Suprascapular neuropathy

Background

The right brachial plexus with its short branches, viewed from anterior view. (Suprascapular labeled at upper left.)

Suprascapular and axillary nerves of right side, seen from posterior view.

• 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