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.