Shoulder Conditions

Shoulder Nerve Pain

Shoulder Nerve Pain: Causes, Symptoms and Treatment Options

Shoulder nerve pain refers to pain, weakness, or altered sensation caused by irritation, compression, or injury to the nerves that supply the shoulder, arm, and hand. It can feel sharp, burning, electric, aching, or associated with pins and needles, and may extend from the shoulder into the arm or neck.

Nerve-related shoulder pain can arise from the shoulder itself or from structures nearby, and accurate diagnosis is essential to guide appropriate treatment.

What is the pectoralis major muscle?

Shoulder nerve pain can result from a range of conditions affecting the nerves as they travel from the neck to the arm.

Common causes include:

Nerve compression within the shoulder

Nerves can be compressed or irritated as they pass through narrow spaces around the shoulder, leading to pain or weakness.

This may occur due to:

Cervical spine (neck) conditions

Some shoulder nerve pain originates in the neck rather than the shoulder itself.

Conditions such as:

Cervical spine (neck) conditions can cause pain that spreads (radiates) into the shoulder and arm, sometimes mimicking a shoulder problem. This is not uncommon.

Brachial plexus injury

The brachial plexus is a network of nerves that controls movement and sensation in the shoulder and arm. Injury to this nerve group may occur following trauma, traction injuries, or high-energy sporting or motor vehicle accidents and can lead to pain, weakness, or numbness.

Inflammation of the brachial plexus without injury, called brachial neuritis, is an uncommon cause of nerve related pain, often with weakness, numbness or pins and needles in the shoulder, arm or hand. It may follow viral illness however its exact cause is often not identified. It may persist for up to 2 years but usually resolves. Steroid medication such as prednisolone may be helpful in its initial stages.

Suprascapular nerve compression

Compression of the suprascapular nerve can occur due to:

Suprascapular nerve compression may result in shoulder pain and weakness, particularly affecting the rotator cuff muscles. It may affect both the supraspinatus and infraspinatus muscles, or the infraspinatus alone depending on the location of compression.

Thoracic outlet syndrome

Compression of nerves and/or the main artery supplying blood to the arm as they pass out of the neck and across the first rib into the shoulder.

Symptoms of an aching pain with burning and tingling in the neck and shoulder to the hand, often involving the small finger.

Fatigue and weakness

If the artery is compressed the arm and hand may feel cold or change colour

Symptoms are worse with repetitive overhead movements.

There may be an unusual anatomical abnormality present such as an extra rib (cervical rib)

Post-surgical or Post-traumatic nerve irritation

Nerve irritation can occasionally develop following shoulder injury, or may occur due to inflammation, swelling, or scar formation after a fracture or other injury to the shoulder.

Symptoms of shoulder nerve pain

Symptoms vary depending on the nerve involved but may include:

Sharp, burning, or shooting pain
Pain that radiates away from the shoulder into the arm or hand
Constant pain rather than mainly related to movement
Pins and needles or numbness
Muscle weakness
Difficulty lifting or controlling the arm

Nerve pain often behaves differently to muscle or joint pain and may not improve with simple rest alone.

How shoulder nerve pain is diagnosed

Accurate diagnosis is critical, as treatment depends on identifying the true source of nerve irritation.

Assessment typically includes:

The goal is to determine whether symptoms are arising from irritated or compressed nerves in the neck or shoulder and distinguish this from pain coming from structural issues which may also be present at the same time such as shoulder arthritis or rotator cuff related pain.

A detailed medical and injury history

Physical examination assessing strength, feeling, and reflexes

Examination of both the shoulder and neck

Imaging such as X-rays, MRI, or CT scans, where appropriate

Specialised nerve tests (nerve conduction tests) may be needed

Non-surgical treatment for shoulder nerve pain

Many cases of shoulder nerve pain can be managed without surgery, particularly when identified early.

Non-operative treatment may include:

Rest and activity modification
Physiotherapy focused on shoulder mechanics and posture, and/or neck movement and flexibility
Targeted strengthening and mobility exercises
Anti-inflammatory medication where appropriate
Image-guided injections to a nerve can help confirm a diagnosis or provide ongoing symptom relief

Para-labral cysts can be aspirated (contents sucked out) using a needle under CT or ultrasound guidance to reduce size and thus reduce pressure on the nerve

For specialised cases, a painful nerve can be partially ablated also under image guidance to provide a more lasting relief.

Thoracic outlet syndrome may respond to lifestyle changes and physiotherapy. Injections (cortisone) may be trialled.

Surgery for Nerve Pain: When Is It Needed?

Surgical treatment for shoulder nerve pain is not required in most cases but may be considered when symptoms do not improve with appropriate non-operative care or when there is evidence of ongoing nerve compromise.

Surgery may be discussed if:

Nerve-related pain significantly interferes with daily activities, work, or sleep
Symptoms persist despite adequate non-surgical treatment
Progressive weakness, numbness, or nerve dysfunction is present
Structural compression of a nerve is identified on imaging

The type of surgery depends on the underlying cause of nerve irritation. This may involve relieving nerve compression, addressing shoulder instability, treating associated labral tears or managing other structural contributors identified during assessment.

A common procedure is direct arthroscopic drainage of a paralabral cyst causing pressure on the suprascapular nerve. The labral tear is either debrided or repaired at the same time. The nerve may be freed further by release of the suprascapular ligament above a small tunnel through which it passes and can be compressed.

Resection of a rib or other surgery to relieve pressure can be successful in thoracic outlet syndrome

Recovery Time and Outlook for Shoulder Nerve Pain

Recovery from shoulder nerve pain varies greatly depending on the underlying cause of nerve irritation, the severity and duration of symptoms, and the type of treatment required. Nerve-related symptoms often improve more gradually than muscle or joint pain, and recovery may take longer even with appropriate management.

Nerve function may not return to normal if pain or other symptoms from compression have been present for a long time and/or significant weakness of the muscles supplied by the nerve or significant loss of skin feeling exists.

Many people experience improvement with a structured treatment plan, which may include activity modification, physiotherapy, and targeted injections or other interventions where appropriate.

Ongoing follow-up and guided rehabilitation play an important role in supporting nerve recovery, restoring function, and reducing the risk of recurrent symptoms.

When to See a Shoulder Specialist for Nerve Pain

You may benefit from specialist review if you experience:

Persistent shoulder pain with numbness or tingling
Radiating pain, numbness or tingling into the arm or hand
Unexplained shoulder or arm weakness with no structural issue in the shoulder
Pain which is particularly constant, rather than movement related
Ongoing symptoms despite initial treatment

Specialist assessment can help clarify the diagnosis and guide the most appropriate treatment pathway.

Seeing a shoulder specialist for nerve-related shoulder pain

Shoulder nerve pain can be complex and may have more than one contributing factor. Dr Richard Dallalana provides specialist assessment of shoulder and nerve-related pain, with a focus on accurate diagnosis, identifying contributing conditions, and developing an individualised management plan. On-referral to other specialists such as a neurologist will be made as needed.