Suprascapular Nerve: Is It Important in Cuff Pathology?

Abstract

Suprascapular nerve and rotator cuff function are intimately connected. The incidence of suprascapular neuropathy has been increasing due to improved understanding of the disease entity and detection methods. 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. Suprascapular neuropathy should be considered as a diagnosis if patients exhibit posterosuperior shoulder pain, atrophy or weakness of supraspinatus and infraspinatus without rotator cuff tear, or massive rotator cuff with retraction. Magnetic resonance imaging and electromyography studies are indicated to evaluate the rotator cuff and function of the nerve. Fluoroscopically guided injections to the suprascapular notch can also be considered as a diagnostic option. Nonoperative treatment of suprascapular neuropathy can be successful, but in the recent decade there is increasing evidence espousing the success of surgical treatment, in particular arthroscopic suprascapular nerve decompression. There is often reliable improvement in shoulder pain, but muscle atrophy recovery is less predictable. More clinical data are needed to determine the role of rotator cuff repair and nerve decompression in the same setting.

MRI appearance of the superior transverse scapular ligament

“…The most common cause of suprascapular neuropathy is suprascapular entrapment at the suprascapular notch, either as an isolated phenomenon or as part of other shoulder pathology [8,10], although other causes include direct trauma [12], stretching due to repetitive overhead motion [23], and acute brachial neuritis (Parsonage-Turner syndrome) [24,25]. Therefore, knowledge of the normal appearance of the STSL may be important for diagnosing abnormalities of the STSL and detecting findings suggestive of suprascapular nerve entrapment, planning for surgery or image-guided intervention [26], and identifying anatomic variants [27,28].…”

“…Suprascapular nerve entrapment can contribute to shoulder pain. Most etiologies occur at the suprascapular notch, including abnormalities and anatomic variations of the STSL [3], ganglion or paralabral cyst formation [4,5], and traction related to rotator cuff tears [6][7][8][9][10]. While anatomic and surgical consideration has been paid to the STSL for evaluation of suprascapular nerve entrapment [11][12][13], the STSL has not been formally identified or characterized on imaging.…”

Morphology of suprascapular notch in medieval skeletons from Bulgaria

“…Kopell and Thompson [16] were the first to define a suprascapular neuropathy syndrome. The common symptoms of the suprascapular neuropathy are a deep, diffuse and dull shoulder pain, weakness in external rotation and abduction of the upper extremity, and atrophy of both supraspinatus and infraspinatus muscles [9,24,30]. Cohen et al [7] described 2 cases of entrapment of the suprascapular nerve from a calcified superior transverse scapular ligament, and both patients were members of the same family, which suggests a genetic precondition for the ossification.…”

“…The suprascapular nerve provides sensory innervation to the posterosuperior aspect of the shoulder and motor innervation to supraspinatus and infraspinatus muscles and its dysfunction is intimately associated with rotator cuff pathology [30].…”

Suprascapular neuropathy related to rotator cuff tears: A short review

“…Recently, SSN neuropathy related to rotator cuff tears has become a topic of discussion [7][8][9][10][11][12] . Rotator cuff tears medialise muscle fibres and tether the SSN at the suprascapular notch, thus resulting in suprascapular neuropathy.…”