Suprascapular neuropathy Impormasyon In-depth

Ang iyong nararamdaman

Ang suprascapular neuropathy ay nangangahulugang ang nerve na nagbibigay-daan sa dalawa sa iyong mga kalamnan sa balikat ay na-irita o naipit. Ang sakit ay karaniwang nasa likod ng balikat, patungo sa panlabas na gilid ng shoulder blade. Maraming tao ang naglalarawan dito bilang isang mapurol na kirot (dull ache) na kumakalat sa buong balikat sa halip na isang matalas na sakit sa isang partikular na spot.

Ang kirot ay madalas na dahan-dahang nabubuo, at may tendensiyang manatili sa isang area: humigit-kumulang isang lapad ng kamay sa itaas at likuran ng pangunahing joint ng balikat. Ang mga aktibidad na nakataas ang kamay (overhead activity) ay isang karaniwang trigger, kaya ang paghagis, pag-serve, o pag-abot sa isang mataas na shelf ay maaaring magdulot ng mga sintomas o magpalala sa mga ito. Ang ilang tao ay nakapapansin din ng pag-click, pag-catch, o pag-lock sa balikat kasabay ng kirot.

Kung ang nerve ay matagal nang na-irita, ang mga kalamnan na sinusupurtahan nito ay maaaring manghina o lumiit (waste away). Maaari kang makapansin ng isang lubog o patag na hitsura sa likod ng iyong balikat, sa itaas o ibaba ng spine ng shoulder blade. Hindi ito nangyayari sa lahat, at depende ito sa kung paano nag-branch ang nerve patungo sa mga kalamnan na iyon sa iyong katawan.

Sa araw-araw, ang panghihina at kirot ay may tendensiyang lumitaw sa mga gawaing nangangailangan ng pag-angat ng iyong braso paitaas o palabas. Ang pag-abot ng isang mabigat na bowl sa isang mataas na shelf, pagsampay ng labada, o pagsuot ng jumper sa iyong ulo ay maaaring magmukhang mas mahirap kaysa dati. Ang mga sport na may overhead movement ay madalas na unang bagay na iyong mapapansin.

Ang nerve ay maaaring maipit sa isa sa dalawang makitid na daanan malapit sa shoulder blade, at ang pressure doon ay karaniwan sa mga taong gumagawa ng maraming overhead sport. Ang nerve ay maaari ring ma-stretch dahil sa paulit-ulit na overhead activity, o ma-irita pagkatapos ng isang injury. Minsan ay walang malinaw na sanhi, at ang nerve ay basta na lamang humihinto sa paggana nang maayos sa sarili nito.

Kung ang alinman dito ay pamilyar, mahalagang ipasuri ang iyong balikat upang matukoy ang sanhi.

Ano ang aktwal na nangyayari

Ang suprascapular nerve ay isang sangay ng isang mas malaking network ng nerve na tumatakbo mula sa iyong leeg pababa sa iyong balikat. Binibigyan nito ng lakas ang dalawang kalamnan sa likod ng iyong shoulder blade na nag-aangat at nagpapaikot ng iyong braso. Sa pagpunta nito roon, kailangang dumaan ng nerve sa dalawang makitid na puwang malapit sa shoulder blade, tulad ng isang kable na dumadaan sa mga masisikip na uka sa buto.

Sa bawat isa sa mga puwang na ito, isang maliit na strap ng tissue ang tumatawid sa ibabaw ng nerve. Ang nerve ay tumatakbo sa ilalim habang ang isang blood vessel naman ay tumatakbo sa itaas. Kung ang nerve ay naipit sa unang puwang, parehong apektado ang mga kalamnan sa balikat. Kung maipit ito sa pangalawa, na mas malayo pa, isa lamang ang apektado. Ang isang fluid-filled sac mula sa isang punit sa lining ng balikat ay maaari ring pumuwersa sa nerve kahit saan sa landas nito.

Hindi lamang pressure ang problema. Ang nerve ay maaari ring mabatak, na nangyayari sa loob ng maraming taon ng overhead sport o kapag ang isang malaking tendon tear sa balikat ay humihila sa mga bahagi palabas ng tamang posisyon. Sa ilang tao, walang anumang pag-ipit o pagbatak, at ang nerve ay simpleng namamaga (inflamed). Mahalaga ito dahil maraming tao na akala ay may problema sa isang makitid na puwang ay nagpapakita pala ng mga palatandaan ng mas malawak na nerve irritation, na nagbabago sa kung paano ito sinusuri at ginagamot.

Ang mga sintomas na nabasa mo sa itaas ay direktang resulta nito. Kapag ang nerve ay hindi makapagdala ng mga signal nang maayos, humihina ang dalawang kalamnan at, sa paglipas ng panahon, ay maaaring lumiit o matuyo (waste away). Ang kirot sa likod ng balikat ay nagmumula sa mismong iritasyon ng nerve.

Ano ang maaari naming gawin tungkol dito

Si Dr. Kieran Hirpara, isang upper-limb surgeon sa Mater Private Hospital Rockhampton, ay nagsisimula sa mga opsyon na hindi gaanong invasive na angkop sa iyong kondisyon. Ang mga pasyente ay karaniwang nirerefer sa aming klinika ng kanilang GP; kung iminungkahi ng isang physiotherapist na magpatingin sa amin, kakailanganin mo pa rin ng referral mula sa iyong GP upang maging eligible para sa Medicare rebate. Sa iyong unang pagbisita, kumukuha kami ng history, sinusuri ang iyong balikat, at nag-aayos ng mga scan kung kinakailangan upang kumpirmahin ang sanhi.

Ang unang hakbang ay karaniwang pahinga at pagbabago sa kung paano mo ginagamit ang iyong balikat. Ang pagbabawas ng mga aktibidad na nakataas ang kamay (overhead activity) ay nag-aalis ng pressure sa nerve. Ang mga gamot na anti-inflammatory ay maaaring magpakalma sa kirot habang nagpapagaling. Layunin ng physiotherapy na panatilihing normal ang paggalaw ng iyong balikat at palakasin ang mga kalamnan sa paligid ng iyong shoulder blade. Gagabayan ka ng iyong physiotherapist sa mga ehersisyo na nagpapatatag sa shoulder blade at nagpapalaki ng mga kalamnan na kumokontrol dito. Karaniwan naming binibigyan ang approach na ito ng sapat na pagsubok bago pag-usapan ang anumang susunod na hakbang. Kung ang nerve ay naiipit ng isang bagay tulad ng cyst, o ang kalamnan sa likod ng iyong balikat ay nagsimula nang manghina o lumiit (waste away), pinapaikli namin ang phase na ito, hindi hihigit sa 3 buwan, upang ang kalamnan ay hindi mapinsala nang permanente.

Kung ang mga hakbang na ito ay hindi nakapagpakalma sa iyong sakit o panghihina, maaaring isaalang-alang ang operasyon. Ang operasyon ay tinatawag na nerve decompression. Pinapalaya nito ang nerve kung saan ito naiipit sa isa sa mga makikitid na puwang malapit sa iyong shoulder blade. Ginagawa ito sa pamamagitan ng keyhole surgery sa karamihan ng mga kaso, at anumang iba pang problema sa loob ng iyong balikat ay maaaring suriin at gamutin nang sabay.

Ano ang dapat asahan

Para sa karamihan ng mga tao, ang kondisyong ito ay hindi nawawala nang kusa kung nananatiling naiipit ang nerve. Kung walang nakadiin sa nerve, ang unang hakbang ay gamutan nang walang operasyon: physiotherapy, anti-inflammatory medicine, at pagbabago sa kung paano ginagamit ang iyong balikat. Maraming tao ang nakakarecover sa pamamagitan ng approach na ito. Kung mayroong bagay tulad ng cyst na umiipit sa nerve, o kung ang iyong sakit at panghihina ay patuloy na lumalala, karaniwang isinasaalang-alang ang operasyon upang palayain ang nerve.

Ang paggaling ay nakadepende sa kung gaano na katagal na naiirita ang nerve. Kung ang mga kalamnan ay hindi pa nanghihina o lumiit (wasted away), ang pagpapalaya sa nerve ay madalas na nag-aalis ng sakit at nagpapahintulot sa pagbabalik ng normal na function ng balikat. Kung ang mga kalamnan ay lumiit na, maaaring hindi na ganap na bumalik ang ilan sa mga pagbabagong iyon, bagaman maaari pa ring bumuti ang lakas at ginhawa. Ang keyhole surgery upang palayain ang nerve ay nagresulta sa pagkawala ng sakit, mas mabuting muscle signals sa testing, at pinabuting function ng balikat sa mga taong sumailalim dito. Ang long-term outlook pagkatapos ng ganitong uri ng operasyon ay mukhang nakaka-encourage, at ang physiotherapy pagkatapos nito ay tumutulong upang mapanatiling maayos ang takbo ng iyong balikat habang pinoprotektahan ito mula sa panghihina.

Kung mayroon ka ring malaking tendon tear sa balikat, iba ang sitwasyon. Ang pag-repair sa tendon ay minsan ay nagbibigay-daan sa nerve na maka-recover nang kusa. Ang pagdagdag ng nerve release sa repair na iyon ay hindi napatunayang nagpapabuti sa mga resulta, at may dala itong maliit na panganib na mas mapalala ang function ng nerve sa halip na mapabuti ito. Maingat itong titimbangin ng iyong surgeon kasama ka.

Ilang tapat na babala. Ang nerve ay dumadaan malapit sa mga blood vessel sa mga makikitid na puwang kung saan ito pinalalaya, at ang pagdurugo doon ay isang kilalang panganib na sinusubukang iwasan ng iyong surgeon. Sa maliit na bilang ng mga tao na pinalaya ang nerve sa pamamagitan ng open incision, kinailangan ng karagdagang operasyon pagkalipas ng ilang taon. At kung ang nerve ay mukhang normal sa testing bago ang operasyon para sa tendon tear, ang pag-release nito ay walang naidaragdag na benepisyo.

Wala sa mga ito ang isang pangako tungkol sa iyong indibidwal na resulta. Ito ay isang makatotohanang paglalarawan ng kung ano ang karaniwang nangyayari, upang makapagplano ka para sa trabaho, sports, at pang-araw-araw na buhay nang may malinaw na mga ekspektasyon.

Kailan dapat magpatingin

Magpatingin sa iyong GP kung mayroon kang kirot sa likod ng iyong balikat na tumatagal na ng higit sa ilang linggo, lalo na kung madalas kang gumagawa ng overhead sport o trabaho. Humingi ng specialist review kung ang kirot ay may kasamang panghihina kapag itinataas ang iyong braso paitaas o palabas, o kung napapansin mong ang mga kalamnan sa likod ng iyong balikat ay mukhang lubog o patag. Magtanong din kung ang iyong balikat ay tumutunog (clicks), sumasabit (catches), o nagla-lock kasabay ng sakit, o kung ang bahaging isang lapad ng kamay sa itaas at likuran ng joint ay maselan kapag pinipindot. Ang mga palatandaang ito ay nagtuturo na ang nerve ay naiipit o naiirita, at mas maagang masuri ito, mas malaki ang pagkakataon na maprotektahan ang mga kalamnan bago sila manghina o lumiit (waste away).

Higit pang kalaliman

Advanced reading: the deeper science (optional)

Ang seksyong ito ay higit pa sa kailangan mo para sa iyong sariling mga desisyon sa paggamot. Ang suprascapular neuropathy ay karapat-dapat sa karagdagang pagbabasa dahil ang parehong nerve ay lumilitaw sa dalawang magkaibang papel, bilang sanhi ng pananakit at panghihina ng balikat, at bilang target para sa pagpapaginhawa ng sakit, at ang ebidensya para sa dalawang ito ay magkaiba nang husto sa kalidad.

Gumagana ang decompression, na may babala tungkol sa atribusyon

Kung saan nakompres ang nerve, ang pagpapalaya nito ay epektibo. Sa 730 na pasyente, ang suprascapular nerve decompression ay makabuluhang nagpapabuti sa mga patient-reported outcome, ay hindi mas mababa (non-inferior) kaysa sa mga katulad na pamamaraan na isinagawa nang walang decompression, at nauugnay sa mataas na rate ng pagbabalik sa sports at relatibong mababang rate ng mga adverse event [1].

Ang pariralang nagbibigay ng diin dito ay "non-inferior to similar procedures without decompression". Ang nerve ay madalas na pinalalaya habang nagsasagawa ng operasyon para sa ibang dahilan, gaya ng cuff repair, o pagtanggal ng ganglion sa shoulder blade, kaya mahirap na i-atribyut ang pagbuti sa decompression mismo. Nakakatulong ito, at hindi nito pinapalala ang kasamang pamamaraan.

Bakit binabago ng antas ng kompresyon ang sitwasyon

Ang nerve ay dumadaan sa dalawang makitid na punto habang bumabalot ito sa shoulder blade, at kung alin sa mga ito ang apektado ang nagtatakda ng presentasyon.

Ang kompresyon sa suprascapular notch, na mas mataas, ay nakakaapekto sa parehong supraspinatus at infraspinatus, na nagdudulot ng panghihina sa pag-angat at external rotation kasama ang pananakit. Ang kompresyon sa spinoglenoid notch, na mas malayo pa, ay nakakaapekto lamang sa infraspinatus, na nagdudulot ng panghihina sa external rotation at kitang-kitang wasting sa uka sa ibaba ng spine ng shoulder blade, na madalas ay may kaunting sakit lamang.

Ang presentasyong isolated-wasting ang madalas na hindi napapansin, dahil hindi ito masyadong masakit. Ang pinakakaraniwang sanhi sa antas na iyon ay isang ganglion cyst na nagmumula sa isang labral tear, na nangangahulugang ang pagtukoy sa pattern na ito ay dapat mag-udyok ng paghahanap sa cyst at sa tear sa likod nito, dahil ang paggamot sa sanhi ay tumutugon sa nerve.

Bilang isang pain block, ang ebidensya ay mas kakaunti kaysa sa iminumungkahi ng paggamit nito

Ang parehong nerve ay malawakang bina-block gamit ang local anaesthetic para sa pananakit ng balikat, kapwa pagkatapos ng operasyon at sa mga chronic na kondisyon. Sa pagsusuri ng mga pisikal na pinsala sa 4,142 na pasyente, ang block ay may mababang panganib ng pisikal na pinsala, ngunit binanggit ng mga may-akda ang heterogeneity sa interbensyon at low-quality na ebidensya, at nananawagan para sa mas mahusay na pagtatasa at pag-uulat ng mga pinsala [2].

Ang "mababang panganib ng pinsala base sa low-quality na ebidensya" ay isang espesipiko at limitadong pahayag. Sinusuportahan nito na ang block ay makatwirang ligtas; hindi ito isang pahayag tungkol sa kung gaano ito kaepektibo, at hindi ito dapat basahin bilang ganoon.

Ang pagkakaibang dapat tandaan

May dalawang bagay na gumagamit ng pangalan ng nerve na ito at hindi dapat pagpalit-palitin. Ang neuropathy ay isang structural problem kung saan ang nerve ay naiipit at madalas ay maaaring i-decompress, na ang mga palatandaan ay wasting at weakness. Ang nerve block ay isang symptomatic treatment na pumuputol sa pain signalling mula sa joint at walang binabago sa structure.

Ang weakness at visible wasting ay tumuturo sa una. Ang pain lamang, nang walang mga findings na iyon, ay karaniwang tumuturo sa ibang bagay, at ang block na nagpapaginhawa rito ay nagbibigay ng analgesia sa halip na nagkukumpirma ng isang diagnosis.

Mga Sanggunian

[1] Sandler AB, Wells ME, Tran C, Arakawa R, Klahs KJ, Scanaliato JP, et al. High rates of return to sport after suprascapular nerve decompression: a systematic review. JSES Rev Rep Tech. 2024;4(4):654-61. https://doi.org/10.1016/j.xrrt.2024.05.007

[2] Annison DR, Smith N, Salt E, Noblet T, Rangan A, McDaid C. Physical harms associated with suprascapular nerve block interventions: a systematic review. Shoulder Elbow. 2024;17(3):236-53. https://doi.org/10.1177/17585732241255679

Evidence & references

This is the clinical evidence summary written for health professionals. It is technical, and it lists the research this page was built from. You do not need to read it to understand your treatment or to make a decision about it.

Overview

The exact association and etiology of suprascapular neuropathy in patients with rotator cuff pathology remain unclear [1].
Shoulder surgeons should consider electrophysiologic evaluation of patients with clinical or radiographic signs of suprascapular neuropathy [2].
Shoulder surgeons should be cognizant of the parameters that constitute an abnormal electrophysiologic study for suprascapular neuropathy [2].
Suprascapular neuropathy has been described with complete neurogenic fatty replacement in patients with intact rotator cuff tendons in the absence of traction or compression mechanisms [3].
Preoperative suprascapular nerve injuries do not have a significant clinical impact [4].
Preoperative suprascapular nerve injuries do not predispose to an acute postoperative lesion [4].
In a young, active cohort, suprascapular neuropathy presented with one of two distinct primary presenting complaints: pain or weakness [5].
Arthroscopic suprascapular nerve decompression for suprascapular neuropathy at the suprascapular and/or spinoglenoid notch in the absence of major concomitant glenohumeral pathology results in good functional outcomes [6].
Arthroscopic suprascapular nerve decompression for suprascapular neuropathy at the suprascapular and/or spinoglenoid notch in the absence of major concomitant glenohumeral pathology results in significant improvements from before to after surgery [6].
In the absence of a well-defined lesion producing mechanical compression of the suprascapular nerve, suprascapular neuropathy should be treated non-operatively [7].
Initial treatment of isolated suprascapular neuropathy is typically nonoperative, consisting of physical therapy, nonsteroidal anti-inflammatory drugs, and activity modification [8].
Open or arthroscopic operative intervention is warranted for isolated suprascapular neuropathy when there is extrinsic nerve compression or progressive pain and/or weakness [8].
Decompression of the suprascapular nerve at the spinoglenoid notch did not lead to a better functional outcome compared to repair alone in patients with posterosuperior massive rotator cuff tears and suprascapular neuropathy [9].
No recommendations regarding suprascapular nerve release in conjunction with rotator cuff repair can be made at this time [10].
Further research is necessary to better delineate the indications for suprascapular nerve release in conjunction with rotator cuff repair [10].
Combined arthroscopic release of the superior transverse scapular ligament and rotator cuff repair in patients with large/massive rotator cuff tears and suprascapular neuropathy did not produce statistically significant improved outcomes compared with repair of the rotator cuff alone [22].

Anatomy & Pathophysiology

Nerve Course and Entrapment Sites

The suprascapular nerve courses from the upper trunk of the brachial plexus to its motor insertion on the supraspinatus and, more distally, the infraspinatus [13].
The superior transverse scapular ligament arises from the medial base of the coracoid overlying the suprascapular notch [32].
The suprascapular artery runs superior to the superior transverse scapular ligament, while the nerve runs deep to it [32].
Entrapment of the suprascapular nerve at the suprascapular notch causes denervation of both the supraspinatus and the infraspinatus [32].
The spinoglenoid ligament overlies the suprascapular nerve at the spinoglenoid notch [32].
Entrapment, traction, or compression of the suprascapular nerve at the spinoglenoid notch causes denervation of the infraspinatus [32].
Anatomical variations at the suprascapular notch, including abnormally oriented subscapularis muscle fibers, anterior coracoscapular ligament, and calcified superior transverse scapular ligament, are predisposing factors for suprascapular nerve entrapment [47].
The distances from the posterolateral corner of the acromion to the suprascapular and spinoglenoid notches were approximately 43 and 32 mm, respectively, regardless of height and sex [46].

Etiology and Mechanisms

Suprascapular nerve neuropathy occurs when the nerve is injured along its course from the upper trunk of the brachial plexus to its motor insertion on the supraspinatus and infraspinatus [13].
Nerve injury can occur from either compression or traction [13].
Cystic lesions arising from a labral or capsular tear can compress the nerve along its course over the scapula [13].
Nerve traction is theorized to arise from chronic overhead athletics or due to a retracted rotator cuff tear [13].
Suprascapular neuropathy with complete neurogenic fatty replacement has been described in patients with intact rotator cuff tendons in the absence of traction or compression mechanisms [3].
A lipoma can cause suprascapular nerve entrapment [11].
A large hematoma of the scapula can cause suprascapular nerve entrapment [16].
Malpositioned superior screws from reverse shoulder arthroplasty can cause suprascapular nerve entrapment [28].
Placement of the superior and posterior screws in the glenoid baseplate during reverse total shoulder arthroplasty risks injury to the suprascapular nerve [48].

Pathophysiology and Tissue Changes

Suprascapular nerve injury is an underlying mechanism leading to compromise of the rotator cuff enthesis structure [12].
Suprascapular nerve injury may cause severe fatty changes and inhibition of postoperative tendon healing in large rotator cuff tears [51].
Decompression provides reliable pain relief, but recovery of shoulder function and restoration of atrophied muscle tissue may be incomplete [18].

Classification

Suprascapular neuropathy can present secondary to various etiologies including entrapment or compression [13].
Entrapment of the suprascapular nerve usually occurs at the suprascapular or spinoglenoid notch [19].
Suprascapular nerve entrapment has been reported secondary to a lipoma [11].
Varicose veins at the spinoglenoidal notch have been identified as an unusual cause of suprascapular nerve compression [19].
Suprascapular neuropathy is associated with rotator cuff tendon tears and fatty degeneration [1].
Chronic rotator cuff tendon tears and suprascapular neuropathy are both associated with fatty infiltration and muscle atrophy of the rotator cuff muscles, but the pattern of fatty infiltration is markedly different in the two situations [14].
Suprascapular nerve injury can occur after reverse total shoulder arthroplasty, with correlation to screw out of vault penetration [4].

Clinical Presentation

Suprascapular neuropathy is a potential source of shoulder pain and functional limitation [13].
Suprascapular nerve entrapment syndrome was first described and correctly interpreted by André Thomas in 1936, predating the commonly credited work of Kopell and Thompson [21].

Investigations

Shoulder surgeons should consider electrophysiologic evaluation for patients with clinical or radiographic signs of suprascapular neuropathy [2].
High-resolution magnetic resonance imaging is recommended to evaluate complex cases of nerve entrapment [49].
MRI-documented spontaneous resolution of a spinoglenoid notch cyst and associated suprascapular nerve palsy has been reported [52].
Surgical treatment for a spinoglenoid notch cyst and associated suprascapular nerve palsy could be withheld if patients show signs of clinical recovery, provided they are followed closely [52].
A complete history and physical, careful attention to auxiliary tests, and treatment of multiple diagnoses in the same shoulder avoids missed pathologic features and necessity for revision operations [11].
The pattern of fatty infiltration is markedly different in patients with chronic rotator cuff tendon tears compared to those with suprascapular neuropathy [14].
Chronic rotator cuff tendon tears and suprascapular neuropathy are both associated with fatty infiltration and muscle atrophy of the rotator cuff muscles [14].
The axillary view taken with the arm in the functional position of elevation in the plane of the scapula is oriented so that both the spinoglenoid notch and the scapular neck are visible [24].
Standardized plain films are almost always sufficient to garner the information needed for shoulder evaluation [24].
The temptation to "overimage" should be resisted, obtaining only the scans or reconstructions that are necessary for the care of the patient [24].
CT scans may offer a few degrees of increased precision in the measurement of glenoid version, but this precision does not improve the quality of the surgery or the clinical outcome [24].
The purpose of imaging of the shoulder is to help establish the diagnosis, determine the severity of the pathoanatomy, assist in surgical planning, and enable the surgeon to illustrate the condition of the shoulder to the patient [24].
At least two X-ray views should be obtained: an anteroposterior in the plane of the glenoid and an axillary projection with the arm in abduction to show the relationship of the humeral head to the glenoid [37].
Magnetic resonance imaging is useful to identify osteonecrosis of the humeral head, or a bone tumour [37].
Magnetic resonance imaging can identify labral tears and rotator cuff tears, although the accuracy for these is enhanced by combining the scan with arthrography [37].
Computed tomography is helpful for planning fracture surgery and shoulder joint replacement [37].
Ultrasound is a simple and accurate test for identifying rotator cuff tears and calcific tendinitis [37].
Ultrasound can be useful in guiding injections or barbotage (aspirating calcific deposits in the rotator cuff) [37].
Arthroscopy is useful for diagnosing and treating subacromial impingement, intra-articular lesions, detachment of the glenoid labrum and rotator cuff tears [37].
The shoulder is a three-dimensional structure that cannot be represented by a single planar view [39].
Critical relationships—such as the degree of centering of the humeral head—change with the position of the arm [39].
Shoulder pathology may be found in a large number of different bones and soft tissues [39].
Overlying and superimposed structures as well as metallic implants may complicate imaging the structures of interest [39].
Surgeons need to develop a judicious approach to imaging that yields the information necessary to treat the patient while avoiding the tendency to "over-image" [39].

Treatment

Non-Operative

Nonoperative treatment should include a period of rest and activity modification, and antiinflammatory medication followed by a supervised physical therapy program [41].
The focus of physical therapy is to preserve the normal physiologic range of motion of the shoulder and strengthen the shoulder girdle [41].
Physical therapy exercises include scapular stabilization, and resistive strength straining of the trapezius, rhomboids, and serratus musculature [41].
When a space occupying lesion is present or there is visible atrophy of the infraspinatus, the course of nonoperative treatment should be minimal (maximum 3 months) to avoid irreversible damage to the infraspinatus [41].

Operative

Open or arthroscopic operative intervention is warranted when there is extrinsic nerve compression or progressive pain and/or weakness [8].
The primary indications for arthroscopic decompression of the suprascapular nerve and the spinoglenoid notch are a prolonged course of symptoms, most commonly a chronic ache in the posterolateral aspect of the shoulder, and a failed minimum 6 month course of nonoperative treatment [41].
Arthroscopic SSN decompression for suprascapular neuropathy at the suprascapular and/or spinoglenoid notch in the absence of major concomitant glenohumeral pathology results in good functional outcomes with significant improvements from before to after surgery [6].
Arthroscopic release of the suprascapular nerve can be performed safely and effectively, with all patients showing improvement in postoperative electromyographic findings and marked improvement in pain relief and function [44].
Arthroscopic release of the suprascapular nerve and transverse ligament is a safe and effective treatment for competitive swimmers with suprascapular neuropathy, allowing return to sport with resolution of pain and improvement in function [45].
Release of the spinoglenoid ligament with resultant suprascapular nerve decompression may result in relief of pain and a return of normal shoulder function [15].
Decompression gives reliable pain relief, but recovery of shoulder function and restoration of atrophied muscle tissue may be incomplete [18].
Combined arthroscopic release of the superior transverse scapular ligament and rotator cuff repair in patients with large/massive RCTs and suprascapular neuropathy did not produce statistically significant improved outcomes compared with repair of the rotator cuff alone [22].
No recommendations regarding suprascapular nerve release in conjunction with rotator cuff repair can be made at this time, and further research is necessary to better delineate the indications in the future [10].

Postoperative Rehabilitation

In cases of isolated suprascapular nerve palsy at the spinoglenoid notch, patients were placed in a simple sling with immediate initiation of pendulum exercises and passive range of motion [42].
Patients were seen again at 1 week after surgery to assess strength and begin physical therapy, which consisted of passive range-of-motion and isometric exercises [42].
If significant infraspinatus atrophy was present, electrical stimulation was used [42].
Resistance and overhead exercises started at 4 to 8 weeks postoperatively in cases of isolated suprascapular nerve decompression at the spinoglenoid notch [42].

Complications

Preoperative suprascapular nerve injuries do not have a significant clinical impact and do not predispose to an acute postoperative lesion [4].

Recovery

Arthroscopic suprascapular nerve decompression for suprascapular neuropathy at the suprascapular and/or spinoglenoid notch in the absence of major concomitant glenohumeral pathology results in good functional outcomes with significant improvements from before to after surgery [6].
Full recovery of shoulder function was achieved following treatment for suprascapular nerve entrapment caused by a large hematoma of the scapula [16].

Key Evidence

[L3] The exact association and etiology of suprascapular neuropathy in patients with rotator cuff pathology remain unclear. [1] (10.1016/j.jse.2013.06.011)
[L4] Shoulder surgeons should consider electrophysiologic evaluation of patients with clinical or radiographic signs of suprascapular neuropathy and be cognizant of the parameters that constitute an abnormal study. [2] (10.1016/j.jse.2010.10.039)
[L4] This is the first description of suprascapular neuropathy with complete neurogenic fatty replacement in patients with intact rotator cuff tendons in the absence of traction or compression mechanisms. [3] (10.1016/j.arthro.2014.01.010)
[L1] Preoperative suprascapular nerve injuries do not have a significant clinical impact and do not predispose to an acute postoperative lesion. [4] (10.1016/j.jse.2023.06.026)
[L4] In this young, active cohort, suprascapular neuropathy presented with one of two distinct primary presenting complaints: pain or weakness. [5] (10.1177/2325967123s00003)
[L4] Arthroscopic SSN decompression for suprascapular neuropathy at the suprascapular and/or spinoglenoid notch in the absence of major concomitant glenohumeral pathology results in good functional outcomes with significant improvements from before to after surgery. [6] (10.1016/j.arthro.2020.10.020)
[L4] In the absence of a well-defined lesion producing mechanical compression of the suprascapular nerve, suprascapular neuropathy should be treated non-operatively. [7] (10.2106/00004623-199708000-00007)
[L5] Initial treatment of isolated suprascapular neuropathy is typically nonoperative, consisting of physical therapy, nonsteroidal anti-inflammatory drugs, and activity modification; however, open or arthroscopic operative intervention is warranted when there is extrinsic nerve compression or progressive pain and/or weakness. [8] (10.2106/jbjs.i.01743)
[L3] Decompression of the suprascapular nerve at the spinoglenoid notch did not lead to a better functional outcome compared to repair alone in patients with posterosuperior massive rotator cuff tears and suprascapular neuropathy. [9] (10.1186/s12891-021-04075-1)
[L4] No recommendations regarding suprascapular nerve release in conjunction with rotator cuff repair can be made at this time, and further research is necessary to better delineate the indications in the future. [10] (10.1016/j.jse.2011.11.033)
[L4] A complete history and physical, careful attention to auxiliary tests, and treatment of multiple diagnoses in the same shoulder avoids missed pathologic features and necessity for revision operations. [11] (10.1097/01.blo.0000063791.32430.59)
[L5] This study identifies suprascapular nerve injury as an underlying mechanism leading to compromise of the rotator cuff enthesis structure. [12] (10.1016/j.jse.2019.12.028)
[L5] [13] (10.5435/jaaos-d-19-00526)
[L4] Chronic rotator cuff tendon tears and suprascapular neuropathy are both associated with fatty infiltration and muscle atrophy of the rotator cuff muscles, but the pattern of fatty infiltration is markedly different in the two situations. [14] (10.1016/j.jse.2013.01.028)
[L4] Release of the spinoglenoid ligament with resultant suprascapular nerve decompression may result in relief of pain and a return of normal shoulder function. [15] (10.1177/03635465990270062101)
[Case_report] Full recovery of shoulder function was achieved. [16] (10.1186/s12891-023-06723-0)
[L5] Decompression gives reliable pain relief, but recovery of shoulder function and restoration of atrophied muscle tissue may be incomplete. [18] (10.5435/00124635-199911000-00002)
[L4] Entrapment of the suprascapular nerve usually occurs at the suprascapular or spinoglenoid notch. [19] (10.1016/j.jse.2011.05.022)
[L4] Suprascapular nerve entrapment syndrome was first described and correctly interpreted by André Thomas in 1936, predating the commonly credited work of Kopell and Thompson. [21] (10.2106/00004623-200108000-00018)
[L1] Combined arthroscopic release of the superior transverse scapular ligament and rotator cuff repair in patients with large/massive RCTs and suprascapular neuropathy did not produce statistically significant improved outcomes compared with repair of the rotator cuff alone. [22] (10.1177/03635465211021834)
[Case_report] This case is the first report of malpositioned superior screw from reverse shoulder arthroplasty causing suprascapular nerve entrapment. [28] (10.1016/j.jse.2009.10.004)
[L4] [41] (10.1016/j.xrrt.2021.04.004)
[L4] [42] (10.1016/j.jse.2013.03.009)
[L4] Arthroscopic release of the suprascapular nerve can be performed safely and effectively, with all patients showing improvement in postoperative electromyographic findings and marked improvement in pain relief and function. [44] (10.1016/j.arthro.2006.10.003)
[L4] Arthroscopic release of the suprascapular nerve and transverse ligament is a safe and effective treatment for competitive swimmers with suprascapular neuropathy, allowing return to sport with resolution of pain and improvement in function. [45] (10.1177/0363546513477383)
[L4] Regardless of height and sex, the distances from the posterolateral corner of the acromion to the suprascapular and spinoglenoid notches were approximately 43 and 32 mm, respectively. [46] (10.1016/j.jseint.2022.04.002)
[L4] Anatomical variations at the suprascapular notch, including abnormally oriented subscapularis muscle fibers, anterior coracoscapular ligament, and calcified superior transverse scapular ligament, are predisposing factors for suprascapular nerve entrapment. [47] (10.1007/s00167-003-0378-3)
[L5] Placement of the superior and posterior screws in the glenoid baseplate during rTSA risks injury to the SSN. [48] (10.1016/j.jse.2020.07.008)
[L5] They recommend high-resolution magnetic resonance imaging to evaluate complex cases of nerve entrapment. [49] (10.1007/s11552-014-9652-8)
[L5] In clinical settings, SN injury may cause severe fatty changes and inhibition of postoperative tendon healing in large RCTs. [51] (10.5397/cise.2022.01207)
[Case_report] The authors report the first MRI-documented spontaneous resolution of a spinoglenoid notch cyst and associated suprascapular nerve palsy, proposing that surgical treatment could be withheld if patients show signs of clinical recovery, provided they are followed closely. [52] (10.1016/j.jse.2006.06.014)

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