Disclosures: Benjamin Westerhaus, MD: No financial relationships or conflicts of interest

Case Description: The patient, with a history of C5-7 fusion seven years prior, was initially referred for sub-acute left shoulder pain. Initial history and physical exam were consistent with chronic cervicalgia and subacromial impingement, and an MRI was obtained to rule out rotator cuff tear. Imaging was negative for tear and subacromial bursa injection was performed. The patient did not experience pain relief and we directed therapy toward cervical spondylosis as the likely pain generator. After left C4 and C5 medial branch blocks (MBB), radiofrequency ablation (RFA) was performed, cervicalgia improved but periscapular pain persisted. After unsuccessful conservative care, MRI of thoracic spine was obtained that demonstrated spondylosis at T5-T6 and T6-T7. Facet injection was attempted without pain relief. MBB of these levels provided pain relief, so RFA was performed, but did not provide adequate pain relief. We then ordered electrodiagnostic testing (EDX) of the left upper extremity with attention to the dorsal scapular nerve (DSN), which showed entrapment of the nerve. After conservative management failed, a nerve block proximally was attempted and provided the patient with remarkable pain relief. A referral was made for hydrodissection of the DSN.

Setting: Outpatient clinic.

Patient: A 54-year-old female with left shoulder pain and cervicalgia. Assessment/

Results: At 8 weeks post-procedure, the patient demonstrated marked improvement in left shoulder pain. She is seeking employment and pursuing a master’s degree in education, after stopping work two years prior due to this pain.

Discussion: This is the first case reported in the available literature to describe successful treatment of dorsal scapular nerve entrapment with hydrodissection.

Conclusion: Dorsal scapular nerve entrapment should be considered in patients with recalcitrant periscapular pain with or without cervicalgia. EDX can aid in diagnosis of DSN entrapment and hydrodissection may be a reasonable treatment option.

Level of Evidence: Level V

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/dorsal-scapular-nerve-entrapment-as-a-masquerader-of-shoulder-pain-and-cervicalgia-successfully-treated-with-hydrodissection-a-case-report/