NERVE ENTRAPMENTS

For patients in Richmond, VA seeking specialized care, understanding the mechanics of nerve entrapments is the first step toward recovery. Dr. Kevin Wall has extensive fellowship training in diagnosig and release the multiple nerves about the shoulder and scapula that may cause patients pain and weakness that otherwise might have no explanation. These nerves include the suprascapular nerve, long thoracic nerve, axillary nerve, dorsal scapular nerve, and the whole brachial plexus.

Suprascapular Nerve Entrapment

[Image Placeholder: MRI showing a paralabral cyst at the spinoglenoid notch compressing the nerve.]

Overview

The suprascapular nerve provides the power to two critical rotator cuff muscles: the supraspinatus and infraspinatus. It travels through two narrow bony tunnels: the Suprascapular Notch and the Spinoglenoid Notch. Entrapment occurs when the nerve is crushed by a tight ligament or compressed by a cyst. When entraped, this nerve often causes profound weakness in these muscles, with or without pain.

Symptoms

  • Painless or painful atrophy: Patients often look in the mirror and notice a "hole" or depression in the back of their shoulder blade.

  • Deep Ache: A gnawing, toothache-like sensation deep in the joint.

  • Weakness: Loss of external rotation strength (difficulty brushing hair or reaching backwards).

Causes

  • Paralabral Cyst: A labral tear allows joint fluid to leak out, forming a cyst that presses on the nerve.

  • Traction: Repetitive overhead motion (volleyball, baseball) stretching the nerve against the ligament.

Surgical Solutions

  • Labral Repair: When a torn labrum and a cyst are the cause, sometimes repairing the labrum is necessary to treat the nerve.

  • Suprascapular Nerve Release: Cutting the transverse scapular ligament to free the nerve.

Long Thoracic Nerve Entrapment

[Image Placeholder: Clinical photo of medial scapular winging.]

Overview

This nerve runs down the side of the rib cage and powers the serratus anterior—the muscle that holds the shoulder blade flat against the chest. Because of its long, exposed course, it is vulnerable to injury from viral illness or traction. Injury here may cause scapular winging.

Symptoms

  • Pain: Signficant nerve pain along the course of the nerve, down the side of the chest wall.

  • Scapular Winging: The bottom of the scapula protrudes aggressively.

  • Weakness: Inability to perform a push-up or punch forward.

  • Neck Pain: Secondary spasm in the trapezius as it tries to compensate.

Causes

  • Parsonage-Turner Syndrome: An inflammatory attack on nerves around the shoulder.

  • Blunt Trauma: Being hit in the ribs or a severe traction injury to the neck.

Treatment

  • Non-Operative: Physical therapy and medications.

  • Long Thoracic Nerve Decompression: An endoscopic procedure to free up the nerve if scar tissue or fibrous bands are compressing it.

  • Pectoralis Major to Scapula Transfer: If the nerve is permanently dead, there is severe winging, and no recovery is demonstrated with physical therapy then the pectoralis major muscle can be transferred to the scapula to do the work of the serratus.

Axillary Nerve Entrapment

[Image Placeholder: Diagram of the Quadrangular Space boundaries.]

Overview

The axillary nerve powers the deltoid (the main lifter of the arm) and the teres minor. It exits the back of the shoulder through a small window of muscles called the Quadrilateral (Quadrangular) Space. Quadrilateral Space Syndrome (QSS) is a rare condition where fibrous bands or hypertrophied muscles strangle the nerve in this window. It is common in overhead athletes but can occur in anyone, especially if there was trauma to that area.

Symptoms

  • Deltoid Fatigue: The arm feels heavy or dead with overhead activity.

  • Numbness: Loss of sensation over the "military patch" area (outside of the upper arm).

  • Vague Posterior Pain: Aching in the back of the shoulder that worsens with throwing.

Treatment

  • Non-Operative: Physical therapy and medications.

Dorsal Scapular Nerve Entrapment

[Image Placeholder: Illustration showing the nerve passing through the Middle Scalene muscle.]

Overview

This nerve powers the rhomboids (major and minor) and the levator scapulae. Its primary job is to retract the scapula (pull it toward the spine). When the scapula is not behaving properly, like in functional STAM, then this nerve can get improperly stretched or compressed and begin to develop pain. Scapulothoracic bursitis commonly occurs in conjunction with this problem.

Symptoms

  • Medial Border Pain: Burning pain along the spine edge of the shoulder blade.

  • Hollowing: Atrophy of the muscle between the spine and scapula.

  • Mild Winging: A subtle lateral drift of the scapula.

Treatment

  • Non-Operative: Physical therapy and medication.

  • Dorsal Scapular Nerve Decompression: An endoscopic procedure where the scapulothoracic space is viewed with a small camera and any scar tissue or fibrous bands around the nerve are removed and the space is often cleaned out.

Brachial Plexus (Thoracic Outlet Syndrome)

[Image Placeholder: Diagram showing the brachial plexus passing under the Pectoralis Minor.]

Overview

Thoracic Outlet Syndrome (TOS) is a compression of the entire bundle of nerves (Brachial Plexus) that serves the arm. While this can happen in the neck (Scalenes) or at the first rib, Dr. Wall specializes in Neurogenic TOS caused by scapular dyskinesis. Specifically, a tight or scarred pectoralis minor muscle can compress these nerves. TOS is a very complicated condition with many forms that can present in many different ways. A thorough workup with multiple different types of surgeons is essential.

Symptoms

  • Paresthesias: Numbness and tingling in the hand or forearm.

  • Heaviness: The arm feels like it falls asleep when held overhead for hair grooming.

  • Scapular Dyskinesis: Often associated with Anterior Tilting of the scapula (fSTAM 1).

Treatment

  • Non-Operative: Physical therapy and medications.

  • Arthroscopic Pectoralis Minor Release: A minimally invasive procedure to cut the tight tendon, instantly taking pressure off the nerve bundle.

  • First Rib Resection: When present, this requires a referral to Thoracic Surgery for bony decompression.