Entrapment of the dorsal scapular nerve (DSN) is an under-recognized cause of neck, upper back, and scapular pain. Symptoms are often similar to other conditions and can be mistaken for rib pain, cervical disc herniation, or shoulder pathology.
The course of the DSN begins at the neck going through the scalene muscles, then passes under the levator scapulae and rhomboids as it runs down the inside border of the scapula.
Typically, a person will complain of pain down the inside border of the scapula on one side, pain across the shoulder blades, lower neck, shoulder, and/or arm pain. It often feels like burning, sharp, stabbing, shooting, or knife-like pain and may feel like it’s actually underneath the shoulder blade.
A lot of overhead activity, reaching out in front of the body, or slouched sitting can all cause this condition to develop. When DSN entrapment is present, aggravating factors may include turning the head to the side of pain, extending the head backward, sleeping on the stomach with head towards the side of pain, and prolonged sitting.