Suprascapular nerve entrapment

Suprascapular nerve entrapment

Dr.Senthilvelan 

Orthopaedic Surgeon

For appointments and queries 
Contact  9566222533/nexusortho@yahoo.com

What is suprascapular nerve entrapment?

Suprascapular nerve entrapment is an uncommon nerve condition in the shoulder, causing pain and weakness. 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 suprascapular nerve passes in a groove in the shoulder blade (scapula), under a ligament, under the supraspinatus muscle (which it supplies) on the top of the shoulder, and then under another ligament before it divides and supplies the infraspinatus muscle in the back of the shoulder. The nerve may be injured before it supplies the supraspinatus muscle (thus causing weakness of both the supraspinatus and infraspinatus) or after it supplies the supraspinatus (causing weakness of only the infraspinatus). These muscles, which are part of the rotator cuff, are important in stabilizing the shoulder and assisting in raising and rotating the shoulder and arm.

Anatomy of suprascapular nerve

How does suprascapular nerve entrapment occur?

Pressure on the supraspinatus nerve at the top or back of the shoulder, often by a cyst from the shoulder joint

Pressure on the supraspinatus nerve at the top or back of the shoulder by one of two ligaments of the shoulder blade that the nerve passes beneath

Repetitive stretch injury to the nerve

What increases the risk?

Contact sports

Sports that require repetitive overhead activity, such as baseball, volleyball or tennis

Poor physical conditioning (strength and flexibility)

What are the symptoms of suprascapular nerve entrapment?

Pain and discomfort (burning or dull ache) that is poorly localized (not confined to one location), often in the top or back of the shoulder

Heaviness or fatigue of the shoulder and arm

Pain that may be made worse by exercise or raising the arm over head

Weakness raising the arm to the side or overhead or rotating the shoulder outward

Tenderness in the top or back of the shoulder

Atrophy of the supraspinatus or infraspinatus muscle.

How is suprascapular nerve entrapment treated?

Non-operative treatment: Initial treatment consists of rest from the offending activity and nonsteroidal anti-inflammatory medications to help reduce inflammation and pain. Stretching exercises of the shoulder muscles are useful. Referral to physical therapy or an athletic trainer may be recommended for further treatment, including ultrasound and other modalities.

Operative treatment: If three to six months of conservative treatment is not successful, surgery may be necessary to free the pinched nerve by cutting the ligaments where the nerve is being pinched. Surgery is also indicated to relieve pressure from the cyst either by removing the cyst or by removing damage within the shoulder joint that may be the cause of the cyst. Surgery may be recommended sooner if there is significant atrophy of the muscles. When surgery is necessary, it provides almost complete relief in most patients who undergo this operation, although the muscle atrophy may not be reversible.

Surgeon performing key hole release of Suprascapular nerve

Arthroscopic picture of Suprascapular artery on top of Transverse scapular ligament

Since the nerve is deeply buried under the large muscles of the shoulder endoscopic techniques are well suited for exploring the nerve. This is not a common procedure and presently only few surgeons have experience with this method.

Arthroscopic view of Suprascapular nerve after release

General postoperative guidelines

Wearing a sling

You will return from theatre wearing a sling. This is for comfort only and should be discarded as soon as possible (usually within the first 2 to 4 days). Some people find it helpful to continue to wear the sling at night for a little longer if the shoulder feels tender.

Driving

You may begin driving one week after your operation or when you feel comfortable.

Returning to work

This will depend on your occupation. If you are in a sedentary job you may return as soon as you feel able usually after one week. 
If your job involves heavy lifting or using your arm above shoulder height you may require a longer period of absence.

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