Suprascapular nerve entrapment: experience with 28 cases

Abstract

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. Over a period of 10 years (1985-1995), the authors treated 28 cases of SNE in 27 patients by surgical decompression of the nerve. One patient underwent operation bilaterally within 5 years. Five patients presented with a history of trauma to the shoulder region. In three patients, a ganglion cyst was the origin of the nerve lesion. In 16 patients, the nerve problem was primarily related to athletic activities. Eight of these patients were professional volleyball players. In the remaining three patients, there was no relationship between the nerve lesion and trauma or athletic activities. Twenty-one patients (22 cases) complained of pain located over the suprascapular notch. Seventeen patients had paresis and atrophy of both the supraspinatus (SS) and infraspinatus (IS) muscles. In 10 patients only the IS muscle was involved. One patient exhibited a sensory deficit over the posterior portion of the shoulder. Electromyography was performed in all cases. The mean follow-up period in the 25 cases (24 patients) that could be evaluated was 20.8 months (range 3-70 months). Nineteen of 22 cases with preoperative pain could be evaluated. Sixteen of these patients were completely free of pain after surgery and three patients found their pain had improved. Motor function in the SS muscle improved in 86.7% and motor function in the IS muscle in 70.8% of cases. Atrophy of the SS muscle resolved in 80.7% and atrophy of the IS muscle in 50% of cases. Surgical treatment of SNE is indicated after failed conservative treatment and in cases of atrophy of the SS and IS muscles. The authors recommend the posterior approach, which minimizes risks and complications and produces good postoperative results.

High Incidence of Complete Ossification of the Superior Transverse Scapular Ligament in Brazilians and its Clinical Implications

“…The suprascapular notch and the overlying STSL constitute a narrow foramen, with inflexible and often sharp edges, through which the suprascapular nerve must pass (Williams et al; Weinfeld et al). The suprascapular nerve is fixed in the osteofibrous foramen of the notch and STSL and by its distal muscular and joint connections (Gelmers & Byus, 1977;Antoniadis et al;Weinfeld et al). Mechanical irritation of the suprascapular nerve can occur at this location with excursions of the scapula, particularly during crossbody abduction, during a variety of activities involving movement of the upper extremity (Clein, 1975;Gelmers & Buys;Antoniadis et al;Weinfeld et al).…”

“…The suprascapular artery and vein pass over the superior aspect of the STSL (Antoniadis et al, 1996;Weinfeld et al, 2002). The suprascapular notch and the overlying STSL constitute a narrow foramen, with inflexible and often sharp edges, through which the suprascapular nerve must pass (Williams et al; Weinfeld et al).…”

Suprascapular nerve entrapment in a patient with a spinal cord injury

“…1,4,5 SNE has been reported in athletes as a non-frequent but underdiagnosed micro-traumatic pathology. 4,5 In individuals with SCI, the upper limbs are overused, especially in activities requiring strength (for example, wheelchair propulsion, transfers) and in activities requiring a wide range of motion (for example, grasping objects located over shoulder height). However, the joints of the upper limbs are not anatomically adapted to these kinds of activities.…”

“…However, in most cases atrophy is not present, and thus the diagnosis of SNE is difficult to affirm. 4,5 A local gluco-corticoid injection is usually performed for this pathology in athletic people. 4,5 In our patient, the gluco-corticoid injection had a rapid and lasting effectiveness.…”

“…If this treatment is not effective, surgical nerve decompression can be proposed. 4,5 The early implementation of such treatments depends on a rapid diagnosis. However, we know that this pathology is under-diagnosed 4,5 and therefore certainly under-treated.…”