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Updated: Dec 26 2023

Suprascapular Neuropathy

Images
https://upload.orthobullets.com/topic/3063/images/suprascapular notch cyst.jpg
https://upload.orthobullets.com/topic/3063/images/clinical image, infraspinatus atrophy smaller.jpg
https://upload.orthobullets.com/topic/3063/images/spinoglenoid notch cystplain.jpg
https://upload.orthobullets.com/topic/3063/images/clinical image, infraspinatus atrophy.jpg
  • Summary
    • Suprascapular neuropathy is compression of the suprascapular nerve that most commonly occurs at the suprascapular notch or spinoglenoid notch by a mass (i.e cyst).
    • Diagnosis can be suspected clincally with weakness and atrophy of the infraspinatous or supraspinatous and confirmed with MRI studies showing cysts in the suprascapular notch or spinoglenoid notch.
    • Treatment of suprascapular nerve compression at the suprascapular notch requires decompression of a cyst when present. Treatment of a spinoglenoid cyst requires either decompression or repair of an associated labral lesion (if present).
  • Etology
    • Pathophysiology
      • suprascapular notch entrapment
        • weakness of both supraspinatus and infraspinatus
    • Associated conditions
      • SLAP tears
  • Anatomy
    • Suprascapular nerve (C5,C6)
      • emerges off superior trunk (C5,C6) of brachial plexus
      • travels across posterior triangle of neck to scapula
      • innervates
        • supraspinatus
        • infraspinatus
    • Suprascapular ligament
      • arises from medial base of coracoid and overlies suprascapular notch
        • suprascapular artery runs above
        • suprascapular nerve runs below
    • Spinoglenoid ligament
      • arises near spinoglenoid notch
        • overlies distal suprascapular nerve
  • Suprascapular notch entrapment
    • Introduction
      • proximal compression of suprascapular nerve in the suprascapular notch
        • leads to weakness of both supraspinatus and infraspinatus
    • Pathoanatomy
      • compression can be from
        • ganglion cyst (often associated with labral tears)
        • transverse scapular ligament entrapment
        • fracture callus
    • Presentation
      • symptoms
        • deep, diffuse, posterolateral shoulder pain
      • physical exam
        • pain with palpation of suprascapular notch
        • weakness of supraspinatus
          • weakness seen with shoulder abduction to 90 degree, 30 degrees forward flexion, and with internal rotation (Jobe test positive)
        • weakness of infraspinatus
          • weakness to external rotation with elbow at side
        • atrophy along the posterior scapula
    • Evaluation
      • MRI
        • important to identify a compressive mass with associated cyst
      • EMG/NCV
        • diagnostic
    • Treatment
      • nonoperative
        • activity modification and organized shoulder rehab program
          • indications
            • no structural lesion seen on MRI
          • technique
            • rehab should be performed for a minimum of 6 months
      • operative
        • surgical nerve decompression at suprascapular notch
          • indications
            • structural lesion seen on MRI (cyst)
            • failure of extended nonoperative management (~ 1 year)
  • Spinoglenoid notch entrapment
    • Introduction
      • distal compression of suprascapular nerve
      • Pathoanatomy
        • compression can be due to
          • posterior labral tears causing a cyst
          • spinoglenoid ligament
          • spinoglenoid notch ganglion
          • traction injury (seen in 45% of volley ball players)
          • transglenoid fixation
            • lies 1.5cm medial to glenoid labrum
    • Presentation
      • symptoms
        • deep, diffuse, posterolateral shoulder pain
      • physical exam
        • infraspinatus weakness
          • weakness to external rotation with elbow at side
        • infraspinatus atrophy along the posterior scapula
        • supraspinatus strength is normal
    • Evaluation
      • MRI
        • important to identify posterior labral lesions with associated cyst
      • EMG/NCV
        • diagnostic
    • Treatment
      • nonoperative
        • activity modification and organized shoulder rehab program
          • indications
            • no structural lesion seen on MRI
          • technique
            • posterior shoulder capsule stretching
      • operative
        • labral repair with arthroscopic cyst decompression
          • indications
            • labral lesion with associated cyst seen on MRI
        • spinoglenoid ligament release with nerve decompression
          • indications
            • no structural lesion seen on MRI and failure of extended nonoperative management (~ 1 year)
          • technique
            • posterior approach commonly utilized
            • decompress nerve in spinoglenoid notch
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