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Neck Pain due to a common, yet underdiagnosed problem: Levator Scapulae Syndrome

David S. Klein, MD FACA FACPM

Are you one of the many people who struggle with neck and shoulder pain? You’re not alone. These complaints are frequent across various age groups and lifestyles. One often overlooked cause of these discomforts is nerve entrapment near the levator scapulae muscle and the scapula. This post explores the causes, symptoms, and management of nerve entrapment in this area, offering practical insights for those experiencing chronic neck and shoulder pain.


Understanding the Anatomy

Levator Scapulae Entrapment of the C-5 dorsal root causes neck and shoulder pain
Tendinitis at this point causes pain in the shoulder, neck and may radiate to the pectoral muscles; referred pain to the thumb, index and middle fingers.

The levator scapulae muscle is positioned at the back and side of the neck, connecting the cervical vertebrae to the upper border of the scapula. Its main job is to stabilize and elevate the shoulder blade, which helps with neck movement. However, if nerves around this muscle become compressed or entrapped, significant pain and discomfort can result.



The Levator Scapulae elevates the head, elevates the shoulder and is easily injured
The Levator Scapulae Muscle is important in posture but is delicate and easily injured.

The brachial plexus, a network of nerves communicating between the spine and the arm, passes close to the levator scapulae. If inflammation occurs in this area, the brachial plexus may become irritated, resulting in pain that radiates from the neck into the shoulder and down the arm. Statistics show that approximately 75% of people will experience some form of neck pain in their lifetime, with a significant percentage attributing it to nerve-related issues.

Eye-level view of human skeletal anatomy highlighting the levator scapulae muscle
Skeletal anatomy showing levator scapulae muscle location.

Causes of Nerve Entrapment


Nerve entrapment at the levator scapulae can result from several factors, including:


  1. Poor Posture: Slouching or maintaining a forward head posture while sitting at a desk can chronically strain the levator scapulae. Research indicates that 80% of office workers may exhibit neck pain due to poor posture, leading to nerve compression over time.


  2. Repetitive Strain: Engaging in repetitive activities like lifting, overhead reaching, or long hours of computer use can create muscle tension and inflammation. In a study, 60% of individuals in labor-intensive jobs reported neck pain related to repetitive strain.


  3. Stress and Tension: Mental stress doesn't just affect moods; it tightens muscles, increasing the risk of nerve entrapment. Studies show that stress-related muscle tension can significantly increase neck pain symptoms.


  4. Injury: Whiplash or other neck injuries can alter muscle balance and positioning, contributing to nerve compression. Data suggests that about 50% of individuals with whiplash report persistent neck pain months after the injury. The Levator Scapulae can be injured with slip and fall accidents, lifting injuries and with general 'wear and tear-repetitive use situations.'


  5. Degenerative Conditions: Conditions like osteoarthritis can result in bone spurs, which can further compress nerves. In older adults, degenerative changes can be a leading cause of nerve-related neck pain.


Understanding these causes is crucial for finding effective treatment and prevention strategies.

Levator Scapulae Syndrome
The pain is often worse with rotation to the opposite side

Symptoms to Watch For


Identifying the symptoms of nerve entrapment in the levator scapulae area is essential for timely intervention. Common symptoms include:


  • Localized Pain: Sharp or dull pain localizing in the neck and upper shoulder region.

  • Radiating Pain: Discomfort that travels down the arm, potentially into the shoulder.

  • Numbness or Tingling: A tingling sensation in the arm or hand, indicating nerve compression.

  • Muscle Weakness: Difficulty raising the arm or gripping objects due to muscle weakness linked to nerve irritation.


If any of these symptoms persist for more than a week, consulting a healthcare provider is wise. Early diagnosis can prevent further complications and enhance recovery.


A combination of interventions, used simultaneously, is usually necessary to get Levator Scapulae Syndrome under control
Therapeutic massage combined with oral anti-inflammatories, muscle relaxants and nerve blocks are often used, in conjunction. This problem is benign, non-life or limb threatening, but it is truly, a pain in the neck.

Diagnosis and Treatment Options


To diagnose nerve entrapment, healthcare providers will conduct a comprehensive medical history and physical examination. Techniques such as MRI or ultrasound may be employed to evaluate the structures near the levator scapulae.


Once diagnosed, effective treatment options include:


  1. Physical Therapy: A qualified physical therapist can design a personalized exercise program to strengthen and stretch neck and shoulder muscles. Studies indicate that physical therapy can reduce neck pain by up to 60%.


  2. Chiropractic Care: Spinal adjustments can help restore alignment and alleviate nerve pressure. Many patients report significant pain relief after chiropractic treatment.


  3. Massage Therapy: Therapeutic massage can reduce muscle tension and promote relaxation in the affected area. Research shows that around 70% of patients experience relief from chronic neck pain following regular massage.


  4. Pain Management: Anti-inflammatory medications or corticosteroid injections may temporarily relieve pain and swelling. An estimated 30 to 90% of those suffering from neck pain find relief through these medications, and injections often provide immediate relief.


  5. Home Care: Utilizing heat or cold packs, along with gentle stretching exercises at home, may assist in symptom management.


  6. Topical Medications: The use of topical anti-inflammatories can provide substantial and nearly immediate relief of pain, if properly applied to the attachment of the Levator at the tip of the Scapula.


    There are any number of topical medicines, prescription and non-prescriptions, available.

    My two favorites are topical MSM, marketed by our practice, nation-wide, as "Kink-Ease," and the widely available topical diclofenac "Voltaren." My preference for the use of Kink-Ease is based on the lower cost per treatment, value per dosage, but also on the fact that it was invented/developed by me.


    I use Voltaren with patients and recommend it many times daily, but while it can be used effectively as a sole agent, it works much better when alternated with the Kink-Ease lotion.


    Voltaren Arthritis Pain Gel
    Voltarin topical diclofenac is now OTC available.

    Kink Ease MSM Salve for arthritis tendinitis bursitis
    Kink-Ease MSM Cream 16 oz. $44.95/bottle Three for $114.62



Recognizing the appropriate interventions is key to alleviating pain and restoring function.


Preventative Measures


Preventing nerve entrapment requires attention to posture and lifestyle habits. Here are some strategies to consider:


  • Maintain Proper Posture: Ensure your sitting and standing positions support a neutral spine. Ergonomically designed office equipment can greatly enhance posture.

  • Incorporate Regular Exercise: Engage in activities that promote flexibility and strength in the neck and shoulders, reducing tension and future pain episodes.

  • Take Frequent Breaks: For those in desk jobs, taking regular breaks to stand, move around, and stretch can combat muscle tightness. A break every hour can significantly reduce discomfort.

  • Manage Stress: Use relaxation techniques such as yoga, meditation, or deep breathing exercises to lessen muscle tension and anxiety.


Implementing these preventative measures can significantly decrease the likelihood of encountering neck and shoulder pain in the future.



Taking Action on Your Health


Neck and shoulder pain caused by nerve entrapment at the levator scapulae muscle and scapula is a common but often undiagnosed issue. By understanding the anatomy, recognizing the symptoms, and exploring effective treatment options, individuals can take charge of their health. Increasing awareness and proactive management can improve quality of life, reducing the impact of pain on daily activities. If you are grappling with these symptoms, consult a healthcare professional to discuss your diagnosis and potential care options.



REFERENCES:



 


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Orlando Florida Longwood Florida Functional Medicine Hormone Replacement Pain  Medicine
David S. Klein, MD FACA FACPM

David S. Klein, MD, FACA, FACPM

1917 Boothe Circle, Suite 171

Longwood, Florida 32750

Tel: 407-679-3337

Fax: 407-678-7246






Orlando Florida Longwood Florida Functional Medicine Hormone Replacement Pain  Medicine
David S. Klein, MD Functional Medicine Physician


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