title: Suprascapular neuropathy: diagnosis and management.
abstract: Although historically considered a diagnosis of exclusion, suprascapular neuropathy may be more common than once believed, as more recent reports are describing the condition as a cause of substantial pain and weakness in patients with and without concomitant shoulder pathology. The etiology is traction or compression of the suprascapular nerve. This can result from a space-occupying lesion, such as a ganglion cyst, or a traction injury as a result of repetitive overhead activities. More recent studies have cited cases of traction injuries occurring with retraction of a large rotator cuff tear. Atrophy of the infraspinatus and/or supraspinatus rotator cuff muscles with resultant weakness in forward flexion and/or external rotation of the shoulder on physical examination may be demonstrated. Magnetic resonance imaging (MRI) is the preferred modality to assess atrophy of the rotator cuff muscles as well as assess potential causes of suprascapular nerve compression. Electromyography and nerve conduction velocity studies remain the gold standard for confirmation of the diagnosis of suprascapular neuropathy; however, nerve pain may occur even in the setting of a negative electromyography. Initial management is usually nonoperative, consisting of activity modification, physical therapy, and nonsteroidal anti-inflammatory drugs. Surgical intervention is considered for patients with nerve compression by an external source or for symptoms refractory to conservative measures. Decompression of the suprascapular nerve may be accomplished through an open approach, although arthroscopic surgical approaches have become more common in the past several years.
authors.affiliation: Harvard Shoulder Service, Massachusetts General Hospital, Boston, MA 02114, USA. jwarner@partners.org
authors.forename: Michael T
authors.initials: MT
authors.lastname: Freehill
authors.forename: Lewis L
authors.initials: LL
authors.lastname: Shi
authors.forename: Jeffrey D
authors.initials: JD
authors.lastname: Tompson
authors.forename: Jon J P
authors.initials: JJ
authors.lastname: Warner
mesh_terms: D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use; D001182:Arthroscopy; D004568:Electrodiagnosis; D006801:Humans; D008023:Ligaments, Articular / Q000293:injuries; D008279:Magnetic Resonance Imaging; D009133:Muscular Atrophy / Q000175:diagnosis / Q000209:etiology; D009408:Nerve Compression Syndromes / Q000150:complications; D009422:Nervous System Diseases / Q000175:diagnosis / Q000628:therapy; D019637:Orthopedic Procedures; D010808:Physical Examination; D026741:Physical Therapy Modalities; D017006:Rotator Cuff / Q000473:pathology* / Q000601:surgery; D012421:Rupture; D012782:Shoulder / Q000294:innervation*
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal