title: Suprascapular neuropathy after distal clavicle resection and coracoclavicular ligament reconstruction: a resident's case problem.
abstract: METHODS
  Resident's case problem.
  
  
  BACKGROUND
  Acromioclavicular joint pathology is reported to be present in up to 30% of all patients complaining of shoulder dysfunction. The operative approach to treating acromioclavicular joint disease often includes a distal clavicle excision and, in circumstances of acromioclavicular joint instability, reconstruction of the coracoclavicular and/or the acromioclavicular ligament. Surgical complications for these procedures are rare, but potentially include suprascapular neuropathy secondary to the course of the suprascapular nerve posterior to the clavicle prior to entering the supraspinatus fossa.
  
  
  METHODS
  A 28-year-old Caucasian woman reported directly to an outpatient physical therapy clinic with a complaint of right shoulder weakness. Three years prior, the patient underwent a distal clavicle excision and coracoclavicular ligament reconstruction. A detailed examination, including diagnostic imaging, identified infraspinatus atrophy and weakness, increasing the suspicion for suprascapular nerve injury. Electromyography was ordered to confirm the clinical and imaging diagnosis of suprascapular neuropathy and to rule out other nerve lesions, especially considering the selective atrophy of the infraspinatus muscle without mechanical explanation.
  
  
  CONCLUSIONS
  The clinical decision making and systematic use of diagnostic testing resulted in identifying a rare case of suprascapular neuropathy, selective to the infraspinatus, in a patient who previously underwent a distal clavicle excision and coracoclavicular ligament reconstruction. Without a spinoglenoid cyst or other suprascapular nerve lesion identified on advanced imaging, it is likely that the suprascapular neuropathy identified in this case was related to the surgical procedure.
  
  
  METHODS
  Differential diagnosis, level 4.
authors.affiliation: US Army-Baylor University Doctoral Fellowship in Orthopaedic Manual Physical Therapy, Brooke Army Medical Center, Fort Sam Houston, TX.
authors.forename: Bradley S
authors.initials: BS
authors.lastname: Tragord
authors.forename: Liem T
authors.initials: LT
authors.lastname: Bui-Mansfield
authors.forename: Theodore
authors.initials: T
authors.lastname: Croy
authors.forename: Scott W
authors.initials: SW
authors.lastname: Shaffer
mesh_terms: D000173:Acromioclavicular Joint / Q000601:surgery*; D000328:Adult; D002968:Clavicle / Q000601:surgery*; D005081:Exercise Therapy; D005260:Female; D006801:Humans; D008023:Ligaments, Articular / Q000293:injuries / Q000601:surgery*; D018908:Muscle Weakness / Q000209:etiology / Q000628:therapy; D009133:Muscular Atrophy / Q000209:etiology / Q000628:therapy; D009408:Nerve Compression Syndromes / Q000175:diagnosis* / Q000209:etiology / Q000628:therapy; D019637:Orthopedic Procedures / Q000009:adverse effects* / Q000379:methods; D012782:Shoulder / Q000601:surgery*; D000070599:Shoulder Injuries
keywords: acromioclavicular joint; electromyography; infraspinatus; nerve injury; scapula