Upper-to-mid-back or shoulder blade pain is a common reason people see a sports doctor or physiotherapist. Common causes include a back muscle strain, rib pain, and cervical or thoracic disc degeneration. A less common but frequently missed cause is dorsal scapular nerve entrapment. So how do we diagnose it, and what can we do about it?
What is the dorsal scapular nerve?
The dorsal scapular nerve arises from the brachial plexus — the network of nerves from the neck and armpit. It passes through a neck muscle (the middle scalene), runs down between the trapezius and levator scapulae, then deep to the rhomboids along the inner border of the shoulder blade, ending at the tip of the scapula.
The nerve supplies the muscles along the inner scapula — the levator scapulae, rhomboid minor, and rhomboid major — and the skin next to the mid-back (T5–T6) vertebrae.
What causes dorsal scapular nerve entrapment?
Several causes have been identified:
- Repetitive heavy lifting, such as weight training, which increases tension on the nerve
- Wearing a scoliosis brace, which can put traction on the nerve
- Repeated shoulder dislocation
- Acute whiplash injury
Dorsal scapular nerve entrapment symptoms
Symptoms range from mild discomfort on the inside of the shoulder blade to severe shoulder blade pain.
Typically, there’s pain and stiffness along the inner shoulder blade. The onset can be gradual or sudden, and the pain may be sharp, stabbing, or dull, sometimes spreading to the base of the neck. In some cases, the muscles along the inner scapula waste, leading to winging of the shoulder blade. Rarely, numbness and pins and needles occur over the inner aspect of the scapula.
On examination, your doctor may find stiffness and tenderness over the lower neck and upper thoracic spine, sometimes extending into the scalene muscles. Neck movement can aggravate the symptoms. Where muscle weakness is marked, abnormal scapular movement, such as winging, may be visible, and tactile sensation over the inner scapula may be reduced.
It’s essential to exclude other conditions that mimic nerve entrapment — spinal disc or joint problems, thoracic outlet syndrome, muscle strain, and shoulder joint or tendon pathology. An MRI and nerve studies help confirm the diagnosis.
How to treat dorsal scapular nerve entrapment
Start with simple, non-invasive treatment: soft-tissue therapy to the inner border of the scapula, joint mobilisation of stiff, painful neck and mid-back joints, and adjuncts such as acupuncture. Stretching exercises focus on releasing tension in the levator scapulae and rhomboids, while scapular stabilising and strengthening exercises correct muscle wasting and abnormal winging.
Medications are generally less effective. But neuropathic medications such as amitriptyline or duloxetine may be considered if the pain is nerve-like — sharp, burning, stabbing — or if there’s numbness or pins and needles.
Dorsal scapular nerve block
Where non-invasive treatment fails, a cortisone infiltration around the nerve may help. The injection site is usually at the neck near the middle scalene, or deep to the rhomboids on the inner scapula. A positive response also helps confirm the diagnosis.
A dorsal scapular nerve block should be performed under ultrasound guidance to improve accuracy and avoid important structures such as blood vessels and the lung. See a doctor experienced in nerve injections.
Frequently asked questions about dorsal scapular nerve entrapment
What does dorsal scapular nerve entrapment feel like?
Usually, pain and stiffness along the inner border of the shoulder blade, which can be sharp, stabbing, or a dull ache and may spread to the base of the neck. Some people get numbness or pins and needles over the inner scapula, and in more severe cases, the muscles waste, causing the shoulder blade to “wing”.
How is it diagnosed?
Through a careful history and examination — reproducing the pain, checking for scapular winging and altered sensation — supported by MRI and nerve conduction studies, and by excluding mimics such as disc problems, thoracic outlet syndrome, and shoulder pathology. A positive response to a targeted nerve block also supports the diagnosis.
Can dorsal scapular nerve entrapment be treated without surgery?
Yes — most cases are managed non-surgically with soft-tissue therapy, joint mobilisation, targeted stretching, and scapular strengthening. Neuropathic medication or an ultrasound-guided nerve block can help stubborn cases.
Why is dorsal scapular nerve entrapment so often missed?
Because it’s uncommon and its symptoms overlap with far more frequent causes of shoulder blade pain — muscle strain, rib pain, and neck disc problems. It’s worth considering when inner shoulder blade pain doesn’t fit those, especially with nerve-like features or scapular winging.
What makes dorsal scapular nerve pain worse?
Repetitive heavy lifting and overhead loading, sustained postures, and neck movement can all aggravate it, which is why activity modification is part of the treatment.
Final word from Sport Doctor London about dorsal scapular nerve entrapment
Dorsal scapular nerve entrapment is a less common — and easily missed — cause of neck and shoulder blade pain. See a doctor experienced in diagnosing and managing nerve entrapments so that the cause can be identified and treated correctly. A dorsal scapular nerve block is often effective.
To book an assessment with Dr Masci in London, contact the team here or call +44 (0) 203 488 0350.
Can you please advise me of any doctors in the United States that treat dorsal scapular nerve entrapment? Thank you.
Hi Sheena,
Unfortunately, I don’t know any doctors in the States who treat this condition.
Lorenzo
I go to Stretch Lab and ask for a scapula release It’s my favored thing ever!!! Not sure if it would be good for your condition but damn it feels great!