By continuing to browse this site you are agreeing to our use of cookies. The suprascapular nerve passes through several osseoligamentous structures and can be compressed in several locations. At a mean of fifty one months follow up, no complications and no symptomatic recurrences were noted and all had improved strength in external rotation [72]. Great bang for your buck in terms of quality and content. Schrder C.P., Skare ., Stiris M., Gjengedal E., Uppheim G., Brox J.I. The https:// ensures that you are connecting to the A clinical test known as the suprascapular nerve stretch test has been described by Lafosse . Suprascapular nerve pathology has recently gained popularity among the causes of shoulder pain and weakness. Clin Orthop Relat Res 1996; (330): 202-7. Thank you for all the work that goes into supplying this CPD resource - great stuff". Obtained with the patient rotated 3545 towards the affected shoulder or the beam has to be tilted laterally from the standard AP view. Hemostasis is critical during the whole procedure. A consistent ligamentous structure from the lateral side of the scapular spine to the posterior aspect of the shoulder capsule is now visible. Coracoid (C), acromion (A). In a study by Martin et al., fifteen patients with isolated suprascapular nerve pathology were managed non operatively and the follow-up was about four years. National Library of Medicine Warner J.P., Krushell R.J., Masquelet A., Gerber C. Anatomy and relationships of the suprascapular nerve: anatomical constraints to mobilization of the supraspinatus and infraspinatus muscles in the management of massive rotator-cuff tears. Lajtai G., Pfirrmann C.W., Aitzetmller G., Pirkl C., Gerber C., Jost B. Infraspinatus muscle-splitting incision in posterior shoulder surgery. Latjai G., Pfirrmann C.W.A., Aitzetmller G., Pirkl C., Gerber C., Jost B. Spinoglenoid notch decompression: the patient is prepared in the beach-chair position. Symptoms can start suddenly after a specific shoulder trauma or insidiously without any history of injury. Some authors have advanced two hypotheses of vascular etiologies in athletes. The transverse scapular ligament resected. . Very good clinical results have been described, especially in those patients with no signs of atrophy. It is characterized by an acute and sudden onset of pain in the upper limb followed by multiple atrophy and motor weakness and slow recovery. It consists of repeated kinking of the nerve against the borders of osteofibrous tunnel (suprascapular notch) during shoulder motion, causing suprascapular neuropathy [1,8,21,23]. An insidious onset of pain with no shoulder trauma (common). b. 2014 Jan;55(1):41-4. doi: 10.11622/smedj.2014009. These are edema, atrophy and fatty degeneration of the muscles. Dr. Riley J. Williams, orthopedic shoulder specialist serving patients in Manhattan, Brooklyn, New York City, NY and surrounding areas, has the knowledge and understanding, as well as substantial experience, in treating patients who have experienced suprascapular nerve entrapment. Mall N.A., Hammond J.E., Lenart B.A., Enriquez D.J., Twigg S.L., Nicholson G.P. Keep up to date with the science and best practice in managing sports injuries, Dr. Alexandra Fandetti-Robin, Back & Body Chiropractic. Owing to repetitive microtrauma during overhead sports or massive cuff tears with significant tendon retraction, the SSN may suffer compression or traction neuropathy at the suprascapular notch. Experience with surgery for entrapment syndrome of the suprascapular nerve. Youm T., Matthews P.V., El Attrache N.S. Biomechanical Perspective Using the Finite Element Method. 22). Regarding the spinoglenoid notch, open decompression is usually achieved through a posterior approach, using an incision 3cm medial to the posterolateral corner of the acromion. The association of suprascapular neuropathy with massive rotator cuff tears: a preliminary report. The trocar is introduced into the viewing portal and directed towards the infraspinatus fossa. Under these circumstances, it is not clear if both notches should be decompressed, although there are reports with good results after doing so. In some cases, a single compression is not obvious, but there are clinical and MRI findings of both supra- and infraspinatus denervation. This test is positive if the patients reports pain relief. Before Therefore, they can be easily found by means of MRI-arthrography or CT-arthrography. This is an open access article distributed under the terms of the Creative Commons Attribution 4.0 International Public License (CC-BY 4.0), a copy of which is available at: Ligament, Nerve, Neuropathy, Notch, Release, Repair, Review, Rotator cuff, Suprascapular. Three of the most likely cause's are: Entrapment of the nerve within the suprascapular notch or the spinoglenoid notch. Few complications have been mentioned, most of the patients were free of pain and had recovery of muscle strength, although muscle atrophy did not fully disappear. It utilizes an accessory portal positioned approximately 7 cm medial to the lateral border of the acromion between the clavicle and the scapular spine. The location and the etiology of the compression are those that define the treatment modality. A meta-analysis. described a decompression of the suprascapular nerve at the suprascapular notch or spinoglenoid notch through a subacromial approach. Patients with a suprascapular nerve palsy typically report a non-specific, deep, dull and continuous pain located in the upper-posterior-lateral region of the shoulder. Solheim L.F., Roaas A. Nerve compression by the suprascapular ligament is enhanced by depression, retraction and overhead abduction of the shoulder or extreme scapular motion, as in the case of repetitive pitching or throwing. Suprascapular and Interscalene Nerve Block for Shoulder Surgery: A Systematic Review and Meta-analysis. Regarding the spinoglenoid notch, a hypertrophied inferior transverse scapular ligament [27] and enlarged spinoglenoid notch veins [28] have been found as predisposing factors of nerve compression in this area and selective atrophy of infraspinatus muscle. The test exacerbates the pain at the posterior aspect of the shoulder that may be caused by constriction of the nerve to the suprascapular notch. Special care must be taken during dissection, shaving or electrocautery to avoid iatrogenic injury to the suprascapular nerve and to the relative vessels. Retraction of the deltoid facilitates identification of the superior border of the infraspinatus, which is subsequently mobilized inferiorly to reveal the scapular spine. The .gov means its official. recently described different anatomic variations while pointing out that the presence and the position of this specific ligament as well as the location of the suprascapular bundle vessels can cause compression or protect the suprascapular nerve from compression [21]. Non-specific symptoms make diagnosis often uncertain. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (, suprascapular nerve palsy, spinoglenoid notch, suprascapular notch, Arthroscopic nerve release, shoulder neuropathy, over-head activities. Schematic top view of the right shoulder with the refferal point for establishing Neviaser (blue cross) and LaFosse (green cross) portals. Intraosseous ganglion of the glenoid causing suprascapular nerve entrapment syndrome: a case report. In the follow up through phase of throwing, the shoulder is in extreme external rotation and abduction and the muscles of supraspinatus and infraspinatus impinge upon the scapular spine compressing the motor branch to the infraspinatus muscle [3, 4]. 8600 Rockville Pike The trocar is then directed close to the working portal into the spinoglenoid notch. government site. Although it is rare, some authors have described spontaneous regression of ganglia [56]. Some authors recommend labral repair and cyst decompression in the same procedure [45,46]. Suprascapular nerve entrapment is an increasingly recognized and diagnosed shoulder lesion, but it is still rather infrequent. 99, 1010, 1111). Lafosse has described the suprascapular stretch test. Kopell H.P., Thompson W.A. This exposure avoids injury to the spinal accessory nerve and promotes a rapid rehabilitation. Aszmann O.C., Dellon A.L., Birely B.T., McFarland E.G. [21] the spinoglenoid ligament was present in all 58 specimens lying 4.8mm over the suprascapular nerve. HHS Vulnerability Disclosure, Help official website and that any information you provide is encrypted Neviaser portal (1) is placed approximately 1 cm medial to the acromion, between the clavicle and the scapular spine. 2018 Jan;26(1):240-266. doi: 10.1007/s00167-017-4694-4. Reineck J.R., Krishnan S.G. Subligamentous suprascapular artery encountered during arthroscopic suprascapular nerve release: a report of three cases. Careers, Unable to load your collection due to an error. 66). An extensive research was performed on PubMed and Clinical Key. Witvrouw et al (2000)and Ferreti et al (1997)found that although the condition is common in volleyball players, they did not show progressive shoulder dysfunction or any increased incidence of painful overuse syndromes. Overhead activities can cause dynamic compression to the suprascapular nerve and are well described in volleyball and baseball athletes. Another study by the same author proposed that the nerve is being taught in positions of adduction and internal rotation [22]. In case of ganglion cyst diagnosis, best result are given by labral repair and open or arthroscopic decompression of the cyst (2,9). Youm T., Matthews P.V., El Attrache N.S. Kim S.H., Kim S.J., Sung C.H., Koh Y.G., Kim Y.C., Park Y.S. Bhatia S., Chalmers P.N., Yanke A.B., Romeo A.A., Verma N.N. The suprascapular nerve is vulnerable at several locations. Nerve Compression Syndromes: Causes, Treatment & Prevention In this series, Ryan Frerichs will discuss when, how, and why to utilize radiological imaging to enhance clinical outcomes. [ 42] Next: Other Tests. Suprascapular Nerve Entrapment: Upper Extremity | SpringerLink Collin P., Treseder T., Ldermann A., Benkalfate T., Mourtada R., Courage O., Favard L. Neuropathy of the suprascapular nerve and massive rotator cuff tears: a prospective electromyographic study. Knee Surg Sports Traumatol Arthrosc. 1Department of Orthopaedics and Traumatology, Fondazione Poliambulanza (Brescia)Universit Cattolica del Sacro Cuore, 00168 Rome, Italy, 2Institut Catal de Traumatologia i Medicina de lEsport (ICATME)Hospital Universitari Quirn-Dexeus. The cause of this may be: 8600 Rockville Pike ): S9-S13, Narakas A: Compression syndromes about the shoulder including brachial plexus, in Szabo RM (ed): N e r v e C o m p r e s s i o n S y n d r o m e s : D i a g n o s i s a n d T r e a t m e n t . Undiagnosed and recalcitrant posterosuperior shoulder pain. An all-arthroscopic technique has been described by Lafosse et al. used an all- arthroscopic technique and they successfully decompressed both notches with a series of arthroscopic portals along the scapular spine [75]. Before A high index of suspicion for this diagnosis should exist in overhead athletes such as volleyball, baseball players and swimmers who are at high risk of developing suprascapular neuropathy. It may be injected into the spinoglenoid notch to confirm the diagnosis of suprascapular nerve entrapment. The result is the motor branch of the SSN is squashed into the infraspinatus'. If suprascapular neuropathy is suspected, plain radiographs are mandatory. J Shoulder Elbow Surg 2003; 12(5): 497-500. Results of non-operative treatment. Edema of the supra-spinate and infra-spinate muscles is a pathognomonic sign of suprascapular neuropathy. In the cases of spinoglenoid notch nerve compression, several authors have reported excellent results after operative management, as well. There are two primary sites for entrapment of the SN; the clinical presentation varies depending on the site of entrapment. Habermeyer P, Brunner U, Wiedemann E, Wilhelm K. Heuss D, Lochmller H, Habermeyer P, Reimers C, Pongratz D. Yoo YS, Jang SW, Kim YS, Choi JA, Oh JH, Jeong JY. Management and outcomes of 42 surgical suprascapular nerve injuries and entrapments. Two portals must be made: the viewing portal and the working portal. In type IV, the transverse scapular ligament is ossified and may form a nearly complete or complete bony foramen. This unique blend of animal physical capacity and Long thoracic nerve injury: the shortest route to recovery!

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