What is Cervicogenic Dorsalgia?
Cervicogenic dorsalgia is pain expressed in the dorsal region and having its genesis in a disordered cervical spine. Although this descriptive phrase locates the anatomic region from which the patient’s symptoms originate, the term cervicogenic dorsalgia is seldom an adequate diagnosis for the doctor of chiropractic.
In the past, dorsal scapular nerve (DSN) neuropathy has rarely been considered as a differential diagnosis for mid scapular or upper to mid back pain. However, a number of studies have shown evidence that individuals with these types of pain patterns who do not respond to normal care may be suffering from DSN neuropathy, making this a differential diagnosis that should be included in these types of cases. DSN neuropathy shares many signs and symptoms with other diagnoses, including cervicogenic dorsalgia (CD), notalgia paresthetica (NP), SICK scapula, and a general posterolateral arm pain pattern. From an anatomical standpoint, the DSN provides a direct link from the mid to lower cervical spine to the mid-scapular area.
Signs and Symptoms
DSN neuropathy may present on a spectrum from complete function to complete atrophy of the muscles it innervates. This spectrum would include varying levels of: pain intensity and character along a portion of or its entire pathway; and tightness and weakness in the muscles it innervates.1 Other symptoms may include dysesthesia and pruritis in the midscapular region1, and radiation of the pain along the posterolateral aspect of the shoulder, arm, and forearm21–23,43. Chen et al.21 also report DSN involvement in neck, axilla, and lateral thoracic wall pain.
Other findings may include a loss of pinprick sensation medial to the scapular border1, and varying levels of loss of range of motion of the cervical spine, typically ipsilateral rotation and contralateral lateral flexion22,40. A loss of range of motion of the affected side shoulder has also been outlined although no specific movements were described.1,40 Cervical flexion, ipsilateral lateral flexion1, and extension19 have also been reported to aggravate the pain along the DSN. Pain on palpation of the thoracic spinous21, thoracic facet and costotransverse joints may also be present1. Relative hypertrophy and spasm of the neck musculature has also been reported.40 An elongated C7 transverse process has been reported in association with this condition by a few authors.1,21,40
Weakness of the rhomboids may cause varying levels of winging of the scapula. Ravindran20 describes two cases of suprascapular neuropathy in a brother and sister that played volleyball at a high level. Each had electromyographical confirmation of chronic neurogenic changes in the supraspinati, infraspinati and rhomboid muscles with normal findings in the trapezius, deltoid and serratus anterior. The neurogenic changes mentioned presented as muscle weakness and wasting of the infraspinatus, as well as weakness in the supraspinatus and rhomboids. Both had mild winging of the scapula that didn’t change with shoulder ranges. It was postulated that they either had a concurrent DSN neuropathy or an anatomical variation of the suprascapular nerve innervating the rhomboids – which has not been reported in cadaveric studies.20 Moderate to more severe cases of scapular winging due to DSN injury are reported by several authors.19,28,43–47
