The incidence of nerve root anomalies is 14% , the L5–S1 level being most commonly involved. As are result of age-related changes, the exiting spinal nerves in the cervical spinal region are also frequently affected, or are approached because of cervical osteochondrosis or disc herniation management. Anomalies of the nerve roots often produce pain in the corresponding innervation. Sometimes, ultrasound is a valuable tool to depict an anatomical abnormality .
The cervical 5 (C5) nerve travels abnormally alongside the anterior edge of the anterior scalene muscle and may induce perception which distributes across the right backside of the neck and shoulder, with radiating pain to the right upper arm (Fig. 1a–c). Under ultrasound guidance (Fig. 1b), bolus injection of 2 ml 0.15% ropivacaine plus betamethasone 2.5 mg mixture to the C5 nerve root anterior to the anterior scalene muscle could relieve the shoulder and upper arm pain. During the second visit, the patient complained some back pain remains on the medial scapula area.
Under ultrasound guidance, the dorsal scapular nerve was found to touch the posterior tubercle of the C6 transverse process (Fig. 1d). Bolus injection of 0.25% ropivacaine 2 ml plus 10% glucose 3 ml to the dorsal scapular nerve totally relieved the pain. The C5 nerve bypasses the anterior edge of the scalenus muscle, and the dorsal scapular nerve may also be distributed abnormally and close to the posterior tubercle of the transverse process of C6. Frequent friction of the nerve causes pain in the medial part of the scapula. The patient provided their informed consent to publish the article and all procedures were conducted as part of standard care/treatment.