When Radiculopathy Isn’t Radiculopathy: A Clinical Series (Pt. 4)

Patients presenting with arm pain, weakness, or paresthesia are often diagnosed with cervical radiculopathy, frequently based on incidental degenerative findings on an MRI. However, many of these cases lack true neurological deficits and do not follow clear dermatomal patterns. This article introduces "subscapularis syndrome" as a critical and underrecognized cause of upper-extremity pseudo-radiculopathy, drawing a clinical parallel to piriformis syndrome in the lower limb. The subscapularis, the largest rotator cuff muscle, is a primary stabilizer of the shoulder joint. When shoulder mechanics are disrupted, it can become overworked and hypertonic, developing trigger points that refer pain and other symptoms down the arm, mimicking a nerve root issue. This creates a diagnostic pitfall where a spinal pathology is blamed, while the true muscular driver is ignored. A key distinction is that symptoms of subscapularis syndrome are often reproduced with shoulder loading or resisted internal rotation, not isolated neck movements. Correctly identifying this condition allows for effective, conservative management—such as myofascial release and stabilization exercises—that targets the muscular dysfunction directly, often providing relief where spine-focused treatments have failed and avoiding unnecessary invasive procedures.