Males are more likely to suffer from a ganglion compressing the nerve than females. The ligament on shoulder blade can compress the nerve when it gets inflamed. Dec 04, 2018 suprascapular neuropathy typically occurs due to some sort of traction injury to the suprascapular nerve resulting in pain in the shoulders. The suprascapular nerve is a nerve in the shoulder. The nerve then passes under the inferior transverse scapular ligament as it passes around the lateral aspect of the scapular spine through the spinoglenoid notch and enters the infraspinous fossa where it innervates the infraspinatus muscle. Suprascapular nerve compression at the spinoglenoid notch.
Entrapment of the nerve within the suprascapular notch or the spinoglenoid. Comparez facilement des documents ou plusieurs versions dun fichier pdf en utilisant laffichage cote a cote ou sur une seule page pour reperer rapidement les. 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 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. Prahlow, md indiana university school of medicine indianapolis. J a liveson, m j bronson, and m a pollack saul r korey, department of neurology, albert einstein college of medicine, bronx, ny. Initially, your health care provider will embark upon conservative treatment for suprascapular neuropathy. Other masses that have been described in the literature are as follows. If we free up the nerve by releasing the ligament it gets rid of a tremendous amount of pain after surgery. By steadman hawkins clinic featuring peter millett. 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. Lafosse l, tomasi a, corbett s, baier g, willems k, gobezie r. 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 gross anatomy origin.
Suprascapular neuropathy radiology reference article. The suprascapular nerve, supplies the supraspinatus and infraspinatus muscles. Causes weakness of both abduction and external rotation. 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. 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. Nerve injuries associated with scapular fractures have been reported. The nerve can be compressed due to pressure from a cyst. Suprascapular nerve entrapment can cause serious shoulder dysfunction and pain. We found 88 cases of suprascapular nerve entrapment, which fulfilled our inclusion criteria. Suprascapular neuropathy riverside pain physicians. Arthroscopic release of suprascapular nerve entrapment at the suprascapular notch. 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. This is a painful pathological condition of the shoulder in which there is traction damage to the suprascapular nerve resulting in pain in the shoulder. The values for conduction velocity, distal latency, and amplitude in the contralateral unaffected shoulder were used as controls.
Suprascapular nerve an overview sciencedirect topics. Suprascapular notch nerve courses through the suprascapular notch. Dull pain in the back of the shoulder, neck, arm or chest. When there is any sort of disruption within the suprascapular nerve, the muscles it supplies supraspinatus and infraspinatus lose their innervation, which causes the signs and symptoms seen with a suprascapular nerve palsy. Suprascapular vascular anomalies as a cause of suprascapular. Pain and weakness were the presenting symptoms in 14 shoulders and pain alone in 8.
The suprascapular nerve is the only structure that passes deep in relation to the transverse scapular ligament, whereas the associated artery and vein course superficial to the ligament. Suprascapular nerve entrapment is rare and mainly occurs in patients under 40 years of age. Normal values 1 100 subjects temperature greater than or equal to. Suprascapular neuropathy, or suprascapular nerve entrapment, is a condition which is due to irritation and damage to the suprascapular nerve ssn. The nerve travels in a path along the top of the scapula and cuts underneath the spine as it gives off branches to the infraspinatus muscle. Jul 31, 2015 suprascapular nerve entrapment occurs when supraspinatous nerve is entrapped in a space. Ligaments, articular capsule, and synovial suprascapular nerve block in the treatment of frozen. While direct trauma to the suprascapular nerve is the usual cause direct blow to the base of the neck or posterior shoulder, shoulder dislocation or fracture, the problem may result from overuse injuries.
Suprascapular nerve and rotator cuff function are intimately connected. Commonly referred to as a sling effect, this mechanism is well reported in the literature. Peripheral nerve entrapment and injury in the upper extremity. Suprascapular nerve ssn entrapment at the suprascapular notch is an uncommon cause of shoulder pathology that often presents with posterior shoulder. Suprascapular nerve ssn entrapment neuropathy occurring at the transverse scapular notch was first described by thomas in 1936.
Suprascapular nerve entrapment by warren hammer, ms, dc, dabco. Treatment for suprascapular nerve entrapment depends upon the cause, intensity, and duration of your symptoms and the amount of disability. Because the nerve passes through the middle scalene muscle, it can be traumatized during. A simple and effective regional nerve block method for shoulder pain is the suprascapular nerve block. Schematic representation of portal sites in the subacromial space for nerve release at the suprascapular notch. The incidence of suprascapular neuropathy has been increasing due to improved understanding of the disease entity and detection methods. Suprascapular nerve entrapment is a rare condition that can be easily misdiagnosed or even go unnoticed by those who are affected. There can be many reasons for nerve entrapment, especially at the suprascapular and spinoglenoid notches where nerve deviation is limited by bony and ligamentous structures. 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.
It is a relatively rare chronic condition that is commonly not diagnosed. Arthroscopic release of suprascapular nerve entrapment at. A metaanalysis article pdf available in international orthopaedics 266. Jan 01, 20 lafosse l, tomasi a, corbett s, baier g, willems k, gobezie r. Lesions of the suprascapular nerve can occur at the supraspinatus notch ssn or at the spinoglenoid notch sgn. Spinal accessory nerve entrapment syndrome the spinal accessory nerve or cranial nerve 11 can be compressed on multiple sites along its path from the base of the skull to the side of the neck. Nerve root compression is characterized by pain and paraesthesia, felt in the corresponding dermatome, and often followed by sensory and motor deficit in the. The nerve supplies motor innervation to shoulder muscles and sends sensory branches to multiple places in the shoulder region. Nerve becomes enlarged proximal to site of compression 24 cm nerve returns to normal caliber or size after entrapment area. Suprascapular nerve entrapment due to a stenotic foramen.
Suprascapular nerve entrapment due to a stenotic foramen ncbi. The bone serves as a protector for many of the nerves of the back and arm that lie underneath it. Isolated mononeuropathy of the suprascapular nerve. The suprascapular nerve can become compressed and entrapped, resulting in unpleasant suprascapular nerve entrapment. The ligament on the shoulder blade can compress the nerve when it gets inflamed. The ssn compression syndrome is the second most 6 common cause for an atrophy of the ssp and isp after rotator cuff injuries 3. The suprascapular nerve arises from the upper trunk of the brachial plexus, which is formed from the anterior rami of the fifth and sixth cervical nerves. Suprascapular nerve compression produces pain along the back of the scapula and shoulder. Nerve lesions and entrapment neuropathies of the upper limb.
At this site, the nerve is susceptible to compression, entrapment, or traction injury because of limitation of excursion in the fibroosseous tunnel. A nerve entrapment is caused when a peripheral nerve losses mobility, flexibility, or becomes compressed by surrounding tissues. Suprascapular nerve entrapment caused by supraglenoid cyst compression. Nerve compression syndrome, compression neuropathy, nerve entrapment, or a pinched peripheral nerve. Sep 30, 2015 treatment for suprascapular nerve entrapment. This is usually not very common, but it can be caused due to excessive nerve deviation like when performing sporting activities which require frequent overhead positioning of the arms. They were assessed at an average of 30 months 12 to 98 after operation using the functional shoulder score devised by constant and murley. 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. Compression of the nerve occurring at the suprascapular notch was originally described by thomas 1 in 1936 and later by kopell and thompson 2. Dibak injury and or compression of the suprascapular nerve may be by a mass, most commonly a ganglion cyst. However, due to the infrequency of its occurrence, suprascapular neuropathy may be overlooked as the cause of symptoms.
The brachial plexus is a large bundle of nerves which innervates the arm and upper portions of the chest. Repetitive movements, carrying heavy loads, and stretch injuries can cause injury to the suprascapular nerve. Notch is bridged by a thick transverse scapular ligament. Maximal stretching of the nerve with cross body adduction or protracted forward flexion. Decreased mobility of the nerve at site of entrapment. It also supplies sensory fibers to ligaments, bursa and the glenohumeral joint. The average age at the time of surgery was 40 years 17 to 67. In certain body positions, nerves tend to be compressed by surrounding tissues not only under pathological but also. Compression of the nerve occurring at the suprascapular notch was originally described by thomas 1 in 1936 and later by kopell and thompson 2 in 1959. Oct 11, 2018 moore tp, fritts hm, quick dc, buss dd. The suprascapular nerve is an underrecognized cause of shoulder pain and dysfunction. Sonographic diagnosis and treatment of ganglion cysts causing suprascapular nerve entrapment. Suprascapular nerve dysfunction can result from trauma, compression of the nerve by ganglion cysts, or traction from repetitive motion, particularly in athletes.
Suprascapular nerve block in the treatment of frozen shoulder. The diagnosis is typically not considered until patients develop severe weakness secondary to atrophy of the spinatus spinous musculature that the nerve supplies. Median nerve compression by the transverse carpal ligament. Suprascapular nerve ssn dysfunction is an uncommon cause of shoulder symptoms and is therefore often overlooked as a potential source of pathology. Entrapment neuropathy is caused by the prolonged compression or irritation of a nerve plexus or peripheral nerve. The final result is nerve dysfunction and chronic neuropathic pain in the innervation area of the affected nerve. The nerve travels in a path to and along the trapezius muscle for innervation. Suprascapular nerve entrapment syndrome is caused by compression of the suprascapular nerve as it passes through the suprascapular notch. Suprascapular nerve block ssnb is a safe and effective method to treat pain in chronic diseases that affect the shoulder.
They were assessed at an average of 30 months 12 to 98 after operation using the functional. When a nerve is pulled from the spinal cord, such as when a person has a brachial plexus injury that affects the shoulder and arm, we perform either nerve transfer, using a nerve from another part of the body to restore movement, or endtoside repair, which works to repair a partially functioning nerve. October 2008 this video addresses the techniques for arthroscopic suprascapular nerve release. 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. A clinician who does not know of the suprascapular entrapment syndrome is unlikely to identify the nerve pathology. C5 and c6 nerve roots, through the upper trunk, posterior division, and posterior cord of the brachial plexus. Its origins are in five nerves coming from five different parts of an area known as the cervical spine from c5 to t1. The suprascapular nerve is a mixed motor and sensory peripheral nerve arising from the superior trunk of the brachial plexus. Electromyographic emg, evaluation of the infraspinatus, and especially the supraspinatus muscles distinguishes sgn from ssn lesions. Most cases respond to conservative therapy in about 6 months. Any information contained in this pdf file is automatically generated from digital. The entry point is 23 cm into the upper outer quadrant. Entrapment of the suprascapular nerve is frequently overlooked in the differential diagnosis of shoulder pain. Anatomy of nerve entrapment sites in the upper quarter neal pratt, phd, pt department of rehabilitation sciences drexel university philadelphia, pennsylvania abstract.
Suprascapular nerve entrapment dynamic chiropractic. Entrapment occurs as the nerve is relatively fixed at the notch. Operative release for entrapment of the suprascapular nerve was carried out in 35 patients. Suprascapular nerve entrapment or compression in a kayaker. The scapula is the bone that is commonly known as the shoulder blade. This condition can result in pain, weakness, or both depending on the cause. The suprascapular nerve is a branch of the brachial plexus and is formed from the 5 th and 6 th. Jan 01, 2002 suprascapular nerve entrapment should be suspected and included in the differential diagnosis of poorly localized shoulder pain in conjunction with a loss of strength in abduction and external.
Suprascapular nerve entrapment arthroscopic release. The suprascapular nerve is responsible for the sensation in the back of the shoulder and upper arm. An in vitro study of glenohumeral performance after suprascapular nerve entrapment. Suprascapular neuropathy also results in pain and shoulder dysfunction. Commonly the 7 site of compression is at the suprascapular notch and arthroscopic decompression of the nerve 8 is an established therapeutic procedure.
Peripheral nerve entrapment and injury in the upper extremity sara l. Extrinsic compression or traction on the suprascapular nerve can result in suprascapular neuropathy. Fields, md, moses cone health system, greensboro, north carolina p. Manual of nerve conduction studies second edition ralph m. A nerve entrapment can cause neuropathic neurogenic pain that can be either acute or chronic in nature. Suprascapular nerve entrapment arthroscopic release vumedi. Suprascapular nerve entrapment faqs beacon orthopaedics and. Most cases of entrapment occur when the nerve passes through scapular ligament.
Repetitive movements, carrying heavy loads, and stretch injuries can cause injury to. The nerve gives off branches to the suprapinatus muscle as it passes through the supraspinatus ofssa. Loss of honey comb appearance secondary to swelling and edema. It is important to be aware of neuropathy involving the suprascapular nerve. Suprascapular neuropathy or suprascapular nerve entrapment occurs if the suprascapular nerve is compressed as it passes through the suprascapular notch or spinoglenoid notch. The muscles supplied by the suprascapular nerve are the supraspinatus and infraspinatus. Volume 7, issue 2 3 suprascapular nerve entrapment. Clinical presentation nonspecific posterior shoulder pain and weakne. If the patients history reveals a trauma, it is more likely. The suprascapular nerve innervates both motor and sensory across the shoulder, upper arm, and shoulder blade. The supra scapular nerve is a motor nerve that controls the functions of two of the main muscles on the shoulder blade. Treatment at the peripheral nerve center nyu langone health. Suprascapular nerve entrapment is an uncommon cause of shoulder pain and weakness but, because of its infrequent occurrence, it is often overlooked.
This may be caused because of heavy bags hanging from the shoulder for long periods or due to a direct fall injury or a malignant process. Cosgarea, in the athletes shoulder second edition, 2009. When entrapped or stretched, it can cause shoulder dysfunction and pain which over time can cause impingement syndrome and rotator cuff tendon and muscle tears. Anatomy of nerve entrapment sites in the upper quarter. The dorsal scapular nerve is a relatively unknown nerve entrapment that causes shoulder and arm pain. Suprascapular nerve entrapment should be suspected and included in the differential diagnosis of poorly localized shoulder pain in conjunction with a. After the suprascapular nerve block, shoulder pain diminish, and an effective, relatively painfree therapeutic exercise program can be performed. Causes compression of the suprascapular nerve in the scapular region.
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