When Might Nerve Injury Be the Source of Your Shoulder Pain

Shoulder pain usually means rotator-cuff problems, arthritis, or a torn labrum—right?

Not always. In many new patients I see in Amherst, Orchard Park, Niagara Falls, and the greater Buffalo region, the true culprit hides outside the shoulder joint: a nerve that has been pinched, stretched, or inflamed.

Understanding this possibility is essential because treatment changes once nerves join the conversation. Resting a “sore shoulder” does little if the weakness comes from a compressed cervical root at C5-C6.

Cervical Radiculopathy: A Neck Problem Masquerading as a Shoulder Problem

The spinal cord branches into several root nerves in the cervical spine. Each root supplies motor power and sensation to specific muscle groups and skin zones. Compression from a herniated disc, bone spur, or degenerative joint can irritate the root and “refer” pain to the shoulder region.

Red-flag patterns I hear in clinic

Deep, constant ache from the neck into the deltoid that intensifies while looking down at a phone

Burning or electric sensations shooting into the triceps, forearm, or thumb

Weakness when lifting the arm overhead despite a rotator cuff that looks normal on ultrasound

Night pain improved by a slim pillow or recliner rather than by shoulder positioning

If several of these are present, a focused neck exam and plain cervical X-rays (often available same day at our Amherst or Orchard Park offices) become step one. Many patients are relieved to learn the rotator cuff remains intact.

Peripheral Nerve Injuries: When Trouble Lives Outside the Spine

Not every nerve issue originates in the neck. Three peripheral nerves are frequent offenders around the shoulder:

Nerve	Common Injuries	Hallmark Deficit	Typical Triggers
Axillary	Stretch during anterior shoulder dislocation; humeral neck fracture	Deltoid weakness, numb patch over “regimental badge” area	Traumatic fall, contact sports
Suprascapular	Compression in suprascapular notch; traction with massive rotator-cuff tear	Weak external rotation & elevation; deep posterior ache	Volleyball, overhead lifting, SLAP cyst
Long Thoracic	Stretch or viral neuritis	Scapular winging, difficulty pushing away from a wall	Back-pack straps, blunt trauma, idiopathic neuritis

Although rarer than cervical radiculopathy, these injuries still appear in our Western NY practice several times each month—especially after snowboard spills at Holiday Valley or hard tackles during Friday-night football.

Sorting Out the Source: History, Exam, and Select Tests

Detailed history

I start with timeline (“When did you first notice weakness?”), mechanism (“Any recent car accidents on the Thruway?”), and aggravating positions. A blow to the shoulder on the ice at Canalside tells a different story than months of desk work with a forward head posture.

Physical examination

Neck screen: Range of motion, Spurling maneuver, axial percussion
Isolated muscle testing: Supraspinatus, infraspinatus, deltoid, serratus anterior
Sensation mapping: Light-touch comparison along C5–T1 dermatomes
Scapular winging check: Wall push-ups to unmask long thoracic palsy
Shoulder passive range: Limited in adhesive capsulitis, full in radiculopathy

Imaging and electrodiagnostics

Plain radiographs: Cervical and shoulder films rule out fractures, severe arthritis.
MRI of cervical spine or shoulder: Excellent anatomic detail; ordered selectively.
EMG/NCS (electromyography & nerve conduction study):
- Performed by fellowship-trained physiatrists at UBMD and Kaleida facilities
- Helps locate the exact lesion (root vs. plexus vs. peripheral)
- Optimal at three weeks or later after onset to allow for denervation changes
- Can feel peculiar, yet most patients tolerate the 30-minute procedure well

Remember: a normal early EMG does not rule out nerve irritation; sometimes a repeat study is scheduled at eight to twelve weeks.

How Nerves Become Injured Around the Shoulder

High-energy trauma – Motorcycle crash on Route 62 causing shoulder dislocation and axillary nerve stretch

Low-energy repetitive stress – Overhead painting along Lake Erie’s windy shore leading to suprascapular notch irritation

Surgical traction – Rare but possible after multiple prior shoulder operations; scar tissue makes dissection tricky

Idiopathic brachial neuritis (Parsonage-Turner syndrome) – Sudden, severe shoulder pain followed by profound weakness; etiology often viral or autoimmune

Postural compression – Years of hunched laptop work compress lower cervical roots especially in winter months when activity drops

Treatment Pathways: Patience, Therapy, Surgery—In That Order

Conservative first

Most stretch injuries heal without scalpel intervention. A typical cervical radiculopathy plan in Western NY starts with:

Medication – Short steroid taper, NSAIDs (if stomach and kidneys allow), neuropathic agents such as gabapentin

Physical therapy – McKenzie cervical retraction, postural correction, scapular stabilization. Our team partners with therapists in Williamsville, Hamburg, and Niagara Falls who understand nerve-based shoulder weakness.

Activity modification – Limiting overhead presses at LA Fitness or shoveling heavy Lake-effect snow until symptoms calm

Selective steroid injection – Cervical epidural or suprascapular nerve block under fluoroscopy at ECMC or UB Neurosurgery pain suite

Monitoring recovery

Strength often begins to return in 6–12 weeks.

Numbness may lag behind or even persist.

Follow-up EMG can prove re-innervation and guide return to sport or labor.

Surgical considerations

Surgery enters the picture when:

Objective weakness worsens or fails to improve after three to six months.

EMG shows ongoing denervation with no early re-innervation.

An MRI reveals a surgically correctable lesion like a cervical disc herniation or a ganglion cyst compressing the suprascapular nerve.

Cervical decompressions are performed by spine surgeons; peripheral nerve releases (for example, suprascapular decompression) can be done endoscopically or through a mini-open approach.

What Recovery Really Looks Like

Patience is the toughest prescription. Nerves regenerate at roughly one millimeter per day once damage stops—think several months to cross from neck to deltoid. During that period:

Maintain shoulder motion with passive stretches to avoid frozen shoulder.

Strengthen intact muscles (pectoralis, rhomboids) to compensate.

Protect the limb—no heavy lifting competitions at RiverWorks until cleared.

Expect partial recovery—most patients regain functional strength, yet minor residual weakness or sensory change can remain.

Our role is to coach you through the uncertainty with realistic milestones and regular re-checks at our Amherst or Orchard Park clinics.

When to Seek Evaluation for Patients in Buffalo, Amherst, Orchard Park, and Niagara Falls

If you notice:

Sudden shoulder or arm weakness after a pop, dislocation, or heavy impact

Burning or shocking pain from neck into arm, especially if night-dominant

Visible scapular winging or difficulty lifting a jug of milk overhead

Persistent numbness in the outer shoulder or thumb despite rest

Failed physical therapy for “shoulder impingement” with unexplained strength loss

Early assessment improves outcomes, streamlines imaging, and prevents unnecessary shoulder surgery.

Key Takeaways for Western NY Residents

A painful, weak shoulder is not always a shoulder problem; cervical roots and peripheral nerves frequently mimic joint disease.
Detailed history, tailored examination, and—when indicated—EMG or MRI will reveal the true source.
Most nerve injuries improve without surgery, yet recovery can span months; guided therapy and realistic checkpoints maintain morale.
Local expertise matters. Dr. Matthew DiPaola and his team coordinate imaging, therapy, and surgical care across Amherst, Orchard Park, and Niagara Falls so you spend less time driving and more time healing.

Ready for answers? Call 716-204-3200 today or book online. Your shoulders—and the nerves that run them—will thank you.