Nerve Impingement Near the Shoulder (Pinched Nerve)

Where the nerve gets pinched

The nerves to the shoulder and arm start as nerve roots leaving the spinal cord in the neck. They join into a network, the brachial plexus, which passes between the collarbone and first rib and then divides into named nerves. Compression can happen at several points:

Cervical radiculopathy: the most common cause

In people over 40, the usual cause is wear and tear in the neck (cervical spondylosis). Bone spurs and thickened ligaments narrow the opening where the nerve root exits. In younger people, a herniated disc is more likely, sometimes after lifting or a sudden movement. The C6 and C7 roots are affected most often.

Symptoms

• Radiating pain: burning, sharp or electric, often from the neck or top of the shoulder down the arm in a band
• Pain between the shoulder blades on one side
• Tingling ("pins and needles") or numbness in part of the arm or hand
• Weakness, such as dropping objects or difficulty lifting the arm
• Pain worse with certain positions, such as looking up, coughing or turning the head
• Relief when resting the hand on top of the head, a classic sign of a pinched nerve root

Pinched nerve or shoulder joint problem?

Shoulder joint problems such as a rotator cuff injury or frozen shoulder cause pain with arm movement, usually felt at the outer upper arm, and rarely cause tingling below the elbow. Nerve impingement causes pain that travels past the elbow, numbness or tingling, and pain triggered by neck movement. Both can occur together.

Causes and risk factors

• Age-related disc and joint changes in the neck
• Disc herniation
• Repetitive overhead work or sports (volleyball, baseball, swimming)
• Poor posture with the head held forward for long periods
• Heavy bags carried on one shoulder
• Neck or shoulder injury, including whiplash
• Cysts, especially a ganglion cyst pressing on the suprascapular nerve
• Less often: tumors, infection or inflammation of the brachial plexus. Brachial neuritis causes sudden, severe shoulder pain followed days later by weakness, often after an infection, vaccination or surgery.

Diagnosis

The doctor will examine your neck and shoulder movement, muscle strength, reflexes and skin sensation to work out which nerve is involved. The Spurling test (gently tilting and pressing down on the head) reproduces arm pain when a nerve root is pinched.

• X-rays show arthritis and bone spurs.
• MRI of the neck shows discs, nerve roots and the spinal cord. It is usually reserved for symptoms lasting more than 6 weeks, significant weakness or red flags.
• Nerve conduction studies and EMG confirm nerve damage and distinguish a neck problem from carpal tunnel syndrome or brachial plexus problems.
• Ultrasound or MRI of the shoulder if a cyst or rotator cuff problem is suspected.

Treatment

First-line treatment

• Stay active, but avoid aggravating positions such as prolonged looking up, heavy lifting and overhead work. Strict rest and neck collars are not recommended beyond a few days.
• Pain relief: acetaminophen (paracetamol) or anti-inflammatories such as ibuprofen, following the label dose. NSAIDs are not suitable for everyone, including people with stomach ulcers or kidney disease.
• Heat or ice for 15 to 20 minutes at a time.
• Physical therapy: neck and shoulder blade strengthening, posture work, nerve gliding exercises and sometimes traction.
• Prescription medicines for nerve pain or a short course of oral steroids, at your doctor's discretion.

If symptoms persist

• Epidural or nerve root steroid injection guided by imaging can reduce pain for some weeks to months.
• Surgery is considered for progressive weakness, signs of spinal cord compression, or severe pain that has not improved after about 6 to 12 weeks. Options include removing the disc and fusing the vertebrae (ACDF), artificial disc replacement, or widening the nerve exit (foraminotomy). Suprascapular nerve release or cyst removal may help selected people.

Outlook

Most pinched nerves near the shoulder improve without surgery: around three-quarters of people with cervical radiculopathy are better within a few months. Numbness and weakness can take longer to recover than pain. Symptoms may come back, so long-term posture and strength work help.

Frequently asked questions

How do I know if I have a pinched nerve in my shoulder?

Pain that shoots or burns from the neck or shoulder down the arm, especially past the elbow, with tingling, numbness or weakness, suggests a pinched nerve. Pain that gets worse when you tilt your head back or toward the sore side also points to a nerve root in the neck.

How long does a pinched nerve in the shoulder take to heal?

Most cases improve noticeably within 4 to 6 weeks and settle within 3 months with self-care and physical therapy. Numbness or weakness can take longer. See a doctor if weakness worsens or there is no improvement after 6 weeks.

Can a pinched nerve cause pain in the shoulder blade?

Yes. A pinched nerve root in the lower neck often causes a deep ache or burning along the inner edge of the shoulder blade, sometimes before any arm pain starts. Suprascapular nerve entrapment causes aching over the back of the shoulder blade.

Should I see a doctor for a pinched nerve?

See a doctor if the pain is severe, lasts more than a few weeks, or comes with weakness, numbness or muscle wasting. Go to the ER for weakness in both arms or legs, balance problems or loss of bladder or bowel control.

What is the best sleeping position for a pinched nerve in the shoulder?

Sleep on your back or on the pain-free side with a pillow that keeps your neck level with your spine. Avoid sleeping on your stomach with your head turned. Resting the painful arm on a pillow, or above your head if it eases pain, can help.