Because the nerve passes through the middle scalene muscle, it can be traumatized during brachial plexus injections. Role of dorsal scapular nerve entrapment in unilateral interscapular pain DSN entrapment is a frequent underlying causative factor for interscapular pain. Clinical symptoms include muscle weakness and pain in the muscles it innervates: the levator scapula and rhomboids. Suprascapular neuropathy, or suprascapular nerve entrapment, is a condition which is due to irritation and damage to the suprascapular nerve (SSN). more superficial was always the dorsal scapular nerve, and the deeper always the long thoracic nerve. The common causes of neuropathy of the dorsal scapular nerve (DSN) are work-related strain, vehicle trauma, or sports injuries. Dorsal scapular nerve injury: a complication of ultrasound -guided interscalene block. MBB of these levels provided pain relief, so RFA was performed, but did not provide adequate pain relief. Dorsal scapular nerve entrapment and the resulting neuropathy is a rare case of upper thoracic and medial scapular pain. OBJECTIVE The purpose of this paper is to elucidate this little known cause of upper back pain through a narrative review of the literature and to discuss the possible role of the dorsal scapular nerve (DSN) in the etiopathology of other similar diagnoses in this area including cervicogenic dorsalgia (CD), notalgia paresthetica (NP), SICK scapula and a posterolateral arm pain pattern. Less commonly, injury to the spinal accessory nerve can cause paralysis of the trapezius and injury to the dorsal scapular nerve can cause injury to the rhomboid. This dorsal scapular nerve is where pain and weakness can be found in those who play volleyball, boxing, or baseball. This dorsal scapular nerve is where pain and weakness can be found in those who play volleyball, boxing, or baseball. Because the nerve passes through the middle scalene muscle, it can be traumatized during. Background and Objectives The use of ultrasound for in-plane interscalene block shifts needle insertion to a more posterior approach through the middle scalene muscle, when compared with classic nerve stimulator techniques. Nerve injury should be considered when a . A characteristic feature of this disease is the appearance of pulling pain along the medial edge of the scapula. Origins of Rhomboid Major: Spinous processes of T2 through T5 vertebrae. 1. The dorsal scapular nerve innervates the rhomboid major and minor muscles, which provide scapular retraction, elevation, and medial rotation of the inferior scapular angle. This is a previously under-diagnosed cause of neck, mid-back and shoulder pain and dysfunction. Dorsal scapular nerve entrapment was first reported in applied kinesiology in 1981. dorsal scapular nerve (dsn) (latin: nervus dorsalis scapulae) neuropathy has been a rarely thought of differential diagnosis for mid scapular, upper to mid back pain.1upper to mid-thoracic and costovertebral pain and stiffness are a common entity presenting to chiropractic, physiotherapy, massage therapy and medical offices2-4especially following … There may also be pain present over the shoulder region. We then ordered electrodiagnostic testing (EDX) of the left upper extremity with attention to the dorsal scapular nerve (DSN), which showed entrapment of the nerve. Dorsal scapular nerve (DSN) (Latin: nervus dorsalis scapulae) neuropathy has been a rarely thought of differential diagnosis for mid scapular, upper to mid back pain. On examination, there may be mild winging of the scapula with the lower and medial borders of the scapula raised from the chest wall. We report a rare case of dorsal scapular nerve entrapment managed successfully by ultrasound-guided . Although, various nerve injuries or neuropathies either due to neck dissections [ 2 ] or radiotherapy [ 3 ] have been reported in the literature, neuropathy of DSN associated with head and neck malignancy or the . Dorsal scapular nerve (DSN) entrapment syndrome is an under-recognized cause of neck and shoulder pain. This approach shifts the traditional needle insertion point of the Winnie's approach, that is, in the groove between the anterior and the middle scalene muscles,1 to a more distal (either medial or lateral and caudal) puncture site.2 The increased risk of both vascular and phrenic nerve lesions, carried by the medial to . Peripheral Nerve Surgery: A Resource for Surgeons, Purpose: The objective is to provide surgeons and other healthcare providers the information critical for treating persons with complex peripheral nerve trauma., Washington University School of Medicine in St. Louis, WUSTL Positive sharp wave (1 + ) and mildly reduced recruitment were seen on electromyography of the rhomboid major muscle. This is a previously under-diagnosed cause of neck, mid-back and shoulder pain and dysfunction. We then ordered electrodiagnostic testing (EDX) of the left upper extremity with attention to the dorsal scapular nerve (DSN), which showed entrapment of the nerve. The dorsal scapular nerve is a relatively unknown nerve entrapment that causes shoulder and arm pain. The common causes of neuropathy of the dorsal scapular nerve (DSN) are work-related strain, vehicle trauma, or sports injuries. Insertion of Rhomboid Major: By fibrous attachment to medial border of scapula between spine and inferior angle. Once branching from the brachial plexus, the DSN pierces the middle scalene muscle, coursing . DSN injuries can be the origin of a well-defined chronic pain syndrome, often referred to as DSN syndrome. If the cervical spine is fixed, the levator scapulae muscle helps in elevating and rotating the scapula such that the lateral angle moves inferiorly (i.e., rotates the point of the shoulder down). Without damage to the long thoracic, spinal accessory or dorsal scapular nerves, scapular winging may also arise from . Gravity assisted right upper extremity extercises to promote scapular control following damage to the long thoracic nerve Dorsal scapular nerve (DSN) block is often performed in Japanese pain clinics to treat neck pain and katakori (a unique symptom in Japanese population characterized by myofascial pain syndromes such as shoulder girdle pain). This pain caused by repetitive or excessive traction on the nerve supplying movement to the shoulder. As with many of the shoulder and scapular injuries, any injury that affects normal scapular gliding movements can result in pain along the rotator cuff, shoulder, neck, or upper back regions. Supra scapular nerve entrapment may lead to weakness and atrophy of the the rotator cuff muscles. Even though there is a possibility of complications mentioned above, an anatomical relative po- DSN syndrome is often characterized by a dull ache along the medial border of the scapula. The symptoms of it often overlap with other conditions and can be mistaken for cervical disc herniation, rib pain or shoulder pathology. The DSN may be getting caught up in one area, or multiple areas because of muscular tension, poor posture, or both. dorsal scapular nerve to both rhomboids is typically derived from C5 neve close to intervertebral foramen and runs downward and backward thru or across surface of middle scalene, parallel to & below accessory nerve; it then passes medial to or thru levator scapulae (to which it may give a branch) and descends on the deep surface of rhomboids . Scott E Thomas et al. Dorsal Scapular Nerve Entrapment is the irritation or (literal) impingement of the dorsal scapular nerve in your midback. possible role of the dorsal scapular nerve (DSN) in the etiopathology of other similar diagnoses in this area including cervicogenic dorsalgia (CD), notalgia paresthetica (NP), SICK scapula and a posterolateral arm pain pattern. 1. Until now, there is no single article systematically summarizing the anatomy . Along this path the nerve supplies small branches to the levator scapulae, rhomboid major, and rhomboid minor muscles. Dorsal scapular nerve (DSN) (Latin: nervus dorsalis scapulae) neuropathy has been a rarely thought of differential diagnosis for mid scapular, upper to mid back pain. Fig 1: Pain in the levator scapula and rhomboids due to entrapment of the dorsal. Patients were assessed clinically and electrophysiologically. Scott E Thomas et al. 2 ) (9). Has one of your shoulders been feeling a bit off lately? I think, with this patient, that it is the dorsal scapular nerve and I have done the treatment suggested in Dianes manual. Injury in the levator scapulae or the dorsal scapular nerve which innervates it often results in levator scapulae syndrome. A common cause of this pain is entrapment of the dorsal scapular nerve. This is a previously under-diagnosed cause of neck, mid-back and shoulder pain and dysfunction. Facet injection was attempted without pain relief. Dorsal scapular nerve injury: a complication of ultrasound -guided interscalene block. [1] Although, various nerve injuries or neuropathies either due to neck dissections [2] or radiotherapy [3] have been reported in the literature, neuropathy of DSN associated with head and neck malignancy or the sequelae of treatment has not been . Dorsal Scapular Nerve Entrapment Syndrome. INTRODUCTION. Dorsal scapular neuropathy pain is commonly found in people who are active in sports. Etiologies are multiple including discogenic pain, facet syndrome, myofascial pain syndrome (MPS) of upper back muscles, and back strain in the dorsal region.1 Nerve entrapment of the posterior rami of dorsal spinal nerves has been implicated.2 Entrapment of dorsal scapular nerve (DSN) was not previously considered as an etiologic factor for . It commonly pierces the middle scalene muscle and continues deep to levator scapulae, where it then innervates the rhomboid muscles ( Fig. This nerve has been reported to be injured in strenuous weightlifting activities, shoulder dislocation, and entrapment between the scalene muscles. The involvement of the dorsal scapular nerve has been debated and an entrapment of this nerve has been postulated [1] as one of the causes. Consecutive patients with unilateral interscapular pain (n=55) were evaluated and were compared with healthy controls (n=30). If posterior pain is reproduced then this is considered a positive test. The purpose of this study was to document the DSN's anatomy and measure the oblique course it takes with regard to the middle scalene muscle. When the cause of a patient's pain is due to entrapment of the dorsal scapular nerve (DSN), determining where it's getting trapped will help guide treatment . Dorsal scapular neuropathy pain is commonly found in people who are active in sports. A descriptive research study. The dorsal scapular and long thoracic nerves had an ul-trasound appearance of predominantly hyperechoic tissue, with small areas of hypoechoic fascicles within. MBB of these levels provided pain relief, so RFA was performed, but did not provide adequate pain relief. The symptoms of dorsal scapular nerve entrapment neuropathy can be similar to other pathologies mentioned above. The pain still remains i.e. • Nerve: Dorsal scapular nerve. Electrophysiologic evaluation included motor conduction . The most common peripheral nerve disorders at the trunk region include thoracic outlet syndrome (brachial plexus), scapular winging (long thoracic nerve), interscapular pain (dorsal scapular nerve), and lumbar facet joint syndrome (medial branches of spinal nerves). Compression of the dorsal scapular nerve (DSN) is associated with pain in the upper extremity and back. The compound muscle action potential of the right dorsal scapular nerve showed low amplitude (left vs. right side: 5.2 vs. 1.6 mV) and delayed latency (left vs. right side: 4.9 vs. 6.8 ms). US-guided IBPB by posterior approach has the risk of causing nerve injury because there are risks of encounter-ing DSN and LTN. British Journal of Anaesthesia 111 (5): 840-9 (2013) 2. Dorsal scapular nerve entrapment and the resulting neuropathy is a rare case of upper thoracic and medial scapular pain. The dorsal scapular nerve (DSN) is a motor nerve arising from the ventral ramus of the C5 nerve root. Background: Dorsal scapular nerve (DSN) neuropathy has been a rarely thought of differential The motor function of the rhomboid muscles is controlled by the dorsal scapular nerve (DSN). With advances in technology and the development of . Symptoms are often similar to other conditions and can be mistaken for rib pain, cervical disc herniation, or shoulder pathology. [1][2][3] The pain can be either sharp and stabbing as well as dull and giving a sense of traction or itching. Institutional practice. DSN entrapment is a known, yet relatively uncommon, the cause of neck and/or shoulder pain. The mean distance of these ultrasonographically identified nerves to the brachial tious about some nerves, namely dorsal scapular nerve (DSN) and long thoracic nerve (LTN), in posterior approach [2]. A dorsal scapular nerve block is performed for pain in the neck, shoulder, and interscapular region. The dorsal scapular nerve is typically not anaesthetised during a supraclavicular nerve block. Facet injection was attempted without pain relief. A confirmed case of injury to the long thoracic nerve following a posterior approach to an interscalene nerve block. It can be a cause of thoracic outlet syndrome. However, to the best of our knowledge, there are only a few studies regarding anatomical variations in DSN paths around . • Innervation Route: C4, C5 → dorsal scapular nerve → rhomboid major and minor branches. The symptoms of dorsal scapular nerve entrapment neuropathy can be similar to other pathologies mentioned above. In this injury blog, we will explain the ins and out of dorasal scapular nerve entrapment. Entrapment of the dorsal scapular nerve (DSN) is an under-recognized cause of neck, upper back, and scapular pain. Peripheral nerve injury of the upper extremity commonly occurs in patients who participate in recreational (e.g., sports) and occupational activities. This is test is performed by adduction of the forward . The entrapment is often located at the middle scalene muscle, because the nerve often pierces this muscle. The dorsal scapular nerve arises from the anterior portion of cervical nerve C5. Chen reports scalene resection as a way to free compression of the dorsal scapular nerve 21. The dorsal scapular nerve is a relatively unknown nerve entrapment that causes shoulder and arm pain. Typically, patients with dorsal scapular nerve syndrome will present with a history of abnormal movement of the shoulder joint, and perhaps reduced movement. This condition can result in pain, weakness, or both depending on the cause. If this sounds like you, then you may have a problem with a nerve known as the Dorsal Scapular Nerve (DSN). This is a previously under-diagnosed cause of neck, mid-back and shoulder pain and dysfunction. Dorsal scapular nerve syndrome Dorsal scapular nerve syndrome can be caused by nerve compression syndrome. This technique involves injecting a local anesthetic into trigger points (tender points, palpable nodules) located on the line of the dorsal scapular nerve. The anesthetic loosens tension or contracture of muscles and promotes blood circulation . This can cause pain after some surgeries. Neck and rhomboid pain is a frequent patient complaint. [1] [2] [3] If this sounds like you, then you may have a problem with a nerve known as the Dorsal Scapular Nerve (DSN). However, the existence of dorsal scapular nerve irritation causing the same symptoms may be more common than previously thought. Interscapular pain is a common clinical issue with a varying aetiology including discogenic pain, facet syndrome, myofascial pain syndrome (MPS) of upper back muscles, and back strain in the dorsal region. A. Saporito. The course of the DSN begins at the neck going through the . Any treatment suggestions for pain from neck down to the scapulae. The dorsal scapular nerve arises predominately from the 5th cervical nerve and may receive . Compression of the dorsal scapular nerves leads to scapular instability and back pain From the superior angle of the clavicle it runs with an artery along the medial margin of the scapula and underneath the rhomboid muscles. This nerve has been reported to be injured in strenuous weightlifting activities, shoulder dislocation, and entrapment between the scalene muscles. The DSN originates from the ventral ramus of the spinal nerve root C5, and courses posterior inferiorly through the middle scalene muscles and between the posterior scalene , levator scapulae (to which it also provides innervation), and the serratus . pain dorsal scapular nerve? If this sounds like you, then you may have a problem with a nerve known as the Dorsal Scapular Nerve (DSN). Once branching from the brachial plexus, the DSN pierces the middle scalene muscle, coursing deep to levator scapulae and the rhomboid muscles. Dorsal scapular nerve entrapment and the resulting neuropathy is a rare case of upper thoracic and medial scapular pain. The primary cause of this syndrome is due to the impingement or entrapment of this nerve at the middle scalene muscle. Branches from the brachial plexus, including the dorsal scapular and long thoracic nerves, are often anatomically located within the middle scalene muscle. The purpose of this study was to document the DSN's anatomy and measure the oblique course it takes with regard to the middle scalene muscle. The most characteristic manifestations of dorsal scapular nerve entrapment are interscapular, shoulder and arm pain, poor arm abduction, and winged scapula. Shoulder pain may occur. to the spinal accessory nerve disrupting the trapezius muscles, or from an injury to the dorsal scapular nerve affecting the rhombus muscles (Martin & Fish, 2008). The diaganosis of this neuropathy is a challenge because these symptoms are usually considered as a cervical spine manifestation. Reg Anes Pain Med 2013;38:370 3. * PubMed Key Words: dorsal scapular nerve, dorsoscapular nerve, nervus dorsalis scapulae, mid-thoracic pain * EbscoHost that included: Alt HealthWatch, AMED, CINAHL, eBook Collection, ERIC, Medline, Nursing & Allied Health Collection, Psychology and Behavioral Sciences Collection, Rehabilitation & Sports Medicine Source, SportDiscus, American Doctoral Dissertations Key Words: dorsal scapular . DSN entrapment is a known, yet relatively uncommon, the cause of neck and/or shoulder pain. (1) Upper to mid-thoracic and costovertebral pain and stiffness are a common entity presenting to chiropractic, physiotherapy, massage therapy and medical offices (2-4) especially . To determine the contribution of dorsal scapular nerve (DSN) entrapment to interscapular pain. Compression of the dorsal scapular nerve (DSN) is associated with pain in the upper extremity and back. The dorsal scapular nerve (DSN) is a motor nerve arising from the ventral ramus of the C5 nerve root. Suprascapular nerve pain can sometimes be elicited by moving the shoulder backwards while the head is tilted to the opposite shoulder. The cause of this problems is commonly injury to the long thoracic nerve which controls the serratus anterior muscle. The dorsal scapular nerve (DSN) is a motor nerve arising from the ventral ramus of the C5 nerve root. Once branching from the brachial plexus, the DSN pierces the middle scalene muscle, coursing deep to levator scapulae and the rhomboid muscles. Editor'In-plane ultrasound guidance is often used for interscalene block. The location of pain medial to the scapula is consistent with the dorsal scapular nerve. The largest previous series to the Dorsal Scapular Nerve Syndromes The nerve entrapment involving the dorsal scapular nerve produces weakness in the levator and rhomboid muscles. With advances in technology and the development of knowledge and skills of treating practitioners, it has become apparent that this problem is . It is an under-recognized cause of neck, upper back and shoulder blade pain. The purpose of this study is to identify the surface projection of the DSN relative to . Even though entrapment of the DSN within the middle scalene muscle is typically the primary cause of pain, it is still easily missed during diagnosis. The dorsal scapular nerve is a branch of the brachial plexus.It supplies rhomboid major muscle, rhomboid minor muscle, and levator scapulae muscle.It causes the scapula to be moved medially towards the vertebral column.Dorsal scapular nerve syndrome can cause a winged scapula, with pain and limited motion. Dorsal scapular nerve syndrome is most commonly caused by a compression of the nerve due to nerve entrapment, often seen in occupations which involve raising the arms over long periods of time (e.g. D. Strengthening of the right deltoids to help stabilize the shoulder to compensate for damage to the dorsal scapular nerve B. painters, electricians) and athletes. Pain between the scapulae in the upper back is generally attributed to tight or overstretched muscles in the upper-back region. 2) Head rotation and SB to affected side increases pain in the extremity 3) If the anterior scalene is involved pulse will be altered 4) Tender rhomboids to palpation 5) Possible atrophy of rhomboids with winging ***6) MOST IMPORTANT SIGN- tenderness over 2/3 of scalene muscle, pressure is painful and causes radiation of pain into (scapula and . The entrapment of the dorsal scapular nerve may cause neck, shoulder and inter-scapular pain. 4 Since then advances in applied kinesiology have shown increasing integration of this entrapment with other conditions such as the anterior cervical subluxation (hidden cervical disc) and suprascapular nerve entrapment. When the cause of a patient's pain is due to entrapment of the dorsal scapular nerve (DSN), determining where it's getting trapped will help guide treatment and in giving the proper home exercises. A winged scapula is the most common symptom. The scapular is then retracted with the other hand. Background: Dorsal scapular nerve (DSN) syndrome is often associated by dull or aching pain along the medial border of the scapula that can radiate to the lateral aspect of the upper limb. Levator scapulae is a skeletal muscle of the neck that is responsible for lifting the scapula, or shoulder blade. British Journal of Anaesthesia 111 (5): 840-9 (2013) 2. This has classically been attributed to the C5 nerve. Both of these mechanisms can result in scapular winging. 16-08-2007, 12:50 PM. A confirmed case of injury to the long thoracic nerve following a posterior approach to an interscalene nerve block. Even though entrapment of the DSN within the middle scalene muscle is typically the primary cause of pain, it is still easily missed during diagnosis. Levator scapulae syndrome is identified by pronounced sharp pain in and around the neck. pain left scapulae area when turning head to the left. This association cannot be accounted for based on the previous understanding that only the dorsal scapular nerve mediates this location of pain at the medial border of the scapula. Etiologies are multiple including discogenic pain, facet syndrome, myofascial pain syndrome (MPS) of upper back muscles, and back strain in the dorsal region.1 Nerve entrapment of the posterior rami of dorsal spinal nerves has been implicated.2 Entrapment of dorsal scapular nerve (DSN) was not previously considered as an etiologic factor for . It is a relatively rare chronic condition that is commonly not diagnosed until other more common causes of shoulder pain . The symptoms of dorsal scapular nerve entrapment neuropathy can be similar to other pathologies mentioned above. It is innervated by branches from the ventral rami of the C3 and C4 spinal nerves and the dorsal scapular nerve (C5). This pain caused by repetitive or excessive traction on the nerve supplying movement to the shoulder. Reg Anes Pain Med 2013;38:370 3. The dorsal scapular nerve innervates the rhomboid major and minor muscles, which provide scapular retraction, elevation, and medial rotation of the inferior scapular angle. Alternatively, the 'cross-body adduction test'can be useful as a diagnostic tool for suprascapular nerve entrapment in either the scapular or spinoglenoid notch. Is the neck and mid-back region around the shoulder blade feeling stiff and heavy? A. Saporito. Chen planned the operation for the dorsal scapular nerve, but does incidentally mention the long thoracic nerve as also passing through the middle scalene. Nerve entrapment at the scalenus medius or its stretch during overhead activities induces nerve trunk pain secondary to the sensitization of nociceptors within the nerve sheath. (1) Upper to mid-thoracic and costovertebral pain and stiffness are a common entity presenting to chiropractic, physiotherapy, massage therapy and medical offices (2-4) especially . 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