pain dorsal scapular nerve?

[mike]

Any treatment suggestions for pain from neck down to the scapulae. I think, with this patient, that it is the dorsal scapular nerve and I have done the treatment suggested in Dianes manual.
The pain still remains i.e. pain left scapulae area when turning head to the left. I think I have cleared the neck, not sure of course but a god downregulation of the sympaticus for sure (pt snoring after a while).
Sometimes when the pt has ritzopati from the neck the pain is being felt down to the scapulae. Any experience from this?

/Mike

[nari]

Hi Mike

Can you explain ritzopati a bit more?

Nari

[emad]

Nari , I googled it , seems sweden vocublary for cervical disorders Ritzopati nacke , Cervikal Ritzopati .

cheers
Emad

[Diane]

Hi mike,
Bear in mind that you may need to modify positions suggested in the manual for patients whose anatomy may vary. Eg., the dorsal cutaneous rami of T2 are extraordinarily long on some people and may overlap the medial tips of scapulae by quite a length. (I'd like to dissect a superficial back some day and find out if they anastomose with any other cutaneous nerves up there..)

[bernard]

J Neurosurg. (http://javascript%3Cb%3E%3C/b%3E:AL_get%28this,%20%27jour%27,%20%27J%20Neurosurg.%27%29;) 1999 Mar;90(3):580-2.Related Articles (http://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&DbFrom=pubmed&Cmd=Link&LinkName=pubmed_pubmed&LinkReadableName=Related%20Articles&IdsFromResult=10067935&ordinalpos=1&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVAbstract), Links (http://javascript%3Cb%3E%3C/b%3E:PopUpMenu2_Set%28Menu10067935%29;)
Hyperactive rhizopathy of the vagus nerve and microvascular decompression. Case report.

Resnick DK (http://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=Search&Term=%22Resnick%20DK%22%5BAuthor%5D&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVAbstract), Jannetta PJ (http://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=Search&Term=%22Jannetta%20PJ%22%5BAuthor%5D&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVAbstract).

Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pennsylvania 15213, USA.

A 37-year-old woman underwent microvascular decompression of the superior vestibular nerve for disabling positional vertigo. Immediately following the operation, she noted severe and spontaneous gagging and dysphagia. Multiple magnetic resonance images were obtained but failed to demonstrate a brainstem lesion and attempts at medical management failed. Two years later she underwent exploration of the posterior fossa. At the second operation, the vertebral artery as well as the posterior inferior cerebellar artery were noted to be compressing the vagus nerve. The vessels were mobilized and held away from the nerve with Teflon felt. The patient's symptoms resolved immediately after the second operation and she has remained symptom free. The authors hypothesize that at least one artery was shifted at the time of her first operation, or immediately thereafter, which resulted in vascular compression of the vagus nerve. To the authors' knowledge, this is the first reported case of a hyperactive gagging response treated with microvascular decompression. The case also illustrates the occurrence of a possibly iatrogenic neurovascular compression syndrome.

Publication Types:
Case Reports (http://javascript%3Cb%3E%3C/b%3E:AL_get%28this,%20%27ptyp%27,%20%27Case%20Reports%27%29;)PMID: 10067935 [PubMed - indexed for MEDLINE]

A Rhizopathy is a vascular nerve compression.

[emad]

Hi Bernard :

seems we were so distant from the approprite meaning . RHIZO = root .I do not know , it is my first time to see it . may be it is old .

cheers
Emad

[bernard]

You're right Emad.
The compression seems to occur, too, at the root area.

[mike]

Yes, ritzopati means projection in dermatoms (”damage” to a nervroot). Caused by, for example pathological changes in the intervertebral discs or intervertebral joints etc. It produces pain and parastesia in dermatoms. I didn’t know that you don’t use the term in other languages.
Mike

[nari]

Mike, that's fine. The word is new to me, I had heard only of rhysolysis, which is decompression of the nerve root; I should have been able to work it out, though..
Symptoms are certainly referred to the scapulae from the neck; neurodynamics would help here, but DNM would be more efficient and likely more effective.

Nari

[kongen]

Mike: Any symptoms in the shoulder area? left arm? Upper limb neural tests positive? If so, you can also try a lateral glide of the cervical segments to the right with the arm positioned in the relevant upper limb neural test.

[mike]

no, no symtoms from the arm just this tiny "rope" feeling when turning head to the left. The pt test negative on the neurodynamics.
Thanks for your tip anyway Kongen!:thumbs_up
I will try to vary the positions more during DNM on the dorsal scapular next time I see her. Maybe some rotation of the skin over the nerve will do!
Mike

[kongen]

Let us know how you do! BTW: How are your pasients responding to DNM and how is their attitude towards the treatment method? Just curious.. :)

[Sarah]

Mike,

Have you tried cervical traction to see if it has any effect?

Sarah

[Erica]

Hi Mike,
Try checking Cervico-thoracic jxn if you have not done so already.
Erica

[emad]

I would like to share here one of my odd patients , she is a 50 years woman performed an operation to put on a lense in her eye .the Doctor asked her to sleep / lie on the same shoulder 30 days . She came to me with that shoulder severe pain , can not sleep . At first I thought it might take 3 weeks and all will be fine . Now I am still seeing her for about 4 months with 70 % progress . what i meant to say , really there is individulaity in pain , therapy and managment . what works for A patient may not work for C patient !
cheers
Emad

[nari]

Emad, how did she sleep on the same side all night?? Was she prevented from moving at all? If so, no wonder she has pain.
The other thought is that the surgeon did something unusual while performing the operation - do you know how she was positioned and how long the procedure took?

You are right; every patient with the 'same pain' is different, and that needs to be recognised especially with universal protocols.

Nari

[emad]

Yes nari , The surgeon advised her to sleep on the left side for month time during night sleep . Actually , I do not know the long duration of the operation , i will ask her . Yes , I saw from time to time drop feet after labour !! I think one of the main reasons , we are still developing nation practising non-quality practice . This woman is unique in having strange huge fear from medical and hosptal procedures , at intial evaluation I assessed her she was crying .
cheers
Emad