Faculty of Medicine, Physical Medicine, Rheumatology, and Rehabilitation Department, Main University Hospital, Alexandria University, Alexandria, Egypt.
Arch Phys Med Rehabil. 2013 Jun;94(6):1118-25. doi: 10.1016/j.apmr.2012.11.040. Epub 2012 Dec 6.
To determine the contribution of dorsal scapular nerve (DSN) entrapment to interscapular pain.
A descriptive research study.
Institutional practice.
Consecutive patients with unilateral interscapular pain (n=55) were evaluated and were compared with healthy controls (n=30). Patients were assessed clinically and electrophysiologically. Electrophysiologic evaluation included motor conduction study of the DSN and electromyography of rhomboid major and levator scapula. Electrophysiologic workup for exclusion of other disorders was carried out.
Not applicable.
Not applicable.
Unilateral interscapular pain was reported by all patients. Etiologies of pain varied among the studied patients. Scapular winging was observed in 9 patients (16.4%). Electrophysiologic abnormalities consistent with DSN lesion were detected in 29 patients (52.7%). Twenty-five patients demonstrated electromyographic abnormalities recorded from rhomboid major and levator scapula. Prolonged latency of the compound muscle action potential was found in 4 patients on the affected side.
DSN entrapment is a frequent underlying causative factor for interscapular pain. Nerve entrapment at the scalenus medius or its stretch during overhead activities induces nerve trunk pain secondary to the sensitization of nociceptors within the nerve sheath. Myofascial pain syndrome of the rhomboids with entrapment of the nerve by taut bands is another source of pain. Last, the development of scapular winging may induce stretch of the cutaneous medial branches of the dorsal primary rami of thoracic spinal nerves. This would refer pain to the interscapular region. Awareness of possible DSN entrapment in cases of upper dorsalgia is highly indicated.
确定肩胛上神经（DSN）卡压对肩胛间疼痛的影响。
描述性研究。
机构实践。
连续 55 例单侧肩胛间疼痛患者（n=55）进行评估，并与健康对照组（n=30）进行比较。患者进行临床和电生理评估。电生理评估包括 DSN 的运动传导研究和菱形肌和斜方肌提肌的肌电图。进行了排除其他疾病的电生理检查。
不适用。
不适用。
所有患者均报告单侧肩胛间疼痛。疼痛的病因在研究患者中各不相同。9 例患者（16.4%）出现肩胛翼状畸形。29 例患者（52.7%）检测到与 DSN 病变一致的电生理异常。25 例患者从菱形肌和斜方肌提肌记录到肌电图异常。在受影响的一侧，4 例患者的复合肌肉动作电位潜伏期延长。
肩胛上神经卡压是肩胛间疼痛的常见潜在病因。中斜角肌的神经卡压或其在头顶活动中的伸展会导致神经干疼痛，这是由于神经鞘内伤害感受器的敏化所致。菱形肌的肌筋膜疼痛综合征伴紧张带卡压神经也是疼痛的另一个来源。最后，肩胛骨翼状畸形的发展可能会导致胸脊神经背侧初级分支的皮内侧支伸展。这将使疼痛放射到肩胛间区域。在出现上背痛的情况下，高度提示可能存在肩胛上神经卡压。
