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 spinoglenoid notch entrapment weakness of infraspinatus only 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 affects infraspinatus only 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
Technique Guide CPT Codes: 64708 Neuroplasty, major peripheral nerve, arm or leg, open; other than specified Technique guides are not considered high yield topics for orthopaedic standardized exams including ABOS, EBOT and RC. Suprascapular Nerve Decompression (Suprascapular Notch) Orthobullets Team Shoulder & Elbow - Suprascapular Neuropathy Technique Guide CPT Codes: 64708 Neuroplasty, major peripheral nerve, arm or leg, open; other than specified Technique guides are not considered high yield topics for orthopaedic standardized exams including ABOS, EBOT and RC. Suprascapular Nerve Decompression (Spinoglenoid Notch) Orthobullets Team Shoulder & Elbow - Suprascapular Neuropathy
QUESTIONS 1 of 26 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 Previous Next Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK (SBQ19SE.9) A 27-year-old minor league baseball pitcher presents to your office complaining of vague, deep shoulder pain which worsens during the late cocking phase of his throwing cycle. He also reports a recent decrease in velocity. He denies any history of instability. On examination, he has full strength with shoulder abduction, negative empty can test, as well as weakness with shoulder external rotation and resisted cross-body adduction. Radiographs are unremarkable and an MRI is obtained which demonstrates a tear of the posterior labrum with an adjacent paralabral cyst. Given this history, which of the following structures seen on the reference MRI in Figure A would be be expected to be affected? QID: 216799 FIGURES: A Type & Select Correct Answer 1 Structure 2 11% (84/774) 2 Structure 3 5% (38/774) 3 Structure 4 66% (509/774) 4 Structures 1 & 5 6% (49/774) 5 Structures 3 & 4 11% (85/774) L 3 Question Complexity Select Answer to see Preferred Response SUBMIT RESPONSE 3 Review Tested Concept Review Full Topic (SBQ19HK.4) A 17-year-old male high school baseball pitcher presents to your office complaining of posterior shoulder pain and weakness. His father says his coaches have reported a decrease in velocity as of late. On clinical examination he has an abnormal O’Brien’s test and weakness in external rotation with the arm by his side. He has 5/5 strength with empty can testing. Radiographs do not show any abnormalities and MRI is seen in Figure A. Based on his diagnosis, which muscle would be affected and at risk for atrophy without intervention? QID: 216790 FIGURES: A Type & Select Correct Answer 1 Supraspinatus 8% (69/832) 2 Infraspinatus 86% (714/832) 3 Teres minor 4% (37/832) 4 Deltoid 1% (5/832) 5 Serratus anterior 0% (2/832) L 1 Question Complexity Select Answer to see Preferred Response SUBMIT RESPONSE 2 Review Tested Concept Review Full Topic Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK (OBQ18.231) A 35-year-old athlete presents with chronic left shoulder pain with worsening external rotation weakness when his elbow is at his side. He has full external rotation when his arm is elevated. His clinical picture is depicted in Figure A. If an MRI is obtained, which of the following images (Figures B-F) would most likely be found? QID: 213127 FIGURES: A B C D E F Type & Select Correct Answer 1 Figure B 3% (62/1898) 2 Figure C 75% (1421/1898) 3 Figure D 14% (265/1898) 4 Figure E 4% (76/1898) 5 Figure F 3% (53/1898) L 2 Question Complexity A Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 2 Review Tested Concept Review Full Topic (SBQ16SM.97) Figure A is the MRI image of a 27-year-old tennis player who presents with a 3-month history of shoulder pain and weakness. Which of the following muscles would most likely present with weakness? QID: 212173 FIGURES: A B Type & Select Correct Answer 1 A only 3% (42/1263) 2 B only 63% (797/1263) 3 C only 5% (59/1263) 4 A & B 20% (249/1263) 5 B & C 9% (110/1263) L 1 Question Complexity E Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 2 Review Tested Concept Review Full Topic Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK (SBQ16SM.4) A 27-year-old volleyball player complains of worsening right posterolateral shoulder pain and weakness for the past 4 weeks. She denies any injury to the shoulder. Her examination reveals 5/5 muscle strength with shoulder elevation, abduction and internal rotation. She is found to have weakness in external rotation with the elbow at the side and gross inspection is remarkable for mild atrophy along the posterior scapula. She has an unremarkable lift-off test. Which nerve and corresponding site of compression is most likely responsible? QID: 211150 Type & Select Correct Answer 1 Suprascapular nerve and Suprascapular notch 11% (201/1808) 2 Axillary nerve and Quadrilateral space 4% (73/1808) 3 Suprascapular nerve and Spinoglenoid notch 82% (1483/1808) 4 Upper subscapular nerve and Spinoglenoid notch 2% (41/1808) 5 Radial nerve and Triangular interval 0% (1/1808) L 2 Question Complexity A Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 3 Review Tested Concept Review Full Topic (OBQ13.42) Figure A and B are MRI images of a 42-year-old male with symptoms of right shoulder neuropathy. If this patient has an abnormality detected on EMG and nerve conduction testing, which of the following nerves is most likely to be involved? QID: 4677 FIGURES: A B Type & Select Correct Answer 1 Subscapular nerve 6% (307/5304) 2 Axillary nerve 3% (184/5304) 3 Musculocutaneous nerve 1% (79/5304) 4 Suprascapular nerve 88% (4681/5304) 5 Long thoracic nerve 0% (25/5304) L 3 Question Complexity B Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 4 Review Tested Concept Review Full Topic (OBQ12.24) A 22-year-old right-handed semi-professional baseball player complains of right shoulder pain and progressive weakness. He denies any traumatic events. His exam is noted to have a normal "empty can" and "belly press" tests. Resisted external rotation with the arm at the side does exhibit weakness. His MRI images are shown in figure A and B. What is the most likely cause of his symptoms? QID: 4384 FIGURES: A B Type & Select Correct Answer 1 Suprascapular nerve entrapment at the suprascapular notch 12% (783/6755) 2 Suprascapular nerve entrapment at the spinoglenoid notch 83% (5581/6755) 3 Axillary nerve entrapment in the posterior triangle 2% (153/6755) 4 Axillary nerve entrapment in the axillary pouch 1% (56/6755) 5 Axillary nerve entrapment at near inferior neck of glenoid 2% (113/6755) L 3 Question Complexity A Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 2 Review Tested Concept Review Full Topic Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK (OBQ11.179) A 44-year-old male presents with a 2 month history of posterior shoulder pain. He is noted to have normal forward flexion and abduction strength and isolated weakness on shoulder external rotation. He has slight atrophy of his periscapular area. He has no numbness or paraesthesias. Which pathology would best explain his symptoms? QID: 3602 Type & Select Correct Answer 1 Cranial nerve XI palsy 1% (33/4729) 2 Spinoglenoid notch cyst 78% (3676/4729) 3 Axillary nerve palsy 1% (67/4729) 4 Suprascapular notch cyst 19% (878/4729) 5 Parsonage-Turner Syndrome 1% (58/4729) L 1 Question Complexity B Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 2 Review Tested Concept Review Full Topic Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK (OBQ10.168) A 29-year-old male volleyball player presents with a one year history of right shoulder weakness and deep aching pain. He denies any history of trauma or prior shoulder problems. A clinical photograph and representative sagittal MRI image are shown in Figures A and B respectively. He is diagnosed with a ganglion cyst of the shoulder. Based on the images provided, where is the cyst located? QID: 3261 FIGURES: A B Type & Select Correct Answer 1 Suprascapular notch 7% (208/2784) 2 Spinoglenoid notch 80% (2224/2784) 3 Quadrangular space 5% (136/2784) 4 Subscapular recess 6% (173/2784) 5 Triangular interval 1% (27/2784) L 1 Question Complexity B Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 2 Review Tested Concept Review Full Topic Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK This is an AAOS Self Assessment Exam (SAE) question. Orthobullets was not involved in the editorial process and does not have the ability to alter the question. If you prefer to hide SAE questions, simply turn them off in your Learning Goals. (SAE07SM.89) A 22-year-old volleyball player reports the insidious onset of superior and posterior shoulder pain. Radiographs are normal. An MRI scan is shown in Figure 25. What is the most specific physical examination finding? QID: 8751 FIGURES: A Type & Select Correct Answer 1 Positive impingement sign 10% (71/715) 2 Positive apprehension 14% (101/715) 3 Positive active compression 11% (77/715) 4 Weakness of external rotation 55% (396/715) 5 Weakness of abduction 9% (67/715) L 4 Question Complexity D Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 4 Review Tested Concept Review Full Topic This is an AAOS Self Assessment Exam (SAE) question. Orthobullets was not involved in the editorial process and does not have the ability to alter the question. If you prefer to hide SAE questions, simply turn them off in your Learning Goals. (SAE07SM.51) A 22-year-old professional baseball catcher has posterior shoulder pain and severe external rotation weakness with the arm in adduction. Radiographs are normal. MRI scans are shown in Figures 15a through 15c. Management should consist of QID: 8713 FIGURES: A B C Type & Select Correct Answer 1 aspiration and steroid injection. 14% (91/631) 2 rest. 4% (24/631) 3 acromioplasty. 2% (10/631) 4 arthroscopic repair and decompression. 73% (460/631) 5 rehabilitation. 7% (45/631) L 3 Question Complexity E Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 4 Review Tested Concept Review Full Topic (SBQ07SM.51) A 34-year-old competitive weightlifter presents with increasing pain during bench pressing. Despite modifications in his workout, he is unable to compete. His physical exam demonstrates weakness in external rotation. Radiographs are unremarkable. His MRI findings are seen in Figure A. Treatment should include which of the following? QID: 1436 FIGURES: A Type & Select Correct Answer 1 Refrain from weightlifting for a minimum of 6 weeks 5% (118/2511) 2 Physical therapy with rotator cuff strengthening 8% (199/2511) 3 Suprascapular cyst decompression 6% (161/2511) 4 Infraspinatus rotator cuff repair and acromioplasty 4% (91/2511) 5 Spinoglenoid cyst decompression with posterior labral repair 77% (1932/2511) L 2 Question Complexity B Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 5 Review Tested Concept Review Full Topic (OBQ07.107) A patient with shoulder pain and weakness has an MRI showing a cyst in the suprascapular notch. Which of the following muscles is most likely to show weakness? QID: 768 Type & Select Correct Answer 1 Deltoid 0% (6/2418) 2 Supraspinatus 5% (123/2418) 3 Supraspinatus and infraspinatus 85% (2053/2418) 4 Infraspinatus 9% (221/2418) 5 Teres minor 0% (11/2418) L 1 Question Complexity A Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 3 Review Tested Concept Review Full Topic (OBQ05.131) A 24-year-old avid volleyball player has noted gradual onset of shoulder fatigue and weakness limiting his game. Radiographs done by his primary care physician were normal and he has failed to improve with 6 weeks of physical therapy. Given the MRI image shown in Figure A, this patients physical exam may reveal weakness with which of the following actions? QID: 1017 FIGURES: A Type & Select Correct Answer 1 Adduction 1% (21/2584) 2 Internal rotation 2% (42/2584) 3 Abduction and external rotation 55% (1411/2584) 4 Abduction 12% (304/2584) 5 External rotation 30% (783/2584) L 2 Question Complexity D Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 3 Review Tested Concept Review Full Topic (OBQ05.15) A 21-year-old collegiate volleyball player is noted to have weakness in external rotation and isolated atrophy of the infraspinatus on physical examination as seen in Figure A. An axial MRI image is shown in Figure B. This clinical condition is most likely caused by compression of the: QID: 52 FIGURES: A B Type & Select Correct Answer 1 Axillary nerve at the triangular space 1% (5/987) 2 Suprascapular nerve in the suprascapular notch 9% (89/987) 3 Axillary nerve in the quadrangular space 2% (15/987) 4 Suprascapular nerve in the spinoglenoid notch 88% (868/987) 5 Long thoracic nerve anterior to the scalenus and the first rib and posterior to the clavicle 1% (6/987) L 1 Question Complexity A Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 4 Review Tested Concept Review Full Topic (OBQ05.202) A patient is scheduled to undergo arthroscopy for a SLAP tear of his shoulder. Based on the sagittal images of the right shoulder MRI shown in Figure A, what additional physical exam finding is the patient likely to display? QID: 1088 FIGURES: A Type & Select Correct Answer 1 Weakness in forward elevation 4% (47/1256) 2 Weakness in internal rotation 11% (143/1256) 3 Weakness in external rotation 79% (993/1256) 4 Positive impingement maneuver 4% (51/1256) 5 Scapular winging 1% (15/1256) L 3 Question Complexity A Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 3 Review Tested Concept Review Full Topic (OBQ04.127) A 25-year-old volleyball player has recurrent right shoulder pain. On exam she has right shoulder weakness to external rotation with her arm at her side and atrophy below the scapular spine. There is no external rotation lag sign. Jobe drop arm and hornblower's tests are negative. The O'Brien's active compression test is positive. What will most likely be found on MRI of her shoulder? QID: 1232 Type & Select Correct Answer 1 Partial articular sided tear of the infraspinatus 4% (108/2625) 2 Partial articular sided tear of the supraspinatus 1% (39/2625) 3 Full thickness tear of the infraspinatus 5% (131/2625) 4 Inferior labral tear with quadrangular space cyst 3% (74/2625) 5 SLAP tear and spinoglenoid notch cyst 86% (2257/2625) L 1 Question Complexity C Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 5 Review Tested Concept Review Full Topic
All Videos (11) Podcasts (1) Login to View Community Videos Login to View Community Videos Suprascapular Neuropathy (Narrated Professionally) Kemal Gokkus Shoulder & Elbow - Suprascapular Neuropathy C 5/1/2021 76 views 5.0 (1) Login to View Community Videos Login to View Community Videos SLAP with Spinoglenoid Cyst - Joo Han, Oh M.D., Ph.D. Shoulder & Elbow - Suprascapular Neuropathy A 12/21/2020 155 views 4.0 (2) Login to View Community Videos Login to View Community Videos Arthroscopic Decompression of Spinoglenoid Notch Cyst & SLAP Repair Through a Single Working Portal Shoulder & Elbow - Suprascapular Neuropathy D 12/16/2020 95 views 0.0 (0) Shoulder & Elbow | Suprascapular Neuropathy Shoulder & Elbow - Suprascapular Neuropathy Listen Now 13:11 min 10/15/2019 328 plays 5.0 (2) See More See Less
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