Jonathan Aarons M.D.

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.

Parsonage Turner Syndrome, also called acute brachial neuritis, is painful condition of the shoulder and arm.  Maurice Turner and John Parsonage published the first documented case in the Lancet in 1948.  The pain comes on suddenly and is severe.  It is burning in nature and radiates from the shoulder into the arm.  Muscle weakness of the extremity follows soon after the pain.  There is occasionally numbness and tingling that is associated with the disease as well.  The pain is worse at night and causes sleep disturbance.  Although no definitive cause of Parsonage Turner Syndrome is known, it is though to occur most frequently after a viral illness or an immunization suggesting an auto-immune etiology.  Parsonage Turner syndrome is rare, occuring 1.64 times in 100,00 people and has a male predominance.  The symptoms of Parsonage Turner syndrome are similar to those of a bulging or herniated cervical disc.  Electromyography and Nerve Conduction studies can usually differentiate between them.  MRI and CT scans of the neck and shoulder can look for other causes of the symptoms such as tumors.  Treatment of Parsonage Turner Syndrome begins with pain control.  This includes non-steroidal anti-inflammatory medications and narcotics.  Medications such as Gabapentin and Pregabalin are useful as well.  Physical therapy is a cornerstone of treatment, including TENS.

Scapulocostal Syndrome is a painful syndrome of the neck and arm.  The pain usually originates in the neck and radiates to the shoulder and arm.  The pain can be dull, aching or burning.  It can radiate into the hand and cause tingling of the fingers.  The syndrome is thought to be due to an injury or overuse of the muscles of the shoulder.  The most tender spot tends to be beneath the scapula.  Rotating the scapula forward by having the patient touch the opposite shoulder will expose this tender spot and allow it to be treated.  Scapulocostal syndrome can be confused with cervical spine problems such as cervical radiculopathy.  Osteoarthritis, rheumatoid arthritis and rotator cuff problems also present with similar symptoms and must be excluded.  The neurological exam of the patient with scapulocostal syndrome is normal with the exception of trigger points in the affected muscles.  Trigger points are areas of muscle that are tender to touch.  Pressure on these muscles will reproduce the symptoms and provide some confirmation for the diagnosis.  Chest X-rays, MRI and CT scans of the shoulder and neck are useful to exclude other causes.  Electromyography and nerve conduction studies are useful to look for diseases of the muscles and nerves.   Treatment begins with conservative modalities such as heat, ice, physical therapy and non-steroidal anti-inflammatory medications.  Injection into the muscle of a dilute solution of a local anesthetic combined with a steroid may provide prolonged relief.