Dorsal scapular nerve entrapment: a systematic review

Periscapular and interscapular pain are common musculoskeletal complaints; however, dorsal scapular nerve (DSN) entrapment neuropathy remains an under-recognized and frequently overlooked etiology. DSN pathology may mimic multiple cervical, shoulder, and upper-extremity disorders, resulting in delayed diagnosis and treatment. To systematically review the current literature regarding the anatomy, etiology, clinical manifestations, diagnostic evaluation, and treatment of DSN entrapment neuropathy.

A systematic review was performed using PubMed/MEDLINE, Scopus, and Google Scholar databases through January 1, 2026. Search terms included combinations of "dorsal scapular nerve," "dorsal scapular neuropathy," "dorsal scapular nerve entrapment," "scapular winging," "scapulothoracic pain," and "nerve decompression." English-language clinical studies, case reports, case series, anatomical investigations, and diagnostic studies relevant to DSN pathology were included. Non-English publications, duplicate reports, unrelated shoulder conditions, and studies lacking clinical relevance were excluded.

The literature primarily consists of case reports, small case series, anatomical studies, and technical reports. The DSN most commonly originates from the C5 nerve root and frequently traverses the middle scalene muscle, which represents the most common site of entrapment. Patients typically present with medial scapular border pain, scapular dyskinesis, rhomboid weakness, and subtle scapular winging. DSN neuropathy may clinically mimic cervical radiculopathy, thoracic outlet syndrome, myofascial pain syndrome, and rotator cuff pathology. Electromyography and nerve conduction studies may support diagnosis, although findings are operator dependent and technically challenging. High-resolution ultrasound and magnetic resonance imaging may demonstrate nerve edema, muscle denervation, or scapular asymmetry. Conservative management including activity modification, rehabilitation, physical therapy, and image-guided injections remains first-line treatment. Surgical decompression has been described in refractory cases, although evidence remains limited and heterogeneous.

DSN entrapment neuropathy is an uncommon but clinically significant cause of periscapular pain. Recognition of characteristic clinical features and understanding of the anatomical course of the nerve are essential for accurate diagnosis. Current evidence regarding management remains limited to low-level studies, highlighting the need for prospective investigations with standardized diagnostic criteria and outcome measures.