suprascapular neuropathy

The suprascapular nerve follows a tortuous course from the neck to the posterior shoulder. Harbaugh Reference article, Radiopaedia.org (Accessed on 05 Jul 2023) https://doi.org/10.53347/rID-37641. NA Suprascapular neuropathy and cervical radiculopathy are common imitators of cuff disease. The exact location of the entrapment of the nerve determines whether supraspinatus as well as infraspinatus muscles are involved or just the infraspinatus muscle is involved. , Dillingham TR, Andary M, et al. When suprascapular neuropathy is suspected, radiography should be performed. Patient 1 first noted symptoms after awakening from sleep with his shoulder fully abducted. Once considered a diagnosis of exclusion, SN is now becoming a well-recognized condition stemming from traction or compression of the nerve at some point along its course. Suprascapular Neuropathy Differential Diagnoses - Medscape NCS=nerve conduction study, EMG=electromyography, Fibs=fibrillation potentials, PSWs=positive sharp waves, MUAPs=motor unit action potentials. The consent submitted will only be used for data processing originating from this website. Background and Purpose. Romeo Arthroscopy. In our experience this seems to be a very sensitive test for pain coming from irritation of the nerve. The individual then goes through an exercise program which is designed to improve flexibility and stability of the shoulders. There may also be atrophy of the infraspinatus muscle in the back of the shoulder (see figure) and when this occurs it is usually associated with marked weakness in the setting of a chronic SSN dysfunction. Romeo AA, Rotenberg DD, Bach BR. With a reduction of muscle performance of one or both of these suprascapular innervated muscles, impingement of subacromial structures against the coracoacromial arch during shoulder elevation could result.6167 Simulated SSN in cadaver models has demonstrated excessive humeral head translation during shoulder elevation, indicating theoretical support for the increased risk of development of SAIS in patients with SSN.65 Thus, patient education to avoid repetitive overhead activities in order to minimize the risk for developing SAIS is appropriate for patients with SSN. All authors provided writing, data analysis, and consultation (including review of manuscript before submission). A ligament called the spinoglenoid ligament may also be released (reference Plancher and find image showing this anatomy). Arthroscopic management of spinoglenoid cysts associated with SLAP lesions and suprascapular neuropathy. The upper-limb tension test (ULTT) is a sensitive (0.97) clinical screening tool for cervical radiculopathy.32 The ULTT is not specific, however, so a positive ULTT still requires further clinical correlation before diagnosing cervical radiculopathy. This examination finding had specificity of 0.80, but sensitivity of only 0.32. JD The SSN originates above the brachial plexus being made up of branches from the C4, C5, C6 levels that come together to form the SSN. MR Patterns of Denervation Around the Shoulder | AJR JJ Belling Sorensen It originates from the roots of C5 and C6, with a variable contribution from C4, at Erb point. MA Suprascapular Neuropathy - Symptoms, Causes and Treatment The incision extends from the anterior (front side) shoulder near the clavicle, to the posterior (back side) of the acromion. In this fluoroscopic image, we can see the contrast (black) indicating that the needle is in the suprascapular notch. The course of the nerve through narrow osseoligamentous structures renders it susceptible to compressional and traction injuries at the suprascapular and spinoglenoid notches. The trapezius muscle attaches up in the cervical spine and can be uncomfortable for many days to weeks due to its retraction during surgery. The aim of this review is to summarize some important aspects of this shoulder pathology. Suprascapular nerve | Radiology Reference Article | Radiopaedia.org Along with standard views, the suprascapular notch and Stryker views are also taken. D , Zlatkin MB, Esterhai JL, et al. Nardin 2001;386:131-8. What is the surgery to decompress the suprascapular nerve? Described surgical treatment procedures for suprascapular neuropathy unrelated to a space-occupying lesion include simple widening of the spinoglenoid notch or suprascapular notch, depending on. 12 Sign & Symptoms of Brain Nerve Damage in the Body (Neuropathy), Neuropathy: Classification, Types, Causes, Risk Factors, Symptoms, Treatment, Investigations, Shoulder Instability: Causes, Symptoms, Diagnosis, Treatment, Recovery & Exercise, Proximal Humerus Fracture in Children: Causes, Symptoms, Treatment & Complications, Dietary Dos and Donts for Migraine Sufferers, Shirshasana (Headstand) Versus Inversion Therapy Using Inversion Table, Understanding Joint Pain and Tips to Get Relief Using Home Remedies, Erectile Dysfunction: Does Opioid Cause ED, Libido: Opioid Induced Female Sexual Dysfunction, Treatments rendered for Suprascapular Neuropathy. This table is based on an integration of the evidence and our clinical experience. Of 10 patients with SSN reported by Post and Mayer,6 8 patients were initially misdiagnosed, leading to inappropriate intervention. Dr. Warners ten-year experience with arthroscopic release of the suprascapular nerve. Arthroscopy. Case Descriptions. suprascapular nerve is the lateral branch of the superior trunk of the brachial plexus . The patient who was managed surgically had only minimal improvement in symptoms and function. , Clark P, Sutherland K. Calis For full access to this pdf, sign in to an existing account, or purchase an annual subscription. These findings include pain in the posterior shoulder, a history of direct trauma or repetitive traction to the suprascapular nerve, and weakness and atrophy of the muscles innervated by the suprascapular nerve. SR Agre H To aid in differential diagnosis, key diagnostic findings of SSN, SAIS, rotator cuff pathology, cervical radiculopathy, and upper trunk brachial plexopathy are presented in Table 5. : Suprascapular nerve: is it important in cuff pathology? SC Some surgical procedures of the shoulders may also damage the Suprascapular Nerve like a Bankart Repair which can injure the Suprascapular Nerve. . A typical cause is a cyst which occurs as the result of a blow-out of the joint capsule. , Cioni R, Federico A. Montagna Suprascapular neuropathy | MedLink Neurology ADVERTISEMENT: Radiopaedia is free thanks to our supporters and advertisers. Surgical Measures: In case if conservative treatments fail to relieve symptoms then the next route taken is a surgical approach to treat the condition, although there are contradictory theories in the literature in which some studies suggest that surgery should be the treatment of choice for Suprascapular Neuropathy. Reflex testing for the C56 innervation pathways of the biceps brachii and brachioradialis muscles may be abnormal with radiculopathy, but not with SSN. Special arthroscopic portals are used to introduce the arthroscopic instruments so that the suprascapular nerve, artery and transverse scapular ligament are visualized (see pictures below). In some patients who have had prior surgery without pain relief, a fluoroscopic injection into the suprascapular notch (as described above) may give pain relief. The authors thank Venetia Valiga for providing the illustration of the suprascapular nerve. F The differential diagnosis of patients with suprascapular neuropathy is presented and illustrated using 5 patients with this condition. 2. As the tendon tears and pulls away from its normal attachment (retracts) the nerve, which is attached to the muscle, is pulled at an angle and may kink as it goes through the suprascapular notch or around the base of the scapular spine where it is in a fixed position. All patients were instructed to protect the suprascapular nerve and minimize their risk of aggravating SAIS symptoms by avoiding carrying backpacks or bags with straps over their shoulders, repeated overhead actions, nerve traction maneuvers such as horizontal adduction, and any other aggravating activities. The duration of symptoms ranged from 1 week to 6 months. The suprascapular nerve (SN) is a derivative of the upper trunk of the brachial plexus formed by the ventral rami of C5 and C6 nerve roots that provides both motor and sensory innervation to parts of the upper body. The patients (1 female, 4 male) ranged in age from 19 to 36 years (X=29.6, SD=6.8). Suprascapular neuropathy has often been overlooked as a source of shoulder pain. Suprascapular neuropathy: diagnosis and management Although historically considered a diagnosis of exclusion, suprascapular neuropathy may be more common than once believed, as more recent reports are describing the condition as a cause of substantial pain and weakness in patients with and without concomitant shoulder pathology. A history of surgery, recent viral illness, glenoid cyst, or metastatic disease also may be the cause of SSN; however, in many cases, the cause remains undetermined.15,7,47,48,50. Suprascapular Neuropathy : JBJS - LWW Aiello Electrophysiologic findings confirmed the presence of SSN at the area of the suprascapular notch in patients 1 to 4 and in the region of the spinoglenoid notch in patient 5. In addition, pain with muscle testing interfered with identifying any true weakness in patients 1 and 2. Etiologies for suprascapular neuropathy may include repetitive overhead activities, traction from a rotator cuff tear, and compression from a space-occupying lesion at the . Structure[ edit] Origin[ edit] Evidence for the optimal management of SSN is conflicting and primarily is in the form of case series and expert opinions. P We have found very reliable outcome in our patients with arthroscopic release of the nerve giving profound pain relief in 71% within 9 weeks of surgery. This is a study done for other common nerve problems such as carpel tunnel syndrome. 2003;19:E15-21. K We also used the Spurling test to test for cervical radiculopathy.32 The test was negative in all patients. Advances in correlation of nerve conduction study results with treatment choices and outcomes provide a motor-based prognostic model for suprascapular neuropathy. Suprascapular Neuropathy Workup: Imaging Studies, Other Tests - Medscape The specificity for diagnosing cervical radiculopathy in the presence of 2 or 3 abnormalities with these tests ranges from 0.74 to 0.98.34. This can occur due to winging of the scapula. Weakness was noted in the infraspinatus muscle in all patients and in the supraspinatus muscle in 4 of the patients. The suprascapular nerve's roots emerge from the fifth and sixth cervical vertebrae (C5 and C6) in your neck. Compression or traction of the suprascapular nerve can result in signs and symptoms that are similar to those of other upper-extremity disorders. Epub 2011 Feb 1. All patients underwent radiographic examination of the cervical spine, shoulder, and scapula in an attempt to screen for relevant bone or other dense tissue abnormalities. Suprascapular Neuropathy may also be caused in the elderly population due to a large rotator cuff tear. 52 year old bodybuilder and weight lifter one year after suprascapular nerve release and partial repair of a massive rotator cuff tear. The surgeon for patient 4 chose to operate because her symptoms had been present for 9 months and she had not improved with 3 months of nonsurgical intervention. It can result in pain, weakness, or both. Murrell J Bone Joint Surg Am. Discussion. Mr Walsworth and Mr Mills provided concept/idea/project design, data collection, subjects, and facilities/equipment. It then goes underneath the muscles of the rotator cuff to which it gives small nerve branches.. Interrater kappa coefficients for identification of muscle weakness without using a muscle test grade have been estimated to be 0.62 to 0.69 for the muscles of the rotator cuff and C56 innervated muscles.32 When a formal muscle test grade was applied, these tests had ICCs that ranged from .79 to 1.00 for intrarater reliability and from .55 to .72 for interrater reliability.33 Although examiner agreement to detect weakness in the shoulder region and C56 myotomes is variable, we believed that the results of our tests of the supraspinatus and infraspinatus muscles were clinically meaningful. Patients with full thickness rotator cuff tears often have weakness and atrophy similar to that of patients with SSN; thus, differentiating a full-thickness tear from SSN can be difficult.38 Incidence of full-thickness tear increases after the age of 50 years and is most common in patients over 60 years of age,39,40 whereas SSN is most common in patients under 40 years of age.41 Therefore, SSN was considered a more likely diagnosis than full-thickness rotator cuff tear in these patients. However, it also was possible that both the suprascapular nerve and the subacromial soft tissue structures were injured concomitantly due to repetitive shoulder activities or positioning during sleep or surgery. Imaging Studies. . In fact, in our recent (unpulished) study, 90% of patients who had relief with this injection had a good outcome with surgical release of the nerve. GA , Thomas E, Bonnel F, Blotman F. Warner The key physical examination data are summarized in Table 2. JA Cummins Atrophy of the supraspinatus and infraspinatus muscles of patient 1 is depicted in Figure 2. J Bone Joint Surg Am. The condition may be more common than once thought as it is being diagnosed more frequently. The patient's age may be particularly useful in determining whether SSN or a full-thickness rotator cuff tear is more probable, as the incidence of full-thickness rotator cuff tear increases after the age of 50 years.39,40 A cluster of 3 positive findings of supraspinatus muscle weakness, infraspinatus muscle weakness, and a positive impingement sign have demonstrated high probability (98%) for predicting whether a patient will develop a rotator cuff tear.37 This cluster, however, would have yielded false positive diagnoses in 4 of our 5 patients. We speculate that the poor outcome was due to severe nerve entrapment for a prolonged period. Suprascapular Nerve Pathology: A Review of the Literature Physical therapist examination findings were consistent with subacromial impingement syndrome and suprascapular neuropathy. Predators Stalk Your Pension Leaflet, Articles S