In 1982, aiello et al2 differentiated suprascapular nerve entrapment at the spinoglenoid notch. Arthroscopic decompression of the suprascapular nerve. A prospective series of 10 patients with preoperative electromyographic. The suprascapular notch is located on the lateral part of the superior border of the scapula, medial to the coracoid process. Males are more likely to suffer from a ganglion compressing the nerve than females. Our hypothesis was that ultrasoundguided ssax would provide postoperative analgesia equivalent to isb. Potential complications may occur, especially the injury of the ss artery. Suprascapular neuropathy or suprascapular nerve entrapment occurs if the suprascapular nerve is compressed as it passes through the suprascapular notch or spinoglenoid notch. C5 to c7 merge into lateral cord brachial plexus, goes through axilla, under coracobrachialis, through biceps and under deep fascia at the elbow.
It is covered by the superior transverse scapular ligament which gives passage to suprascapular nerve to supraspinous fossa. Suprascapular nerve block is indicated for relief of acute shoulder pain e. Management and outcomes of 42 surgical suprascapular nerve. Suprascapular nerve and rotator cuff function are intimately connected. The nerve can be compressed due to pressure from a cyst. Treatment for suprascapular nerve entrapment involves decreasing muscle adhesions and fascial restrictions along the suprascapular nerves path. The suprascapular nerve is a mixed motor and sensory nerve that innervates the glenohumeral joint and the surrounding posterior shoulder girdle. Check out our blog for diagnosis and treatment information.
Introduction the suprascapular nerve provides sensory innervation to the glenohumeral joint shoulder. Approaches to common peripheral nerves bioness stimrouter pns. Suprascapular neuropathy radiology reference article. It also supplies sensory fibers to ligaments, bursa and the glenohumeral joint. Suprascapular nerve block is a safe and extremely effective procedure in shoulder pain therapy. Suprascapular nerve block in the treatment of frozen shoulder. Suprascapular nerve is a mixed nerve, both motor and sensi tive, originated in upper trunk of brachial plexus, c5 and c6 roots, receiving in over 50% contributions of fourth cervical root. Suprascapular nerve entrapment is rare and mainly occurs in patients under 40 years of age. Over a period of 10 years 19851995, the authors treated 28 cases of sne in 27 patients by surgical decompression of the nerve. The suprascapular nerve supplies sensory fibers to about 70% of the shoulder joint, including the superior and. Notch is bridged by a thick transverse scapular ligament. Kopell and thompson1 initially described suprascapular neuropathy at the suprascapular notch in 1959. Nerve compression syndrome occurs when a nerve is squeezed or compacted. Suprascapular nerve entrapment syndrome snes is a neuropathy caused by compression of the nerve along its course.
Posterior shoulder pain and arthroscopic decompression of. Background and objectives the primary objective of this study was to compare the analgesic efficacy of combined suprascapular and axillary nerve block ssax with interscalene block isb after arthroscopic shoulder surgery. Suprascapular nerve lesions at the spinoglenoid notch. Ssn entrapment also can be caused by bone spurs or bridges, which may encroach on the nerve at the suprascapular notch, and taut ligaments 4, 5, whichj can impinge the nerve at the suprascapular notch andor further distally at the spinoglenoid notch also called the. There is a wide variety of mechanisms that can cause injury or compression to the suprascapular nerve during its course through the various. Arthroscopic suprascapular nerve ssn decompression at the suprascapular ss notch. Compression of the nerve at both the suprascapular and spinoglenoid notches are commonly reported mechanisms of injury and will be discussed in detail. There can be many reasons for nerve entrapment, especially at the suprascapular and spinoglenoid notches where nerve deviation is limited by bony and ligamentous structures. Suprascapular nerve entrapment at the suprascapular foramen is well documented in the literature. Posterior shoulder pain and arthroscopic decompression of the suprascapular nerve kevin d. A comparison of combined suprascapular and axillary nerve bl.
Peripheral nerve entrapment and injury in the upper extremity sara l. Stenosis of the suprascapular or spinoglenoid notch, with a calcified or. Introduction the suprascapular nerve is a mixed motor and sensory peripheral nerve arising from the 5th and 6th cervical nerves of the brachial plexus with variable contributions from the 4th cervical nerve roots. Suprascapular nerve entrapment is a rare condition that can be easily misdiagnosed or even go unnoticed by those who are affected. After branching from the brachial plexus the suprascapular nerve accompanies the suprascapular artery and vein laterally and posteriorly deep to the trapezius muscle to the superior margin of the scapula, where it passes through the suprascapular notch inferior to the superior transverse scapular ligament to enter the supraspinous fossa. Suprascapular nerve entrapment should be suspected and included in the differential diagnosis of poorly localized shoulder pain in conjunction with a. Suprascapular nerve entrapment is an acquired neuropathy secondary to compression of the nerve in the bony suprascapular notch. Initially, your health care provider will embark upon conservative treatment for suprascapular neuropathy. The suprascapular notch or scapular notch is a notch in the superior border of the scapula, just medial to the base of the coracoid process. The suprascapular nerve is the major sensory supply to the shoulder joint and motor supply to the supraspinatus and infraspinatus muscles. They were assessed at an average of 30 months 12 to 98 after operation using the functional shoulder.
Lets get to the bottom of this condition and talk about who could be affected, what body parts are involved, and what are the symptoms, causes and treatments of this potentially silent condition of the shoulder. Massage therapy, manual therapy, graston technique, and active release technique art are excellent tools at addressing the muscle and fascial adhesions. After the suprascapular nerve block, shoulder pain diminish, and an effective, relatively painfree therapeutic exercise program can be performed. Clinical observation of the patients shoulder girdle is. The muscles supplied by the suprascapular nerve are the supraspinatus and infraspinatus. The suprascapular nerve white arrows leaves the brachial plexus and travels posteriorly under the transverse scapular ligament with the vein, while the artery white arrowhead travels over the ligament. Jul 31, 2015 suprascapular nerve entrapment occurs when supraspinatous nerve is entrapped in a space. There may al so be compression at the suprascapular notch or spinoglenoid notch by soft tissue tumor, bone tumor, cyst secondary to capsular or labrum injury. The bone serves as a protector for many of the nerves of the back and arm that lie underneath it. Suprascapular nerve syndrome and treatment the suprascapular nerve travels across top of the scapula and cuts between the bone and the transverse scapular ligament. Suprascapular nerve entrapment due to a stenotic foramen. Suprascapular neuropathy in volleyball players british. Suprascapular nerve entrapment faqs beacon orthopaedics.
The suprascapular nerve can become compressed and entrapped, resulting in unpleasant suprascapular nerve entrapment. Suprascapular nerve compression is a rare pathology of the shoulder of nervous origin. When entrapped or stretched, it can cause shoulder dysfunction and pain which over time can cause impingement syndrome and rotator cuff tendon and muscle tears. Suprascapular nerve entrapment faqs beacon orthopaedics and. The physical examination plays a critical role in discerning the site of suprascapular nerve injury. Arthroscopic treatment of suprascapular nerve neuropathy. Pdf anatomy of suprascapular notch ssn, suprascapular.
Suprascapular nerve entrapment is a rare but serious chronic nerve condition whose symptoms mimic more common conditions such as rotator cuff tears or other joint diseases. Suprascapular nerve an overview sciencedirect topics. Suprascapular nerve entrapment with isolated paralysis of the. Suprascapular nerve entrapment occurs when supraspinatous nerve is compressed or is entrapped in a space.
Suprascapular nerve entrapment sne in the suprascapular notch is a rare entity that must be considered in the differential diagnosis of radicular pain, as well as that of shoulder discomfort. Suprascapular nerve entrapment in the suprascapular notch, especially in the spinoglenoid notch, is a rare entity that must be considered in the differential diagnosis of radicular pain, as well as that of shoulder discomfort. Causes weakness of both abduction and external rotation. The suprascapular nerve is vulnerable to compression at the suprascapular notch as well as at the spinoglenoid notch. Most cases of entrapment occur when the nerve passes through scapular ligament. Suprascapular nerve, nerve entrapment syndromes, rotator cuff. The suprascapular nerve can become compressed and entrapped, resulting in unpleasant suprascapular nerve entrapment symptoms. This syndrome belongs to a group of diseases called compression syndromes, in which a nerve is compressed in one of the anatomic tunnels through which it runs. Despite a lack of scientific evidence, excessive strain on the nerve is often cited as a possible cause of this syndrome. Suprascapular nerve block is a safe and welltolerated method. Suprascapular vascular anomalies as a cause of suprascapular.
Suprascapular neuropathy is a rare cause of shoulder pain with an injury to the nerve intrinsically related to the anatomy and course of the. Suprascapular neuropathy in volleyball players europe pmc. Suprascapular nerve entrapment caused by protrusion of an. Suprascapular nerve entrapment caused by an intraosseous. We present a puzzling case of a man with suprascapular nerve neuropathy that may have been associated with an appendectomy. Suprascapular notch nerve courses through the suprascapular notch. Kopell and thompson 2 are credited with providing the first description of the suprascapular nerve entrapment syndrome. A shortcut to arthroscopic suprascapular nerve decompression at. Treatment of this unusual form of sne may be by injection with longacting local anesthetics or phenol neurolysis.
If the patients history reveals a trauma, it is more likely that the ligament is compromising the nerve. Entrapment occurs as the nerve is relatively fixed at the notch. Electromyographic emg, evaluation of the infraspinatus, and especially the supraspinatus muscles distinguishes sgn from ssn lesions. Suprascapular nerve compression is a rare but important entity that is often missed in clinical practice. Nerves in the torso, limbs, and extremities may be affected. Clinical presentation nonspecific posterior shoulder pain and weakne. Suprascapular nerve entrapment is an uncommon cause of shoulder pain that is being encountered more frequently in clinical practice with the increasing use of backpacks instead of briefcases. The most commonly encountered cause of this condition is a ganglion, usually arising from a posterior labral tear. Pdf introduction the ductal syndromes of the shoulder combine all the compressive processes of the suprascapular nerve at the level of its.
Arthroscopic treatment of suprascapular nerve neuropathy 229 a position of overhead throwing. The full text of this article is available as a pdf 6k. Suprascapular nerve exposed top arrow after releasing spinoglenoid ligament bottom left arrow at spinoglenoid notch bottom right arrow. In a recent study physical therapy was found to be effective in reducing pain severity and functional disability, and the addition of suprascapular nerve block to physical therapy improved functional status and pain levels in patients with adhesive capsulitis. However, suprascapular nerve entrapment caused by an intraosseous ganglion occurring in the glenoid is rare. Aug 26, 2011 suprascapular nerve neuropathy constitutes an unusual cause of shoulder weakness, with the most common etiology being nerve compression from a ganglion cyst at the suprascapular or spinoglenoid notch. Patient information sheet suprascapular nerve blocks what is the suprascapular nerve.
Entrapment of the suprascapular nerve is a rare but increasingly recognized disease entity that contributes to pain and. The ligament on shoulder blade can compress the nerve when it gets inflamed. The scapula is the bone that is commonly known as the shoulder blade. Peripheral nerve injury of the upper extremity commonly occurs in. The purpose of this report was to determine a detailed description of a rehabilitation programme of a volleyball player who had a decompression surgery for suprascapular nerve entrapment and to expose the longterm functional outcomes which lead to. Patient information sheet suprascapular nerve blocks. Suprascapular nerve entrapment due to a stenotic foramen ncbi. Suprascapular nerve entrapment syndrome is caused by compression of the suprascapular nerve as it passes through the suprascapular notch. Suprascapular neuropathy typically occurs due to some sort of traction injury to the suprascapular nerve resulting in pain in the shoulders. Case report a 22 year old medical student presented with. Identification of ganglion cyst causing suprascapular.
Lesions of the suprascapular nerve can occur at the supraspinatus notch ssn or at the spinoglenoid notch sgn. Entrapment neuropathy of the inferior branch of the. The nerve dysfunction often results from a traction injury or compression, and a common cause is increased tension on the nerve from retracted rotator cuff tears. Compression of the nerve may occur at two distinct locations. Jan 01, 20 several authors have described suprascapular nerve palsy in patients with a massive rotator cuff tear associated with fatty infiltration or muscle atrophy. When entrapped or stretched, it can cause shoulder dysfunction and pain which over time can cause impingement syndrome and.
Arthroscopic release of suprascapular nerve entrapment at. Athletes who participate regularly in overhead sports are more susceptible to developing suprascapular neuropathy. However, this pathology has been reported in volleyball players. Persistent shoulder pain due to a suprascapular nerve. Therefore, it was not a clinical trial in which possible complications of method could be detected 11. The suprascapular nerve passes through the suprascapular notch which is converted into foramen by superior transverse scapular ligament. Pdf compression of the suprascapular nerve by a ganglion cyst of. The transverse scapular ligament can be identified at the base of the coracoid, just medial. If entrapment occurs more distally along the course of the suprascapular nerve, innervation of the infraspinatus muscle only is affected. The suprascapular nerve arises from the upper trunk of the brachial plexus which is formed by the union of the ventral rami of the fifth and sixth cervical nerves. The ligament on the shoulder blade can compress the nerve when it gets inflamed. Peripheral nerve entrapment and injury in the upper extremity aafp. Background suprascapular nerve entrapment with isolated paralysis of the infraspinatus muscle is uncommon.
The suprascapular nerve entrapment is clinically manifested by the presence of deep, dull and diffuse pain in. Until recently, the diagnosis of suprascapular nerve entrapment was only considered after development of marked weakness and atrophy of the supraspinatus or infraspinatus muscles. Treatment for suprascapular nerve entrapment depends upon the cause, intensity, and duration of your symptoms and the amount of disability. Oct 11, 2018 suprascapular neuropathy is a less common cause of shoulder pain in athletes but is seen particularly in those who participate in overhead activities. The suprascapular nerve, supplies the supraspinatus and infraspinatus muscles. Protective and predisposing morphological factors in. Entrapment of the nerve at more distal anatomical sites has not been reported. Introduction also known as scapular notch syndrome. We report here a young physically active man with ssn secondary to a ganglion paralabral cyst at the spinoglenoid notch identified by high resolution neurosonography. The case was attributed to nerve injury as the most likely cause that. Suprascapular nerve ssn entrapment at the suprascapular notch is an. J a liveson, m j bronson, and m a pollack saul r korey, department of neurology, albert einstein college of medicine, bronx, ny.
Dec 04, 2018 suprascapular neuropathy typically occurs due to some sort of traction injury to the suprascapular nerve resulting in pain in the shoulders. Maximal stretching of the nerve with cross body adduction or protracted forward flexion. Pettersonc aplancher orthopaedics and sports medicine, new york, ny, usa bdepartment of orthopaedic surgery, albert einstein college of medicine, new york, ny, usa corthopaedic foundation, stamford, ct, usa abstract. Operative release for entrapment of the suprascapular nerve was carried out in 35 patients. Suprascapular nerve entrapment is an uncommon but significant cause of shoulder pain, and a ganglion originating from the soft tissues around the spinoglenoid notch has been reported to be a cause of suprascapular nerve entrapment. Suprascapular nerve definition of suprascapular nerve by. Pathology trauma andor entrapment to nerve with pain within ulnar distribution relevant anatomy. C5, c6 motor branches to the supraspinatus and infraspinatus muscles sensory branches to the shoulder and acromioclavicular joints in the suprascapular notch, the nerve passes under. A possible association between the suprascapular nerve entrapment and. Anatomy of nerve entrapment sites in the upper quarter. Peripheral nerve entrapment and injury in the upper extremity. Sep 26, 2016 the anatomic course of the suprascapular nerve. The suprascapular nerve is a nerve in the shoulder. After branching from the upper trunk, the nerve passes across the posterior triangle of the neck parallel to the inferior belly of the omohyoid muscle and deep to the trapezius muscle.
This test is performed by the examiner rotating the head of the patient laterally and away from the affected shoulder while retracting the shoulder with. Pdf a rare cause of compression of the suprascapular nerve. The suprascapular nerve entrapment syndrome was first described by andr. We describe a novel allarthroscopic technique for suprascapular nerve ssn decompression and present our preliminary results for this procedure. A series of 27 cases, the largest reported to date, is presented and examined as to the best and most appropriate method of diagnosis and treatment. Anatomy of nerve entrapment sites in the upper quarter neal pratt, phd, pt department of rehabilitation sciences drexel university philadelphia, pennsylvania abstract. Other causes of suprascapular neuropathy include traction injury at the level of the transverse scapular ligament or the spinoglenoid ligament and direct trauma to the nerve. Preferential positioning on one side, which is not unusual in lung diseases, may cause traction and entrapment of the suprascapular nerve. Ligaments, articular capsule, and synovial suprascapular nerve block in the treatment of frozen shoulder. Suprascapular nerve decompression chicago sports medicine symposium, august 5 th, 2016 disclosure none relevant to this presentation anatomy upper trunk brachial plexus. This notch is converted into a foramen by the superior transverse scapular ligament, and serves for the passage of the suprascapular nerve but not its corresponding artery. Entrapment at this level may result in denervation changes of both muscles. C5, c6 motor and sensory supplies supraspinatus infraspinatus deep to transverse scapular ligament in suprascapular notch 3 cm medial to supraglenoid tubercle.
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