Neck and shoulder pain often occur simultaneously and sometimes is they’re even indistinguishable. Muscles from the shoulder girdle attach to the cervical spine, nerves from the neck course to innervate the shoulder, scapular mobility can affect neck range of motion and vice versa. We will save the scapular/neck strength, mobility and motor control talk for another time. Today we want to look at how the nerves and pain patterns of the neck effect the scapula.
The spinal segments of neck are ordered C (cervical) 1 – C7 from the top down. The nerves that extend from the cervical portion of the spinal cord are numbered according to the spinal segment that they exit. As nerves exit the spinal cord they course to an area of the body where they provide innervation to skin, muscle or joints to allow for sensory or motor input. Any disruption to the nerve can result in aberrant sensory, pain or motor patterns. A disruption can occur anywhere from the time the nerve leaves the spinal cord (ie. Disc herniation or stenosis of the spine) to the full course of the nerve (ie restrictions in fascia or muscle). While these issues aren’t always the cause of pain, they can attribute to the symptoms you may be experiencing. The pictures below can give you an idea of how these nerves innervate the muscles and skin of the scapula.
The capsule of the cervical joints are also highly innervated by these nerves. The capsule encloses the bony portions to ensure articulation between the joints and serve as passive restraints for motion of the spine. They can become irritated by dysfunction, inflammation or through a variety of other issues. As the capsule becomes irritated the receptors can ‘refer’ pain to areas around or on the scapula. For example, joint capsule irritation in the C4-C6 area tend to refer pain right above the scapula, C6-C7 tend to refer to the inside of the shoulder blade and the mid scapular region. Below is another picture to help you visualize the pain referral patterns.
The best remedy for easing the pain that originates in spine and presents itself in the shoulder blade is to find a good therapist to combine manual therapy and active exercises. The treatment can include soft tissue mobilizations, joint mobilizations, nerve glides, facial manipulations along with controlled articular rotations, postural breathing techniques and additional active exercises. Each situation is different so find someone who can help YOU!
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