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The four commonly used central pain stimuli are: the trapezius squeeze - which involves gripping and twisting a portion of the trapezius muscle in the patient's shoulder [1] mandibular pressure - this is the manual stimulation of the mandibular nerve, located within the angle of the jaw
However, imaging studies are unable to show cause of shoulder pain in diagnosing. For example, MRI imaging would show rotator cuff pathology and bursitis but is unable to specify the cause. [15] On physical exam, the physician may twist or elevate the patient's arm to test for reproducible pain (the Neer sign and Hawkins-Kennedy test).
Trapezius palsy, due to damage of the spinal accessory nerve, is characterized by difficulty with arm adduction and abduction, and associated with a drooping shoulder, and shoulder and neck pain. [8] Intractable trapezius palsy can be surgically managed with an Eden–Lange procedure .
There are several options of treatment when iatrogenic (i.e., caused by the surgeon) spinal accessory nerve damage is noted during surgery. For example, during a functional neck dissection that injures the spinal accessory nerve, injury prompts the surgeon to cautiously preserve branches of C2, C3, and C4 spinal nerves that provide supplemental innervation to the trapezius muscle. [3]
Injury to the accessory nerve can result in neck pain and weakness of the trapezius muscle. Symptoms will depend on at what point along its length the nerve was severed. [5] Injury to the nerve can result in shoulder girdle depression, atrophy, abnormal movement, a protruding scapula, and weakened abduction. [5]
Shoulder problems, including pain, are common [20] and can relate to any of the structures within the shoulder. [21] The primary cause of shoulder pain is a rotator cuff tear. [20] The supraspinatus is most commonly involved in a rotator cuff tear, [22] but other parts of the rotator cuff may also be involved.