Jonathan Aarons M.D.

The Pronator Syndrome is a painful condition of the forearm and hand.  It is caused by compression of the median nerve by the pronator teres muscle.  The pain is located in the forearm and radiates to the first three and half fingers of the hand.  It may radiate proximally as well into the elbow.  It is made worse may repetitive motions.  It is most common in middle aged females but also occurs in men whose job includes these repetitive motions.  It has similar symptoms both to both tennis elbow and carpal tunnel syndrome and can be easily mistaken for either one.  Testing includes X-rays and MRIs of the forearm to exclude other causes such as fractures and tumors.  Electromyography and Nerve Conduction studies are useful to determine the site of the nerve injury and to look for other coexisting problems such as a herniated cervical disc.  Treatment begins with conservative modalities such as rest, splinting, heat, ice, physical therapy and non-steroidal anti-inflammatory medications.  In severe cases, surgical decompression of the nerve may be necessary.

Infraspinatus tendinitis is one cause of pain in the shoulder.  The infraspinatus muscle is one of the muscles in the rotator cuff.  The belly of the muscle lies below the spine of the scapula and its tendon inserts on the back of the greater tuberosity of the humerus.  It is responsible for external rotation of the shoulder as well as elevation of the shoulder.  The pain of infraspinatus tendinitis is located in the back of the shoulder and the deltoid muscle as well.  The pain occurs when elevating the arm or rotating the shoulder backwards.  The pain may occasionally radiate down the arm and into the fingers.  Infraspinatus tendinitis is usually cause by excessive use either at the gym or by activities involving over the head motions.  The patient may also complain of a “catch” while elevating the shoulder.  If the disease is not treated, the range of motion of the shoulder is progressively diminished causing pain with everyday activities.  Sleep disturbance is also common.  X-rays and MRIs of the shoulder are useful to look for other causes of pain such as fractures or rotator cuff tears.  Blood work is useful to screen for autoimmune diseases.  Treatment begins with conservative modalities such as heat, ice, physical therapy and non-steroidal anti-inflammatory medications.  Injection into the area of the infraspinatus muscle and tendon with a local anesthetic and a steroid may decrease pain and allow more effective physical therapy.

Supraspinatus tendinitis is a common cause of shoulder pain in those people performing overhead activities such as tennis, swimming or baseball.  The rotator cuff of the shoulder consists of four muscles; the supraspinatus, infraspinatus, teres minor and supscapularis.  The supraspinatus is responsible for abduction, moving the arm away from the body.  The supraspinatus muscle may be squeezed by abnormal bony pathology or by inflamed tendons and bursa in the shoulder.  The pain of supraspinatus tendinitis is felt in the upper arm.  The intensity is moderate to severe.  The pain is often felt at night when sleeping on the shoulder.  There is pain over the greater tuberosity of the humerus (upper arm bone).  The pain worsens when elevating the arm away from the body.  As the disease progresses, it becomes more difficult to raise the arm. Testing includes history and physical exam by your doctor.  X-rays of the shoulder will look for abnormal bony pathology.  CT and MRI scans can look for problems in the rotator cuff and shoulder joint.  Initial treatment is conservative and includes heat, ice, physical therapy and non-steroidal anti-inflammatory medications.  Injection into the supraspinatus tendon of a local anesthetic and a steroid may both provide a diagnosis and decrease the pain of supraspinatus tendinits.

Suprascapular nerve entrapment is responsible for a small amount of cases of shoulder pain and is therefore easily overlooked as a cause.  It usually occurs in those people doing overhead activities.  Athletes and patients with rotator cuff tears are at higher risk for these problems.  Suprascapular nerve entrapment may also occur as the result of wearing heavy backpacks.  The nerve is compressed as is traverses a small area of bone called the suprascapular notch.   The suprascapular nerve provides innervation to the supraspinatus and infraspinatus muscles as well as is responsible for sensation from about 70% of the shoulder.  It can be injured by repetitive trauma, compression or stretching during activities.  Suprascapular nerve entrapment can present with a dull, aching pain in the shoulder.  The pain may be worsened by doing overhead activities with the shoulder.  Entrapment of the nerve may also present with muscle weakness alone without pain.  Suprascapular nerve entrapment may be confused with cervical disc disease, shoulder problems such as bursitis and tendinitis, as well as rotator cuff tears.  X-rays are useful to look for fractures.  MRI of the shoulder can look for shoulder pathology such as rotator cuff tears.  Electromyography and Nerve Conduction Studies can test for intrinsic muscle problems and look for nerve damage.  Initial treatment of suprascapular nerve entrapment is conservative and includes physical therapy and non-steroidal anti-inflammatory medications.  Injections into the suprascapular notch with a dilute solution of a local anesthetic and steroid may decrease pain and inflammation of the nerve and aid physical therapy.

The Neck tongue syndrome is a constellation of symptoms that include pain and numbness of one half of the tongue when turning the head to one side.  This condition may occur after trauma or occur due to bony compression of the second cervical nerve from congenital anomalies.  The pain is intermittent and usually occurs with motion of the neck.  There is no clear male or female predominance to this problem.  Aside from numbness of the tongue, there is no other neurological abnormalities.  MRI scans are useful to look for any abnormalities of the cervical spine or brain that may cause this problem.  Since other diseases of the head and neck, such as tumors, dental and sinus problems and demyelinating diseases can also cause these symptoms, they must be excluded as causes of the problem.  Initial treatment of Neck Tongue Syndrome is conservative and includes heat, ice, non-steroidal anti-inflammatories and physical therapy.  A nerve block to the second cervical nerve root with a local anesthetic and a steroid may be useful.  In refractory cases, surgery of the cervical spine may be needed.