Triad of neck – arm – shoulder blade pain


1. Introduction to the Pain Triad

The neck-arm-scapula pain triad is a commonly observed clinical syndrome characterized by pain that radiates from the neck to the arm and scapula. This condition can significantly affect patients' quality of life, limiting their mobility and ability to perform daily tasks. The pain can vary in intensity, from mild to severe, and may be accompanied by tingling, burning, or numbness.


The causes of this pain triad are varied, but usually involve some form of compression or irritation of the cervical nerves. This compression may be due to structural abnormalities or degenerative conditions of the spine. Understanding the pathophysiology of these pains is crucial for effective diagnosis and treatment.

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It is important to note that pain can be intermittent or constant, and its nature can vary. Some patients describe sharp, piercing pain, while others report dull, persistent pain. Early recognition of symptoms and thorough evaluation by a qualified healthcare professional are essential for adequate management.


2. Understanding Pinched or Irritated Nerves

Pinched or irritated nerves in the cervical region are often the result of excessive pressure on the nerve roots. This pressure can be caused by herniated discs, disc bulges, foraminal stenoses, facet osteoarthritis, or other structural abnormalities. When nerves are compressed, they cannot function properly, resulting in pain, weakness, or numbness in the areas innervated by those nerves.


Pain resulting from a pinched nerve is usually localized along the path of the affected nerve. For example, nerve compression at the cervical level can cause pain that radiates to the arm and shoulder blade. This pain may be exacerbated by certain neck movements or prolonged positioning, which can help guide the diagnosis.


Managing pain from a pinched nerve often involves a combination of medical treatments and lifestyle changes. Treatments may include anti-inflammatory medications, pain relievers, and manual therapies. It is also important to identify and modify activities or postures that may worsen the condition.


3. Herniated Disc: A Major Cause

The herniated disc cervical is a common cause of pain in the neck-arm-scapula triad. It occurs when the central gelatinous nucleus of an intervertebral disc shifts and protrudes beyond its normal limits, compressing adjacent nerves. This nerve compression can lead to intense pain, often described as shooting or electric, that spreads down the arm.

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Risk factors for developing a herniated disc include aging, trauma, repetitive movements, and certain genetic predispositions. Symptoms may be exacerbated by specific neck movements, such as flexion or rotation, and may be accompanied by muscle weakness or changes in reflexes.


The diagnosis of a herniated disc is usually confirmed by medical imaging, such as MRI or CT scan. These exams allow you to visualize the position of the intervertebral discs and identify any protrusion or herniation that could compress the nerves. Herniated disc treatment aims to reduce pain and inflammation, improve nerve function, and prevent recurrence.


4. Disc Bulge and Its Implications

The bulging of the disc, although less severe than disc herniation, can still cause significant pressure on the cervical nerves. Unlike a herniation, where part of the nucleus protrudes through the covering of the disc, a disc bulge involves a protrusion more uniform of the disc as a whole. This phenomenon may be due to age-related wear and tear, injuries, or repeated loads on the spine.


Symptoms of a bulging disc may include local pain in the neck, as well as radiating pain that follows the path of compressed nerves. This pain may be accompanied by numbness or tingling sensations in the arms or hands. As with a herniated disc, neck movements can make symptoms worse.


Treatment for a bulging disc aims to reduce pressure on the affected nerves and improve spinal function. This may include manual therapies, strengthening and stretching exercises, and lifestyle modifications to reduce stress on the spine. In some cases, more invasive procedures may be necessary, but these are generally considered a last resort.


5. Foraminal Stenosis: Definition and Symptoms

The stenosis foraminal is a pathological condition characterized by the narrowing of the foramina, the openings through which nerves leave the spine. This narrowing can be caused by various factors, such as degenerative changes, herniated discs, or bony growths (osteophytes). When these openings narrow, they can compress the nerves, causing pain, weakness, and numbness in the innervated areas.


Symptoms of foraminal stenosis can vary depending on the location and severity of the nerve compression. Patients may experience radiating pain, abnormal sensations in the arms, and sometimes decreased muscle strength. These symptoms may worsen with certain activities or positions, such as neck flexion or extension.


Diagnosing foraminal stenosis usually involves imaging tests such as MRI or CT scan, which help visualize the structure of the spine and identify areas of narrowing. Treatment may include medications, injections, manual therapies, and in some cases, surgery to widen the foraminal openings and relieve pressure on the nerves.


6. Spinal Stenosis: Understanding the Impact

The spinal stenosis is another degenerative condition affecting the spine, where the spinal canal itself becomes narrower. This reduction in space can compress the spinal cord and nerves, causing symptoms similar to those of foraminal stenosis, but often with a wider scope. Patients may experience pain in the neck, back, and extremities, as well as numbness, tingling, and in severe cases, dysfunction of internal organs.


Spinal stenosis is often the result of aging and wear and tear of the spine. Intervertebral discs can weaken and become dehydrated, while ligaments can thicken and bones can develop growths. These changes can gradually reduce the space in the spinal canal.


Treatment for spinal stenosis may vary depending on the severity of symptoms. Non-surgical options include medications, physical therapies, and epidural injections. In cases where symptoms are severe or progressive, surgery may be necessary to decompress the affected area.


7. Facet Osteoarthritis and Cervical Pain

Facet osteoarthritis is a form of degeneration of the facet joints, which are small joints located between and behind the vertebrae. This condition can cause pain and stiffness in the neck, often made worse by specific movements or prolonged positioning. Facet osteoarthritis can also contribute to nerve compression by causing joints to enlarge, reducing the space available for the nerves.


Symptoms of facet osteoarthritis include localized pain in the neck, which may radiate to the shoulders or upper back. Patients may also experience decreased neck flexibility and mobility. In some cases, facet osteoarthritis may coexist with other degenerative conditions, such as spinal or foraminal stenosis, exacerbating symptoms.


Treatment for facet osteoarthritis aims to manage pain and maintain spinal mobility. This may include anti-inflammatory medications, manual therapies, strengthening and stretching exercises, and sometimes corticosteroid injections. Management of facet osteoarthritis often requires a multidisciplinary approach to optimize results.


8. Diagnosis of the Pain Triad

Accurate diagnosis of the neck-arm-scapula pain triad is essential for effective treatment. This process begins with a detailed clinical evaluation, including the patient's medical history, physical examination, and symptom assessment. The physical exam may include tests of mobility, strength, and reflexes to assess nerve function.


Imaging tests such as MRI, CT scan, and sometimes X-ray, are crucial to visualize the structure of the spine and identify potential causes of pain. These examinations can reveal disc herniations, disc bulges, foraminal or spinal stenoses, and signs of facet osteoarthritis.

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In addition to imaging, electrodiagnostic tests like electromyography (EMG) can be used to assess nerve and muscle function. These tests help confirm the presence and extent of nerve compression. An accurate diagnosis is crucial to developing a personalized and effective treatment plan for each patient.


Here is a table summarizing the probable causes of the neck-arm-scapula pain triad:

Probable Cause Description Associated Symptoms
Cervical Disc Herniation Protrusion of an intervertebral disc which compresses the cervical nerves. Radiating pain, numbness, weakness in the arm.
Bulging Of The Disc Generalized protrusion of the disc without rupture of the annulus fibrosus. Local or radiating pain, sometimes numbness.
Stenosis Foraminal Narrowing of the foraminal openings through which the nerves leave the spine. Radiating pain, numbness, weakness.
Spinal Stenosis Narrowing of the spinal canal compressing the spinal cord and nerves. Pain in the neck and back, numbness, weakness.
Facet Osteoarthritis Degeneration of the facet joints between the vertebrae. Pain and stiffness in the neck, worse with movement.
Other Structural Anomalies Spinal misalignments, trauma, or other conditions affecting the cervical spine. Variable pain, stiffness, limitation of movement.

This table provides an overview of the most common causes of the neck-arm-scapula pain triad, with a brief description of each condition and the typically associated symptoms. It is important to note that these conditions can coexist and accurate diagnosis requires a complete medical evaluation.


Here is a table detailing health conditions that could coexist and cause symptoms similar to those of the neck-arm-scapula pain triad:

Co-existing Condition Description Similar Symptoms Interaction with the Pain Triad
Carpal Tunnel Syndrome Compression of the median nerve at the wrist. Pain, numbness, weakness in the hand and wrist. May be confused with or exacerbate symptoms radiating into the arm.
Vertebral Subluxation Misalignment or displacement of a vertebra, which can occur in the neck or between the shoulder blades. Local pain, stiffness, limitation of movement. May increase pressure on cervical nerves, intensifying radiating pain.
Rotator Cuff Tendonitis Inflammation of the rotator cuff tendons in the shoulder. Pain in the shoulder, weakness, difficulty raising the arm. May coexist with pain of cervical origin, making the diagnosis more complex.
Thoracic Exit Syndrome Compression of nerves or blood vessels in the space between the collarbone and the first rib. Pain and numbness in the neck, shoulder and arm. Symptoms may mimic those of cervical nerve compression.
Myofasciitis Inflammation and pain in the muscles and fascia, often due to overuse or trauma. Muscle pain, stiffness, painful trigger points. May worsen or mask symptoms of the pain triad.
Cervical Arthritis Inflammation of the joints in the cervical region of the spine. Neck pain, stiffness, limitation of movement. May contribute to nerve compression and exacerbate radiating pain.
Cardiac Pathology Heart problems, such as angina, which can cause referred pain in the arm. Pain in the chest radiating to the arm. Although rare, pain in the arm due to a cardiac cause should be ruled out.

This table shows how different conditions can present similar symptoms or contribute to the complexity of diagnosing and treating the neck-arm-scapula pain triad. He emphasizes the importance of a thorough medical evaluation to distinguish these conditions and develop an appropriate treatment plan.


9. Presentation of Neurovertebral Decompression

The Spinal decompression therapy is an advanced technique for treating pain associated with spinal problems, including the neck-arm-scapula pain triad. This non-invasive method uses a specially designed decompression table to apply a controlled traction force to the spine. The objective is to create a vacuum effect which promotes the repositioning of the intervertebral discs and the reduction of pressure on compressed nerves.


The spinal decompression therapy process is personalized for each patient, based on their specific condition and response to treatment. Sessions are generally painless and can provide significant pain relief. This technique is particularly beneficial for patients suffering from herniated discs, disc bulges, foraminal or spinal stenoses, and facet osteoarthritis.


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Besides pain relief, spinal decompression therapy can also help restore normal spinal function, improve mobility, and prevent recurrence of symptoms. It is an attractive alternative to surgery, particularly for patients seeking less invasive treatment options.


10. Process and Effectiveness of Decompression

Neurovertebral decompression treatment involves a series of sessions during which the patient lies on the decompression table. The machine applies gentle, intermittent traction force to the spine, which gently separates the vertebrae and reduces pressure on the discs and nerves. Each session lasts approximately 30-45 minutes and the total number of sessions varies depending on the patient's specific condition.


The effectiveness of spinal decompression therapy has been supported by various studies and clinical feedback. Patients often report a significant reduction in pain and improvement in mobility after treatment. Additionally, this method may reduce the need for pain-relieving medications and provide an alternative to surgery for some patients.


It is important to note that spinal decompression therapy is not a one-size-fits-all solution. Patient selection is crucial, and is most effective when integrated into an overall treatment plan that may include manual therapy, lifestyle adjustments, and other non-surgical interventions.


11. Other Therapeutic Approaches

Although spinal decompression therapy is an effective treatment option, it can be complemented with other therapeutic approaches to optimize results. These approaches may include manual therapy, such as osteopathy, which aims to improve joint mobility and reduce muscle tension. Osteopathic adjustments can be particularly beneficial in correcting spinal misalignments and improving nerve function.


Pain management techniques, such as anti-inflammatory medications and analgesics, can also be used to relieve acute pain and improve the patient's quality of life. Additionally, specific strengthening and stretching exercises may be recommended to support the spine, improve posture, and prevent recurrence.


It is also important to consider lifestyle modifications, such as workplace ergonomics and sleep habits, to reduce stressors on the spine. A holistic approach, combining various treatment modalities, is often most effective in managing the neck-arm-scapula pain triad.


12. Conclusion and Recommendations

In conclusion, the neck-arm-scapula pain triad caused by a pinched or irritated nerve is a complex condition requiring a multidisciplinary treatment approach. Neurovertebral decompression presents itself as a promising treatment option, providing pain relief and improved function without the risks associated with surgery. However, to achieve the best results, it must be integrated into an overall treatment plan including manual therapy, lifestyle adjustments, and other non-surgical interventions.


It is essential for patients suffering from this condition to consult a qualified healthcare professional for an accurate diagnosis and personalized treatment plan. With appropriate care, it is possible to effectively manage pain, improve mobility and regain a satisfactory quality of life.


  1. The neck-arm-scapula pain triad is often caused by a pinched or irritated nerve in the cervical region.
  2. Typical symptoms include radiating pain, numbness, and weakness in the arms and shoulders.
  3. Cervical disc herniation is a major cause of nerve compression and pain.
  4. The disc bulge can also put pressure on the nerves and mimic the symptoms of a herniated disc.
  5. Foraminal stenosis, characterized by narrowing of the nerve openings, can cause pain and discomfort.
  6. Spinal stenosis, involving the narrowing of the spinal canal, can compress the nerves and spinal cord.
  7. Facet osteoarthritis, affecting the facet joints, can contribute to neck pain and nerve compression.
  8. Accurate diagnosis of the pain triad often requires magnetic resonance imaging (MRI) or CT scan.
  9. Neurovertebral decompression is a non-invasive technique to relieve pressure on compressed nerves.
  10. Neurovertebral decompression treatment involves the use of a specialized table to stretch the spine.
  11. Neurovertebral decompression sessions can improve mobility and reduce pain.
  12. Complementary treatment approaches include manual therapy, osteopathic adjustments, and lifestyle modifications.
  13. Pain management may require anti-inflammatory medications and pain relievers.
  14. Strengthening and stretching exercises are essential to support the spine and prevent recurrence.
  15. A holistic, multidisciplinary approach is often most effective in treating the neck-arm-scapula pain triad.

To find out more about non-surgical spinal decompression therapy, please visit our specialized websites:


Preparations for spinal decompression therapy treatment for neck - arm - scapula pain

  • Book your appointment online or contact our staff at the TAGMED clinic to book your appointment by phone.
  • Before going to the TAGMED clinic in Montreal or Terrebonne for your first treatment, there are some things you should absolutely do. First, make sure you have your medical imaging reports (X-ray, MRI, or ultrasound) available.
  • Also, make sure you are aware of the various possible risks and side effects associated with treatment at Tagmed Clinic. You should also take all necessary measures (ex. Apply ice to the inflamed area to ensure that your body is ready for further treatment.
  • Also, make sure you are aware of the various possible risks and side effects associated with treatment at Tagmed Clinic. You should also take all necessary measures (ex. Apply ice to the inflamed area to ensure that your body is ready for further treatment.
  • Finally, if you were unable to complete our form, as mentioned above, arrive 15 minutes before your appointment time to ensure you have enough time to discuss your condition, make the assessment and your treatment.

To be completed before your consultation at TAGMED clinic

Download, print and complete this questionnaire (your health history), before consulting us, in order to save time. (Click on the tablet!)


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