Diffuse dull and radiating pain around shoulder

Introduction The dull pain and radiation pain diffused in the shoulder area is a clinical manifestation of suprascapular nerve compression. Scapular nerve compression is one of the most common causes of shoulder pain. Some scholars abroad believe that this sign accounts for 1% to 2% of all patients with shoulder pain. In 1909, Ewald described a "neuritis" on the shoulder after trauma. In 1926, Foster reported 16 cases of suprascapular neuropathy. In 1948, 4 of 136 cases of shoulder pain reported by Parsonage and Turner had scapular neuritis. These are the first reports of scapular nerve compression syndrome. In 1959, Kopell and Thompson described in detail the compression of the scapular nerve on the incision of the scapula and referred to as the suprascapular nerve entrapment (SNE). Case reports of nerve compression on the scapula have gradually increased. In 1982, Aiello et al. reported cases of SNE compression at the scapular ankle joint. In 1987, Ferretti et al. reported cases of SNE in volleyball players. In recent years, there have been reports of subscapular muscle atrophy and some special compression cases.

Cause

Causes

Scapular nerve compression can be caused by acute injury such as scapular fracture or ankle injury. Dislocation of the shoulder joint can also damage the superior scapular nerve. The shoulder flexion, especially the flexion of the scapula when it is fixed, makes the activity of the superior scapular nerve decrease and is easy to damage. Tumors, ankle joint nodular cysts, and fissures on the scapular scapula are the main causes of scapular nerve compression. It has been reported that the traction of the rotator cuff injury can also cause damage to the superior scapular nerve. Various local lipomas and nodules can compress the trunk of the superior scapular nerve or the branch of the subscapular nerve, causing compression.

Pathogenesis

Sunderland believes that the nerves of the suprascapular nerve are relatively fixed when they are traversed through the scapula, making it easy to be damaged during repeated movements. Repeated movements of the scapula and ankle joint cause the nerve to rub at the incision, and the nerve inflammatory reaction occurs. Edema, which can cause compression damage. It is known that the movement of the distal scapula can cause the suprascapular nerve to tighten, causing a "suspension effect", causing the nerve to hang around the notch and cause neuropathy. Mizuno et al reported that when the paralysis of the paraspinal nerve, the scapula sag down the lateral side of the scapula can cause the superior scapular nerve to be pulled by the transverse ligament of the scapula. The scapular nerve shoulder joint can cause ankle pain, which is the most common symptom in the clinic. The scapular neuropathy is mainly unilateral, and there are reports of bilateral morbidity.

an examination

Related inspection

Electromyography mammography X-ray examination of bone and joint soft tissue CT examination

The diagnosis of suprascapular nerve compression syndrome needs to be diagnosed by careful examination of the medical history and physical examination of the system and myoelectric examination.

1. Scapula pull test: The patient placed the affected hand on the contralateral shoulder and placed the elbow in the horizontal position, so that the affected elbow was pulled to the healthy side, which can stimulate the compression of the scapular nerve and induce the shoulder. Pain.

2. Partial closure of lidocaine injection: 1% lidocaine was injected at the tender point on the scapula. If the symptoms are relieved quickly, it will help diagnose the supracondylar nerve compression syndrome.

3. Myoelectric examination: EMG and nerve conduction velocity examination contribute to the diagnosis of suprascapular nerve compression syndrome. Khaliki found that patients with suprascapular nerve compression syndrome had prolonged evoked potentials. The supraspinal muscle fibers can have positive waves, fibrillation waves, and reduced or disappeared motor potentials.

4. X-ray examination: The scapula is tilted 15° to 30° to the tail on the posterior anterior X-ray film to check the shape of the scapula on the scapula, which is helpful for diagnosis.

Differential diagnosis

Shoulder pain and discomfort: shoulder pain and discomfort, also known as leakage of shoulder wind, inflammation around the shoulder joints, fifty shoulders, and shoulder joint dysfunction are also known as frozen shoulders.

Pain in the shoulder: due to visceral disease, causing shoulder pain, or hyperalgesia, known as suffering. Symptoms appear to be slow, dull, or uncomfortable. They do not completely conform to the nerve direction, the area is blurred, and the pain is blurred.

Neck and shoulder pain: neck and shoulder pain is mainly around the shoulder joint, so it is called shoulder joint inflammation, referred to as shoulder periarthritis, commonly known as condensed shoulder, leaking shoulder wind or frozen shoulder. The onset of the disease is mostly caused by freezing, trauma, and infection of tissues around the shoulder joints, such as tendons and bursae. Many patients are caused by rheumatism. The main symptoms are continuous pain in the neck and shoulders. The upper limbs of the affected side are elevated, rotated, and the swinging is limited. The feeling of cold in the wind is heavy and painful. If not treated in time, prolonged prolongation can cause joint adhesion, the upper limbs of the affected side become thin, weak and even form a disuse atrophy. The disease is more common in middle-aged people around the age of 50, and young people and the elderly also occur. The pain is characterized by pain in the movement of the arm, no pain or slight pain, and it is difficult to comb, dress, lift, and lift. When the attack is severe, it can be painful and it will not sleep all night.

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