Suprascapular neuropathy

Background

• Suprascapular nerve (C5, 6) branches from the superior trunk and innervates the supraspinatus and infraspinatus nerves
• Compression of the nerve in the suprascapular notch (proximal, supraspinatus and infraspinatus affected) or at spinoglenoid ligament (distal, only infraspinatus affected)
• Most often seen in athletes due to repetitive overhead arm movements

Clinical Features

• Shoulder pain
• Weakness of shoulder abduction, flexion, and internal rotation
• May see atrophy of supraspinatus and infraspinatus muscles

Differential Diagnosis

• Structural (direct nerve compression)
  • Paralabral cyst
  • Bone/soft tissue tumor
• Trauma
  • Traction injury
  • Rotator cuff tear
  • Glenohumerol dislocation
  • Scapular fracture
  • Penetrating injury
• Autoimmune
  • Parsonage-Turner syndrome
• Iaotrogenic

Upper extremity peripheral nerve syndromes

Median Nerve Syndromes

• Carpal tunnel syndrome
• Pronator teres syndrome
• Anterior interosseous neuropathy

Ulnar Nerve Syndromes

• Ulnar neuropathy at the elbow and wrist

Radial Nerve Syndromes

• Radial neuropathy at the spiral groove (ie. "Saturday night palsy")
• Posterior interosseous neuropathy

Proximal Neuropathies

• Suprascapular neuropathy
• Long thoracic neuropathy
• Axillary neuropathy
• Spinal accessory neuropathy
• Musculocutaneous neuropathy

Other

• Brachial plexopathy
• Cervical radiculopathy

Evaluation

• See Shoulder (Tests)

• Plain films to evaluate for fracture, callus, or bone tumor
• MRI and EMG outpatient

Management

• Nonoperative - activity modification, avoid overhead activities, physical therapy, NSAIDs, sling
• Operative for space occupying lesions

Disposition

• Discharge with orthopedic follow up

References

1. https://www.orthobullets.com/shoulder-and-elbow/3063/suprascapular-neuropathy?expandLeftMenu=true 2. Boykin RE et al. Suprascapular Neuropathy. JBJS. 2010;92:2348-2368.