Sometimes the root cause of shoulder pain is not in the shoulder. In fact one of the more common conditions that causes shoulder weakness is a pinched nerve in the neck.
It is not uncommon for me to see patients who are mistakenly referred for a “shoulder problem” when in reality the problem is coming from their neck.
Pinched nerves in the neck can lead to weakness in the shoulder muscles and can mimic shoulder and arm problems.
Peripheral nerve problems about the shoulder are rare but can also leave people with weakness that affects their shoulder motion. Peripheral nerves are nerves that live outside of the spine and brain. They bring electrical signals out from the spine to the limbs and torso.
How do you know if a nerve injury is causing your shoulder weakness?
Injury can occur anywhere along the course of the nerve fibers from your spine to the tips of your fingers. A thorough history and physical performed by a knowledgeable specialist will help you better determine whether nerve damage is causing your weakness. A meticulous investigation is sometimes necessary to pinpoint where it may be.
Sometimes a physician will order a test called an EMG to determine whether you have had nerve damage. The EMG can help pinpoint nerve damage and nerve recovery. There are 2 catches to the test: 1) to get the best results, you should have the test performed by a doctor that performs them often 2) the test can be uncomfortable. It involves placing tiny needles into individual muscles in your arm and sending mild currents through them. I’ve had one myself and while I did not find it that painful, I did find it “strange” feeling.
How might you sustain a nerve injury around the shoulder?
Nerve injury around the shoulder can be caused by trauma such as fractures, dislocations or blunt force. A history of trauma should prompt your doctor to remain aware for signs of nerve damage. Numbness, unusual weakness or electric shock-type pain might be a sign of nerve damage.
Not all nerve damage follows trauma. Some disorders such as “brachial neuritis” may occur without warning. “Brachial neuritis” or inflammation around the brachial plexus may present as pain alone or with weakness.
While rare, nerve injury from surgery can happen as well. Typically nerve injuries, even from surgery are stretch-type injuries and often recover on their own. Of course, prevention is always the best medicine. Employing a surgeon who is knowledgeable of the anatomy is critical. Repeat surgeries are often more high risk than first time surgeries because of the difficulty of dissecting through scar tissue, so if you are considering repeat surgery you want to remain especially conscious of this.
Which nerves are commonly injured around the shoulder?
Commonly injured nerves around the shoulder include the axillary nerve which supplies sensation and strength around your deltoid muscle, the suprascapular nerve which supplies your rotator cuff muscles and the long thoracic nerve which powers a muscle around your chest wall.
*Injuries to the axillary nerve or the whole brachial plexus are not uncommon after shoulder dislocation or severe fractures.
*Suprascapular nerve injuries may occur in conjunction with SLAP tears or cysts around the socket. If you have a suprascapular nerve injury you may notice pain or weakness in your rotator cuff muscles.
*Long thoracic nerve injuries are rare and can lead to “winging” of the scapula. Winging is a condition in which the shoulder blade elevates abnormally off of the torso and creates unnatural movement of the shoulder. There’s also something called “pseudo-winging” which looks like winging but is not from nerve damage. It results from abnormal adaptation of the shoulder blade due to pain or weakness in another area.
Most people find the thought of a nerve injury frightening. When they hear the term “nerve injury” they probably visualize a severed nerve. They have a general understanding that nerve injuries can be permanent.
It’s very rare to sustain a severed nerve. Most nerve injuries are stretch injuries or bruises and recover on their own without the need for surgery.
The hard part about nerve injuries is that they require patience through recovery. Some nerves recover quickly. Others take up to a year or more to recover. Some never fully recover. We all hate uncertainty and it’s hard to be patient. But often, time is our best ally if there is a nerve injury.
If your shoulder is weak and you are looking to get to the root cause of the weakness Dr. DiPaola may be able to help. A consultation can help you pinpoint the origin of your weak shoulder and get you on the road to recovery.