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. A mr imaging evaluation of suprascapular nerve entrapment. Suprascapular nerve ssn entrapment neuropathy occurring at the transverse scapular notch was first described by thomas in 1936. A line is drawn along the scapular spine and then bisected by a second line parallel to the vertebral spine. Compression of the suprascapular nerve by a ganglion cyst.
After decompression in those few cases with refractory pain, a nerve neurostimulator can be applied. Shoulder pain is the primary symptom of suprascapular nerve entrapment. The suprascapular nerve passes through the suprascapular notch which is converted into foramen by superior transverse scapular ligament. The ligament on the shoulder blade can compress the nerve. The ligament on the shoulder blade can compress the nerve when it gets inflamed. Suprascapular nerve compression at the spinoglenoid notch was first recognized and described in 1981. Nerve becomes enlarged proximal to site of compression 24 cm nerve returns to normal caliber or size after entrapment area. Entrapment can be relieved arthroscopically in some cases. Ulnar nerve entrapment is a condition where the ulnar nerve becomes physically trapped or. Pain and weakness were the presenting symptoms in 14 shoulders and pain alone in 8. A variant of the suprascapular notch jeremy bruce, john dorizas, 20. Infraspinatus muscle atrophy from suprascapular nerve. For many years, nerve transfer has been commonly used as a treatment option following peripheral nerve injury, although the precise mechanism underlying successful nerve transfer is not yet clear. Suprascapular nerve lesions at the spinoglenoid notch.
Suprascapular nerve ssn entrapment is an uncommon cause of posterior shoulder pain. With the advent of mri, suprascapular nerve compression is becoming increasingly recognised as a cause of shoulder pain in the orthopaedic,14 radiological,5 6 and sports medicine8 literature. Nerve compression syndrome or compression neuropathy, is a medical condition caused by direct pressure on a nerve. This usually requires an open incision which must split the trapezius muscle. 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. Suprascapular nerve compression should be considered in cases of shoulder pain and arm abduction weakness. In 1982, aiello et al2 differentiated suprascapular nerve entrapment at the spinoglenoid notch. Entrapment of the distal suprascapular nerve springerlink. Until recently, the diagnosis of suprascapular nerve entrapment was only considered after development of marked weakness and atrophy of the supraspinatus or infraspinatus muscles.
Clinical presentation nonspecific posterior shoulder pain and weakne. Initially, your health care provider will embark upon conservative treatment for suprascapular neuropathy. The ligament was found to be absent in 50% of females and rudimentary in one female, but absent in only % of the male shoulders. Seven patients with suprascapular nerve palsy are presented, and their evaluation, treatment, and outcome over a mean followup period of 24 months are described. Topographical anatomy of the suprascapular nerve and. To compare a ct guided versus an anatomical landmark approach in a randomised, single blind trial examining the efficacy of suprascapular. Mri of the right shoulder revealed a large spinoglenoid cyst compressing the suprascapular nerve figure, b and c. Full text views reflects the number of pdf downloads, pdfs sent. Suprascapular nerve entrapment is an uncommon nerve condition in the shoulder, causing pain and weakness. The suprascapular nerve is a mixed nerve motor and sensory arising from the upper trunk of the brachial plexus with contributions from the c5 and c6 nerve roots occasionally c4. If entrapment occurs more distally along the course of the suprascapular nerve, innervation of the infraspinatus muscle only is affected. The suprascapular nerve passes in a groove in the shoulder blade.
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. Your ulnar nerve passes through the tunnel to supply sensation to your fingers, and. Specialists at the peripheral nerve center also treat people who have carpal tunnel syndrome, double crush syndrome, meralgia paresthetica, mortons neuroma, neurogenic pyriformis syndrome, peroneal nerve entrapment at the fibular head, and pudendal nerve entrapment. It is known colloquially as a trapped nerve, though this may also refer to nerve root compression by a herniated disc, for example. The bone serves as a protector for many of the nerves of the back and arm that lie underneath it. Carrying a heavy, mobile camera on the shoulder might cause suprascapular nerve entrapment in newsreel cameramen. The suprascapular nerve, formed from the upper trunk of the brachial plexus, can be entrapped at the suprascapular notch and result in significant patient morbidity. Twentyfive shoulders were dissected in cadavers in order to observe the presence of the inferior transverse ligament, the spinoglenoid ligament, and its relationship to the spinoglenoid notch and the suprascapular nerve. Suprascapular nerve entrapment caused by the superior transverse scapular ligament stsl causes pain, and limitation of motion in the shoulder. Entrapment at this level may result in denervation changes of both muscles. The nerve carries most of the pain receptors to the shoulder and rotator cuff muscles and passes through a small notch in the shoulder blade and to the back of the shoulder. Morphological and electromyogram analysis for the spinal. They were assessed at an average of 30 months 12 to 98 after operation using the functional.
Etiologies for suprascapular neuropathy may include repetitive overhead activities, traction from a rotator cuff tear, and compression from a spaceoccupying lesion at the suprascapular or spinoglenoid notch. 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. Suprascapular nerve entrapment due to a stenotic foramen. Apr 17, 20 pinched nerve in shoulder blade one shoulder higher than other cause and treatment barlates duration. Shoulder the suprascapular nerve is an underrecognized cause of shoulder pain and dysfunction. Suprascapular nerve, nerve entrapment syndromes, rotator cuff.
Entrapment of the ulnar nerve in cubital tunnel by free intraarticular. Suprascapular nerve an overview sciencedirect topics. Entrapment of the suprascapular nerve is frequently overlooked in the differential diagnosis of shoulder pain. It involves compression of the suprascapular nerve at the top or back of the shoulder, usually caused by a ligament, a cyst from the shoulder, or excessive stretching.
The most commonly encountered cause of this condition is a ganglion, usually arising from a posterior labral tear. Suprascapular nerve entrapment faqs beacon orthopaedics and. Introduction also known as scapular notch syndrome. Operative release for entrapment of the suprascapular nerve was carried out in 35 patients. The suprascapular nerve arises from the upper trunk of the brachial plexus. The suprascapular nerve is a mixed motor and sensory nerve that innervates the glenohumeral joint and the surrounding posterior shoulder girdle. Suprascapular nerve entrapment is a rare condition that can be easily misdiagnosed or even go unnoticed by those who are affected. 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. Decreased mobility of the nerve at site of entrapment. 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. Furthermore, as the nerve heals, exercises to strengthen the weak muscles should be of benefit. The nerve passes through the notch deep to the transverse scapular ligament, whereas the artery passes over the ligament.
The suprascapular nerve can become compressed and entrapped, resulting in unpleasant suprascapular nerve entrapment symptoms. Suprascapular nerve injury and rotator cuff tear both. The nerve originates 3cm superior to the clavicle, then courses through the posterior triangle in the supraclavicular fossa deep to the omohyoid muscle. Suprascapular nerve entrapment in a canoeist neurology. Jul 31, 2015 causes of suprascapular nerve entrapment. The condition may be more common than once thought as it is being diagnosed more frequently. Treatment for suprascapular nerve entrapment depends upon the cause, intensity, and duration of your symptoms and the amount of disability. Peripheral nerve entrapment and their surgical treatment. Get a printable copy pdf file of the complete article. Suprascapular nerve ssn entrapment at the suprascapular notch is an uncommon cause of shoulder pathology that often presents with posterior shoulder pain and wasting of the supraspinatus ss and infraspinatus is muscles. Suprascapular nerve entrapment occurs when supraspinatous nerve is compressed or is entrapped in a space.
The needle is directed from the top to avoid deep entry into the suprascapular notch, which could risk pneumothorax from rathmell et al. We developed an animal model to investigate the mechanism underlying nerve transfer between branches of the spinal accessory nerve ac and suprascapular nerve ss in rats, so that we could observe. Class iv k cold laser is an excellent treatment for any nerve entrapment, especially for treating suprascapular nerve syndrome. The suprascapular nerve is the major sensory supply to the shoulder joint and motor supply to the supraspinatus and infraspinatus muscles. There was no relationship between suprascapular nerve latencies and the age, professional life, and number of hours worked daily by the subjects. Suprascapular nerve entrapment, a series of 27 cases. Compression of the suprascapular nerve can occur at the suprascapular or. Suprascapular nerve definition of suprascapular nerve by. Patient information sheet suprascapular nerve blocks.
The entry point is 23 cm into the upper outer quadrant. If the patients history reveals a trauma, it is more likely that the ligament is compromising the nerve. The suprascapular nerve is the only branch of the upper trunk c5 and c6 of the brachial plexus, supplying the supraspinatus and infraspinatus muscles and sensation to the acromioclavicular and glenohumeral joints. Suprascapular nerve entrapment in newsreel cameramen.
Management and outcomes of 42 surgical suprascapular nerve. Entrapment neuropathy is caused by the prolonged compression or irritation of a nerve plexus or peripheral nerve. Twentyseven masses were identified adjacent to the suprascapular nerve on magnetic resonance mr images of the. Loss of honey comb appearance secondary to swelling and edema. Technique for endoscopic release of suprascapular nerve.
This disturbance is not rare or unusual, but must be taken into consideration in evaluating patients suspected of having a tear in the rotator cuff. A 15yearold girl described pain, reduced abduction, and external rotation of the left shoulder as well as intermittent paresthesia over the left scapula. Symptoms include numbness, tingling andor pain in the arm, hand andor. Suprascapular nerve block is a safe and effective treatment for chronic shoulder pain in arthritis, which can be performed either by direct imaging ct guided or in the clinic using anatomical landmarks to determine needle placement. Tibial nerve entrapment can cause a v ariety of foot and heel. Suprascapular nerve entrapment is rare and mainly occurs in patients under 40 years of age. 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. Documentation is made with electroneuromyographic testing.
Bilateral suprascapular nerve entrapment by ganglion cyst. Kopell and thompson1 initially described suprascapular neuropathy at the suprascapular notch in 1959. The suprascapular nerve is vulnerable to compression at the suprascapular notch as well as at the spinoglenoid notch. Suprascapular nerve entrapment syndrome is caused by compression of the suprascapular nerve as it passes through the suprascapular notch.
The class iv k laser increases metabolic reactions within the nerve to speed nerve regeneration and repair. Suprascapular neuropathy related to rotator cuff tears. Treatment at the peripheral nerve center nyu langone health. Males are more likely to suffer from a ganglion compressing the nerve than females. Suprascapular nerve ssn entrapment by compression in its course through the suprascapular notch has been well documented. She recalled no trauma, and the symptoms were exacerbated by exercise and abated with rest. 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. It causes varying degrees of supraspinatus andor infraspinatus atrophy, weakness of abduction and external rotation of the shoulder, and vague shoulder pain fig. Suprascapular nerve compression is a rare cause of shoulder pain.
Axillary motor nerve to the deltoid 2 long thoracic motor nerve to the serratus anterior 6 median nerve median motor nerve to the abductor pollicis brevis 10 median motor nerve to the flexor carpi radialis 18 median motor nerve anterior interosseous branch to the flexor pollicis longus 22 median motor nerve anterior interosseous branch. We report the clinical features, radiological findings, arthroscopic management and outcome of three patients with suprascapular nerve compression caused by labral ganglion cyst associated with slap lesion. Entrapment of the suprascapular nerve is a rare but increasingly recognized disease entity that contributes to pain and. Durandeau from the groupe hospitalier pellegrin, bordeaux, france operative release for entrapment of the suprascapular nerve was carried out in 35 patients. A nerve entrapment is caused when a peripheral nerve losses mobility, flexibility, or becomes compressed by surrounding tissues. Suprascapular artery an overview sciencedirect topics. The suprascapular nerve is responsible for the sensation in the back of the shoulder and upper arm. Although isolated ssn neuropathy is a relatively rare phenomenon, its aetiology is thought to be related to traction or compression of the ssn 2,3,4,5. The nerve can be compressed due to pressure from a cyst. Peripheral nerve entrapments clinical diagnosis and. Sep 21, 2017 other rare nerve entrapment syndromes include the suprascapular nerve, which accounts for approximately 0. Peripheral nerve entrapment and injury in the upper extremity. To relieve these symptoms, suprascapular nerve decompression is performed through the resection of stsl.
Nonpharmacologic treatment of peripheral nerve entrapment. Patient information sheet suprascapular nerve blocks what is the suprascapular nerve. Sep 30, 2015 treatment for suprascapular nerve entrapment. However, we are unaware of any such reports in the rheumatological literature. 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 block in chronic shoulder pain. Most cases of entrapment occur when the nerve passes through scapular ligament. Suprascapular nerve entrapment faqs beacon orthopaedics. Each chapter covers a single nerve, or group of closely related nerves, and. Suprascapular neuropathy has often been overlooked as a source of shoulder pain. Suprascapular nerve compression is a rare 8, 44 but important entity that is often missed in clinical practice. B ulnar nerve compression in the cubital tunnel, resulting from articular capsule distention arrow.
Suprascapular neuropathy or suprascapular nerve entrapment occurs if the suprascapular nerve is compressed as it passes through the suprascapular notch or spinoglenoid notch. They were assessed at an average of 30 months 12 to 98 after operation using the functional shoulder. If the nerve is injured or damaged, it can cause a dropfoot due to paralysis of the muscles that it innervates. The final result is nerve dysfunction and chronic neuropathic pain in the innervation area of the affected nerve. Cubital tunnel syndrome oxford university hospitals. Athletes who participate regularly in overhead sports are more susceptible to developing suprascapular neuropathy. Mri may also reveal a ganglion cyst or other mass such as a paralabral cyst with resultant suprascapular nerve compression. Median nerve compression by the transverse carpal ligament.
A nerve entrapment can cause neuropathic neurogenic pain that can be either acute or chronic in nature. Suprascapular neuropathy radiology reference article. Intraop pics of a common peroneal nerve entrapment being released for acute dropfoot. The results of treatment are very good and should encourage surgeons to differentiate patients with suprascapular nerve entrapment from those with from cervical disease. Six months after operative excision of the cyst the patient had regained normal musculature strength. Suprascapular nerve entrapment at the spinoglenoid notch. Suprascapular nerve block is a safe and welltolerated method. Suprascapular nerve entrapment or compression in a kayaker. The common peroneal nerve is located at the fibular neck, just to the outside of the knee. Suprascapular nerve block is a safe and extremely effective procedure in shoulder pain therapy. The diagnosis is typically not considered until patients develop severe weakness secondary to atrophy of the spinatus spinous musculature that the nerve supplies. 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. Peripheral nerve entrapment and injury in the upper extremity sara l.
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