A pinched nerve in the shoulder occurs when a nerve is compressed or irritated anywhere along its path, from the nerve root where it emerges from the cervical spine to the area in the shoulder it supplies. This can lead to shoulder pain, numbness, and pins and needles, and can even affect the movement of the shoulder joint. Pinched nerves occur in about 85 people per 100,000 (1).
If you have a pinched nerve in your shoulder, read further to find out how to release this nerve and ease your symptoms.
Pinched Nerves In The Shoulder: An Overview
A pinched nerve in the shoulder occurs when the nerve that supplies the shoulder is compressed. The affected nerve could be part of the cervical nerve root that emerges from the spinal cord, or it could be one of the many nerves that branch off from the roots that innervate the muscles of the shoulder.
There are many causes of a pinched nerve, including a herniated disc, bony spurs, and foraminal narrowing, among many others.
Conditions That May Cause A Pinched Nerve
So, how does pain from a pinched nerve occur? When a nerve is compressed, it gets irritated and inflamed, causing pain. In some cases, the pain may gradually increase over time with repetitive activities or movements, but sometimes it can occur suddenly. Below is a list of how different conditions can compress the nerve and cause pain:
- Herniated discs: When an intervertebral disc herniates, the soft gel-like center protrudes from its capsule into the spinal canal. In the cervical spine, this may reduce the space where the nerve roots emerge from the spinal cord.
As a result, the nerves can get compressed, which can lead to pain in the shoulder or arm. If treated and managed appropriately, the pain from a pinched nerve due to disc herniation can resolve within four months.
- Disc damage: If a cervical disc is damaged due to trauma, this can create a tear in the disc called annular tear or annular fissure. It can then leak its contents from the disc into the spinal canal, causing chemical irritation to the nerve. This is called a chemical radiculitis.
- Foraminal narrowing: Nerves emerge from the foramen in the cervical spine and travel towards the shoulder to supply sensation and motor control to the arm.
If the foramen is narrowed due to conditions such as osteoarthritis, inflammation, or rheumatoid arthritis, then it can compress the nerves, causing a pinched nerve that leads to pain in the shoulder or arm.
- Muscles compressing individual nerves: The axial nerve or suprascapular nerve can be compressed enroute as they travel within the muscles they supply. This compression could be caused by muscle inflammation, hypertrophy, or even muscle injury.
When these nerves are compressed, it can lead to pain, numbness, and decreased muscle strength in the shoulder.
- Bone spurs: Small bony projections can develop along the edges of the bone, called bony spurs. This commonly occurs in conditions such as osteoarthritis, where the body attempts to repair the inflamed bone by forming new bone.
In the cervical spine, bony spurs can grow near the facet or intervertebral joints, restricting the space where nerves normally travel. This narrowing can pinch the nerve and cause pain in the shoulder or arm.
Early Treatment At Home: Relieving The Pain
If you have a pinched nerve in your shoulder, then you can start with conservative treatments at home to help relieve the pain. In about 85% of cases, pain from a pinched nerve resolves within 8-12 weeks. Here are a few treatment options to try:
Posture Adjustment
If you have to lean forwards, either to read or work, it causes the shoulders to stay hunched forward and downward. Pinched nerves can result from poor posture or sitting for prolonged periods, which can compress the nerves as they exit the spinal vertebrae.
Therefore, it is important to have a good posture while sitting, working, and standing throughout the day. Correcting poor posture takes time and intentional effort, so be persistent when practicing the right posture.
R.I.C.E. Principles
R.I.C.E., or rest, ice, compression, and elevation, are conservative steps that you can take to relieve the pain from a pinched nerve in the shoulder. This method can help reduce pain by resting the shoulder, icing the area, compressing it, and elevating it to reduce inflammation.
As an alternative to cold therapy, you can also use heat packs to increase the blood flow to the area. Cold and hot therapy can be used together for pain relief.
Stretches And Massage
Gentle stretches can relieve the pressure on a compressed nerve. This could include gentle chin tucks, shoulder rolls, and neck bends. Stretches can help loosen the surrounding muscle and lessen the pressure on the compressed nerve. If these stretches cause pain, stop immediately.
Massage techniques like effleurage strokes, where you lightly touch or skim the muscles, and light kneading can also relieve pain in the affected area. These can help to reduce any knots in the shoulder and release tension in the muscles. Relaxed muscles can relieve pressure on the nerve and remedy the symptoms of a pinched nerve.
However, if you experience pain while getting a massage or the pain worsens, then stop at once and seek medical help.
Pain Relievers
Pain relievers can ease the pain caused by a pinched nerve in the shoulder. Over-the-counter (OTC) pain medications like ibuprofen, naproxen, and acetaminophen can be taken for pain relief. You can usually take these for about two weeks, but if you have a history of kidney or liver disease, then talk to your doctor before taking any OTC pain medications. These medications should only be taken temporarily and not designed for long-term use. Long-term use can lead to gut issue but recent research also shows can lead to further orthopedic damage (worsening arthritis over time)
Non-Surgical Procedures For A Pinched Nerve In The Shoulder
If you have tried stretches and pain medications but still haven’t gotten any relief, there are other non-surgical procedures that can help a pinched nerve in the shoulder:
- Physiotherapy: Physiotherapy is a non-surgical intervention that can help relieve nerve compression in the shoulder. Physical therapists use different strategies to improve flexibility, movement, and strength in the shoulder.
Physiotherapy can include manual therapeutic techniques like soft tissue massage, stretching, and joint mobilization. It can also include therapeutic exercises to reduce pain and recondition the affected area.
The physical therapist may also introduce neuromuscular education to retrain the brain and the cervical joints about proper shoulder movement.
- Injections: Nerve blocks can be given by injection to help manage the pain from a pinched nerve. These injections contain a mixture of local anesthetic and steroids and are used to reduce inflammation and numb any pain.
For example, if the suprascapular nerve is pinched, then a nerve block can be given to this specific nerve. For cervical root nerve blocks, transforaminal epidural injections can be given to relieve the pain due to the pinched nerve roots.
*** use of corticosteroids also been shown to be toxic to your tissue which can lead to worsening nerve pain and also worsening degeneration to the area it was injected into!
Surgical Procedures For A Pinched Nerve In The Shoulder
Surgery is usually the last resort for situations where conservative treatment like medications and physical therapy has failed. It is also used for patients who have some neurological deficit like a loss of strength or sensation. Recovery from surgery take months, depending on the procedure. Like any surgery, there are always risks and long-term consequences of cutting on your spine…. We review them here
There are different surgical procedures based on what is causing the pinched nerve. A few of them are listed below:
Anterior Cervical Discectomy And Fusion (aka ACDF)
In an anterior cervical discectomy and fusion surgery, the damaged intervertebral disc is removed. This relieves any pressure on the spinal cord and the nerve roots which in turn relieves the pinched nerve. Since this is a form of surgical decompression, it is also known as anterior cervical decompression.
In the same surgery, fusion surgery is done to stabilize the cervical segment after the disc is removed. Here, a bone graft or an implant is inserted at the location of the affected disc to support the spine with the vertebrae above and below. This can help relieve pain from a pinched nerve.
With fusion of the spine, within a few years, the above and below segments in relation to the fusion will start to degenerate faster than normal. This is known as “Adjacent Segment Disease” meaning the fusion will start to distribute more stress to adjacent areas leading to possibility of additional surgery down the road!
Artificial Disc Replacement
If the intervertebral disc is pinching a nerve, whether from herniation or degeneration, it can be replaced with an artificial disc. Artificial discs are designed to emulate the characteristics of the body’s natural intervertebral discs, allowing them to perform in the same capacity.
A few varieties of artificial discs include the ProDisc-C, Charité Artificial Disc, and Mobi-C® Cervical Disc. These artificial discs are made of ultra-high-molecular-weight polyethylene (UHMWPE), an inert and stiff material. This lowers the chance of a reaction or allergy to the material, and allows the disc to function while also following the natural alignment of the spine.
The thought of ADR is that you can replace the disc and not get any of the adjacent segment disease compared to ACDF? Turns out that is not that case….
The first study on a search of the US National Library of Medicine search was a 5-year randomized controlled trial of disc replacement versus fusion in the neck. It concluded that there is no difference in the rate of ASD between the procedures (2).
Then these studies came after:
- This study demonstrated that the way the spine bones moved is changed by ADR (3). Meaning they don’t move in the way they were designed.
- This high-level meta-analysis concluded that a reduction in ASD can’t yet be proven when ADR is compared to fusion (4).
- This Swedish registry study also concluded no difference in ASD rates between ADR and fusion at 5 years (5).
Healthier Non-Surgical Alternative
Over the last two decades, Centeno-Schutlz Clinic has been dedicated to researching and developing alternative treatments to traditional orthopedic issues (alternative to steroids and surgery). Ortho-Biologics such as platelet rich plasma and bone marrow concentrate have emerged as a better alternative!
PRP For Pinched Nerve
Platelet Rich Plasma (PRP) contains high concentration of growth factors that aid in helping pinched nerves recover. With precision injection techniques, our physicians can evaluate and treat these injuries to allow a natural and accelerated recovery with simple injection based treatments. Here is a quick video explaining how PRP or platelet lysate can help your pinched nerve.
PRP For Cervical Disc Herniation
With cervical disc injuries that happen with car accidents, trauma or just overuse overtime. If patients fail to respond to simpler PRP treatments then more aggressive treatment would be a cervical intradiscal PRP treatment.
This is a highly skilled injection which very few physicians in the country are proficient at doing! Luckily, here at Centeno-Schultz Clinic, two of our physicians: Dr Jason Markle and Dr. John Pitts have mastered this technique allowing for safe and effective treatment utilizing the best techniques with ultrasound and fluoroscopic guidance. This allows for the highest safety but also the most accurate treatment!
Maintaining Good Shoulder Health With Exercise
Shoulder exercises are commonly prescribed by a physical therapist or doctor to both prevent and relieve a pinched nerve. Exercises help to strengthen the muscles in the area and ease pressure on the nerves. Shoulder exercises can also help you maintain good shoulder health by improving the flexibility of the joint.
You can try a few shoulder stretches to ease the pain. There are two commonly prescribed exercises for a pinched nerve in the shoulder: scapular retractions and the prone head lift. Here’s how to complete them:
- Scapular retractions: Start in a standing position. Draw your shoulders backward together towards your spine. Hold this position for 10 seconds and then return to the original position. Repeat this five times.
- Prone head lift: Start by lying down in prone (on your belly), supporting your upper frame on your elbows. Draw your neck towards your chest and lift the back of your head to the ceiling. Hold for five seconds and then return to the original position. Repeat once more.
These exercises can be coupled with conservative and surgical treatment to rehabilitate the shoulder. You can continue these exercises even after your treatment is completed to keep the shoulder flexible and prevent any future pinched nerves. Remember to speak to your doctor before you start any new shoulder exercises.
Treat The Pinched Nerve In Your Shoulder As Soon As Possible
A pinched nerve in your shoulder can be treated with conservative management. However, if you have tried this for a while but have not experienced any relief, you may want a doctor to assess your shoulder. A doctor will identify the cause of the pinched nerve in your shoulder and recommend the appropriate treatments.
Talk to one of our board-certified doctors about what is causing your pinched nerve and what you can do to relieve it.
References
- Magnus W, Viswanath O, Viswanathan VK, et al. Cervical Radiculopathy. [Updated 2022 Jul 18]. In: Stat Pearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK441828/
- MacDowall A, Canto Moreira N, Marques C, Skeppholm M, Lindhagen L, Robinson Y, Löfgren H, Michaëlsson K, Olerud C. Artificial disc replacement versus fusion in patients with cervical degenerative disc disease and radiculopathy: a randomized controlled trial with 5-year outcomes. J Neurosurg Spine. 2019 Jan 11;30(3):323-331. doi: 10.3171/2018.9.SPINE18659. PMID: 30641852.
- Wachowski MM, Weiland J, Wagner M, Gezzi R, Kubein-Meesenburg D, Nägerl H. Kinematics of cervical segments C5/C6 in axial rotation before and after total disc arthroplasty. Eur Spine J. 2017 Sep;26(9):2425-2433. doi: 10.1007/s00586-017-5073-z. Epub 2017 Apr 4. PMID: 28378073.
- Yang X, Janssen T, Arts MP, Peul WC, Vleggeert-Lankamp CLA. Radiological follow-up after implanting cervical disc prosthesis in anterior discectomy: a systematic review. Spine J. 2018 Sep;18(9):1678-1693. doi: 10.1016/j.spinee.2018.04.021. Epub 2018 May 8. PMID: 29751126.
- MacDowall A, Skeppholm M, Lindhagen L, Robinson Y, Löfgren H, Michaëlsson K, Olerud C. Artificial disc replacement versus fusion in patients with cervical degenerative disc disease with radiculopathy: 5-year outcomes from the National Swedish Spine Register. J Neurosurg Spine. 2018 Nov 2;30(2):159-167. doi: 10.3171/2018.7.SPINE18657. PMID: 30485205.
