, they generally only work for a short period of time. 

Anticonvulsants like carbamazepine (Tegretol), gabapentin (Neurontin), lamotrigine (Lamictal), and pregabalin (Lyrica) are frequently prescribed for nerve pain. Anticonvulsants decrease conduction across sodium channels. These channels are necessary for detecting and conducting painful stimuli. 

 Antidepressants can also be utilized in the treatment of severe pinched nerve pain. Common examples include amitriptyline (Elavil) and doxepin (Sinequan). Antidepressants have the unique ability of reducing pain signals by increasing neurotransmitter concentrations and blocking certain ion channels. They do not provide immediate pain relief and take some time to work. 

Physical Therapy

Physical therapy for nerve impingement in the shoulder can include range of motion exercises, manual therapy, muscle strengthening exercises, and functional training.

The range of motion exercises are often self-stretching techniques that help restore normal motion and function of the shoulder.

Manual therapy is a more hands-on approach that can help mobilize the joint. This can include muscle kneading, muscle manipulation, joint manipulation, and mobilization exercises. They are highly skilled techniques targeting specific tissue, muscle or joint. 

A physical therapist may combine different forms of manual therapy with or without movement during the early stages of shoulder pain due to pinched nerves. 

Muscle strengthening is a progressive resistance program that addresses weak muscles and bad posture.There’s no one-size-fits-all physical therapy program. A physical therapist will create a highly specific program to address the symptoms caused by your pinched nerve and which nerve is compressed. They will specifically target the muscle groups supplied by that nerve. 

Functional training usually begins once the pain reduces and when you regain strength and mobility of the shoulder joint. This training involves exercises that prepare you to carry out daily activities in life. They involve all the major muscle groups and train them to work synchronously, something you may have lost while immobile due to an injury or spinal condition. 

Heat

Heat can be an effective treatment option for shoulder-pinched nerve symptoms. Intermittent heat can improve blood flow, relax muscles, reduce stiffness, and promote healing. 

Sleeping With A Supportive Pillow

A medium and high loft pillow can reduce the pain from a pinched nerve in the shoulder. Thicker, supportive pillows cushion the head and neck. Supportive pillows can also help improve the alignment of the spine by maintaining better neck posture while sleeping.

Splints and Collars

Splints and collars can also reduce the pain from cervical radiculopathy and are only prescribed for people with this condition. These collars align the spine and relieve the nerve that is impinged from a herniated disc or due to cervical radiculopathy. 

Doctors recommend them after a confirmed diagnosis of radiculopathy, neck injuries like whiplash injuries, or neck surgeries to support and protect the neck. They are not to be worn continuously and prescribed based on the intensity of your pain. 

Soft collars are usually prescribed for whiplash injuries and are more flexible, allowing mobility of the neck. In the case of cervical radiculopathy or disc hernia where there are neurological symptoms, a hard collar is usually prescribed until the final treatment is decided.

Limiting Physical Movement

Rest and limiting activities that exacerbate the pain can help reduce the pain from a pinched nerve in the shoulder. Rest gives the nerves time to heal especially if the nerves are inflamed or compressed by inflammation. If muscles or tendons are injured, once they heal, the nerves supplying them experience less compression and so limiting physical movement reduces pain. 

Avoid repetitive overhead activities, sudden forceful movements, or any activities that cause pain in the shoulder area. These movements stretch the nerves further and worsen the compression on the nerves. 

Epidural Injections

When conservative therapy fails to provide significant or sustained benefit, some patients are referred for an epidural injection. This is a common procedure in pain clinics that delivers medication around the affected nerves and spine. 

The medications include local anesthetic and steroids, the latter of which are powerful anti-inflammatory medications that can reduce inflammation. Steroid injections do NOT address the underlying problems and have significant side effects including damaging local stem cells.

Surgical Procedures

Surgery should never be a first-line treatment for pinched nerves. Surgery is associated with significant risks that include bleeding, infection, failure, increase in pain, and nerve damage. Surgery changes the underlying anatomy and biomechanics forever. 

These include:

  • Anterior cervical discectomy and fusion (ACDF)

    The ACDF procedure is also known as anterior cervical decompression. In this procedure, the damaged disc is surgically removed, which helps reduce the pressure on the nerves and nerve roots. This can help alleviate the pain and other symptoms.
  • Artificial disc replacement

    During an artificial disc replacement surgery, the diseased or damaged disc is replaced with an artificial one. The artificial discs are usually made of cobalt-chromium or titanium. These discs allow a person to move and bend just as they normally would, unlike other surgeries, which restrict spinal movement. 
  • Posterior cervical laminectomy

    A posterior cervical laminectomy is a surgical procedure performed on the cervical (neck) spine to relieve pressure on the spinal cord or nerve roots. This pressure is often caused by conditions such as spinal stenosis, herniated discs, bone spurs, or tumors.

    The procedure involves removing the lamina, which is the back part of the vertebra that covers the spinal canal. Removing the lamina creates more space in the spinal canal, relieving pressure on the spinal cord and nerve roots.
  • Decompression of the suprascapular nerve

    If the suprascapular nerve is trapped or pinched, then decompression of the suprascapular nerve via arthroscopy can help relieve the pressure on the nerve.

    During the surgery, the transverse scapular ligament is sectioned with arthroscopic scissors, and the suprascapular nerve is decompressed (1).

Diagnosing A Pinched Nerve

A detailed history taken by your doctor and thorough physical examination of the neck and shoulder can provide a clear diagnosis in most patients. Based on this initial evaluation, further testing can be used to confirm the diagnosis.

  • Physical Examination

    Specific physical tests and exams are used to localize the cause of the problem and which nerve is affected. These are known as provocative tests.

    Provocative shoulder tests include Neer’s Test, Hawkins-Kennedy Impingement Test, Painful Arc, and Yocum’s Test. If a person has symptoms of a pinched nerve in the shoulder along with a positive provocative shoulder test, then imaging is recommended.

    Provocative cervical spine tests include Neck Compression Test, Shoulder Abduction Test, Neck Distraction Test, Adson’s Test, Lhermitte’s Sign, and Hoffmann’s Sign. If these tests are positive, then the diagnostic workup starts with an X-ray, followed by an MRI.
  • X-Ray

    For the shoulder, anteroposterior (AP), true AP (Grashey view), axillary, and scapular “Y” views are ordered. These views are not very specific for nerve pathology, but they are helpful to identify any associated shoulder pathology that might cause pinched nerve symptoms.

    For the cervical spine, AP and lateral cervical radiographs and lateral flexion/extension views of the spine are ordered to help diagnose any spondylosis or disc degeneration.
  • MRI

    When cervical radiculopathy is suspected or when provocative tests are positive, a doctor will order an MRI. An MRI is noninvasive and is considered one of the best tests for pinched nerves.
  • Ultrasound

    Ultrasounds are becoming increasingly useful in helping to identify pinched nerves and nerve pathology. An ultrasound can detect changes in the pinched nerve such as swelling and inflammation.
  • Electromyography

    If doctors cannot identify the cause or the level of the nerve compression, then electromyography is the next option. It is controversial because it is not as sensitive as an MRI, but it is specific. When it’s positive, an MRI pinpoints which nerves are affected and is very diagnostic. 

The Non-Surgical Alternatives

There are many non-surgical, but medically supervised, options for managing the pain and symptoms of a pinched nerve in the shoulder.

At Centeno-Schultz, we use a combination of modalities to treat your pinched nerve. Our physical therapy department will collaborate with you to strengthen the cervical spine muscles. They will also address specific needs of the shoulder and spine based on your condition.The physical therapists work with the clinical department to deliver a tailored physical therapy program that focuses on your rehabilitation.

Nerves recover slowly. However, if they are provided with nutrients to help them heal, the pinched nerves can heal quicker. Our board-certified doctors will talk to you about regenerative medicine if that is an option for you.

Stem cell injections are advised in some cases to help the body heal faster as they divide and transform into nerves which further divide and fill in the injured tissue.

At the Centeno-Schultz Clinic, we are committed to providing patients with superior clinical outcomes, beginning with precise diagnostics. Our approach includes a comprehensive review of each patient’s symptoms, medical and surgical history, alongside a thorough physical examination and evaluation of current imaging. Additionally, in-office ultrasound scans provide vital supplementary clinical data.

Treatment strategies are specifically tailored to address the root cause of shoulder symptoms. For instance, the treatment protocol for nerve irritation resulting from cervical disc herniation differs significantly from that for symptoms caused by thoracic outlet syndrome. This underscores the critical need for an accurate diagnosis.

Our treatment modalities focus on the underlying injuries. Commonly employed methods include injections of PRP (Platelet-Rich Plasma) and bone marrow-derived stem cells—both recognized for their regenerative capabilities that enhance blood flow, decrease inflammation, and potentially speed up healing. All injections are meticulously administered under x-ray or ultrasound guidance to ensure the precise delivery of PRP to the affected area.

At the Centeno-Schultz Clinic, every patient receives a customized dosage of PRP and bone marrow-derived stem cells, formulated through advanced cell laboratory techniques. This personalized approach ensures that each treatment is optimally tailored to the patient’s specific condition.

Explore Your Alternatives For Healing Pinched Nerves

Shoulder pinched nerve symptoms can arise from many different causes.  The most common causes include:

  1. Cervical disc herniation
  2. Disc degeneration
  3. Bone Spurs
  4. Cervical Facet Injury/ Arthritis
  5. Poor posture
  6. Trauma
  7. Inflammatory conditions
  8. Thoracic Outlet syndrome.

While many clinics focus primarily on these prevalent symptoms, such an approach often yields limited success. At the Centeno-Schultz Clinic, we recognize the diverse origins of pinched nerve symptoms and understand that optimal patient outcomes begin with an accurate diagnosis.

Following a precise diagnosis, we develop a tailored treatment plan that incorporates advanced regenerative medicine techniques, such as PRP (Platelet-Rich Plasma) and bone marrow-derived treatments. Our team consists of board-certified, fellowship-trained physicians who are leaders in the field of regenerative medicine.

Don’t let a pinched nerve hold you back. Schedule an appointment with us today and experience dedicated, expert care at the Centeno-Schultz Clinic.

References:

  1. Ghodadra N, Nho SJ, Verma NN, et al. Arthroscopic decompression of the suprascapular nerve at the spinoglenoid notch and suprascapular notch through the subacromial space. Arthroscopy. 2009;25(4):439-445. doi:10.1016/j.arthro.2008.10.024
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Thoracic Spine Physician and Expert

John Schultz, MD

John R. Schultz M.D. is a national expert and specialist in Interventional Orthopedics and the clinical use of bone marrow concentrate and PRP for orthopedic injuries. He is board certified in Anesthesiology and Pain Medicine and underwent fellowship training. Dr. Schultz has extensive experience with same day as well as culture expanded bone marrow concentrate and sees patients at the CSC Broomfield, Colorado Clinic, as well the Regenexx Clinic in Grand Cayman. Dr. Schultz emphasis is on the evaluation and treatment of thoracic and cervical disc, facet, nerve, and ligament injuries including the non-surgical treatment of Craniocervical instability (CCI).

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