肩胛上神经病变 资料 In-depth

本页面由机器翻译,尚未经临床医生审核。英文版本为权威版本。

您的感受

肩胛上神经病变意味着为肩部两块肌肉提供神经支配的神经受到了刺激或压迫。疼痛通常位于肩背部,靠近肩胛骨的外缘。许多人将其描述为围绕整个肩部的钝痛,而非某一特定部位的锐痛。

这种酸痛通常逐渐加重,并倾向于局限于一个区域:大约在主肩关节上方和后方一个手掌宽度的范围内。过头活动是常见的诱因,因此投掷、发球或伸手去够高处的架子可能会引发症状或使其加重。有些人还会注意到肩部伴有咔哒声、卡顿或锁定感,同时伴有酸痛。

如果神经受到刺激的时间较长,其支配的肌肉可能会萎缩。您可能会注意到肩背部肩胛骨脊的上方或下方出现凹陷或平坦的外观。这种情况并非发生在每个人身上,并且取决于神经在您体内如何分支到这些肌肉。

在日常生活中,无力和酸痛往往表现在需要将手臂上举或外展的任务中。将沉重的碗放到高处的架子上、晾晒衣服或将套头衫从头上套过可能会感觉比以前更费力。涉及过头动作的运动往往是最先被注意到的。

神经可能在肩胛骨附近的两个狭窄通道之一处受到挤压,对于经常进行过头运动的人来说,那里的压力很常见。神经也可能因反复的过头活动而被拉伸,或在受伤后受到刺激。有时根本没有明显的原因,神经只是自行停止正常工作。

如果这些情况听起来很熟悉,建议对您的肩部进行评估,以确定病因。

实际发生了什么

肩胛上神经是源自颈部并延伸至肩部的一条较大神经网络的分支。它支配肩胛骨背侧的两块肌肉,负责抬举和旋转手臂。在到达目标肌肉的途中,该神经必须穿过肩胛骨附近的两个狭窄间隙,就像电缆穿过骨骼上的紧密凹槽一样。

在每个间隙处,一小条带状组织横跨在神经上方。神经位于下方运行,而血管则位于上方。如果神经在第一个间隙受到挤压,两块肩部肌肉都会受到影响。如果在更靠后的第二个间隙受到挤压,则只有一块肌肉受影响。肩关节滑膜撕裂产生的含液囊肿也可能在神经路径的任何位置压迫神经。

压力并非唯一的问题。神经还可能被拉伸,这种情况常见于长期从事过头顶运动的运动员,或当肩部大型肌腱撕裂导致结构错位时。在某些患者中,根本不存在挤压或拉伸,神经仅仅是处于炎症状态。这一点很重要,因为许多被认为在某一狭窄间隙存在问题的患者,实际上表现出更广泛的神经刺激迹象,这改变了其评估和治疗方式。

您在上文中阅读到的症状直接源于此。当神经无法良好地传导信号时,这两块肌肉会减弱,并随时间推移发生萎缩。肩部背侧的酸痛感源于神经本身受到刺激。

我们如何处理该问题

Mater Private Hospital Rockhampton(洛克汉普顿马特私立医院)的上肢外科医生 Kieran Hirpara 博士,会从适合您病情的最微创方案入手。患者通常由其全科医生(GP)转诊至我们的诊所;如果物理治疗师建议您就诊,您仍需获得全科医生的转诊,方可符合 Medicare(澳大利亚医疗保险)报销资格。在您的首次就诊时,我们会采集病史,检查您的肩部,并在必要时安排影像学检查以确认病因。

第一步通常是休息并调整肩部的使用方式。减少过头活动可减轻神经所受的压力。抗炎药物可在恢复期间缓解疼痛。物理治疗旨在保持肩部正常活动度,并强化肩胛骨周围的肌肉。您的物理治疗师将指导您进行有助于稳定肩胛骨并增强控制其运动的肌肉力量的练习。我们通常会对这一方案进行充分尝试,之后再讨论进一步的治疗。如果神经受到囊肿等结构的压迫,或者肩部后方的肌肉已经开始萎缩,我们会缩短这一阶段,不超过 3 个月,以避免肌肉遭受永久性损伤。

如果上述措施未能缓解您的疼痛或无力,则可能考虑手术。该手术称为神经减压术。它通过在肩胛骨附近狭窄间隙中神经受压的部位进行松解,以解除神经压迫。大多数情况下,该手术通过关节镜(微创)技术完成,同时可检查并处理肩部内部的其他问题。

预期情况

对于大多数人来说,如果神经持续受到压迫,该病症通常不会自行消失。如果没有任何因素压迫神经,第一步是非手术治疗:物理治疗、抗炎药物以及改变肩部使用方式。许多人通过这种方法得以缓解。如果囊肿等结构压迫神经,或者您的疼痛和无力持续加重,通常会考虑进行松解神经的手术。

恢复情况取决于神经受刺激的时间长短。如果肌肉尚未萎缩,松解神经通常能缓解疼痛,并使肩部功能恢复正常。如果肌肉已经萎缩,部分变化可能无法完全逆转,但力量和舒适度仍可能改善。通过微创手术松解神经,在接受手术的人群中已显示出疼痛缓解、测试中肌肉信号改善以及肩部功能提升的效果。此类手术后的长期预后看起来令人鼓舞,术后的物理治疗有助于保持肩部良好功能,同时保护其免受无力影响。

如果您同时患有肩部大型肌腱撕裂,情况则有所不同。修复肌腱有时能让神经自行恢复。在肌腱修复的基础上增加神经松解手术,并未被证明能改善效果,且存在使神经功能变差而非变好的微小风险。您的外科医生会与您仔细权衡这一点。

一些坦率的注意事项。神经在松解的狭窄间隙处靠近血管,该处的出血是外科医生努力避免的已知风险。在少数通过开放切口松解神经的患者中,数年后需要再次手术。此外,如果肌腱撕裂手术前测试显示神经外观正常,松解神经不会带来任何益处。

以上任何内容都不是对您个人结果的承诺。这是对通常会发生的情况的真实描述,以便您能够围绕工作、运动和日常生活,带着清晰的预期进行规划。

何时就医

如果您的肩部后方疼痛持续数周以上,尤其是如果您经常从事过头顶运动或工作,请咨询您的全科医生。如果疼痛伴随手臂上举或外展时的无力,或者您注意到肩部后方的肌肉出现凹陷或扁平,请要求专科医生评估。如果疼痛伴随肩部弹响、卡顿或锁定,或者关节上方及后方约一掌宽的位置按压时感到疼痛,也请提出咨询。这些迹象表明神经受到挤压或刺激,越早检查,越能更好地保护这些肌肉,防止其萎缩。

深入探讨

Advanced reading: the deeper science (optional)

本节内容超出了您自身治疗决策所需的范围。肩胛上神经病变值得额外阅读,因为同一神经在两种截然不同的角色中出现:既是肩痛和肌无力的病因,又是疼痛缓解的治疗靶点,且针对这两种情况的证据质量差异很大。

减压手术有效,但归因存在保留意见

在神经受压的部位,解除压迫是有效的。在 730 名患者中,肩胛上神经减压术 显著改善了患者报告结局,不劣于未进行减压的类似手术,且与 较高的运动回归率和相对较低的不良事件发生率 相关 [1]。

此处起关键作用的短语是“不劣于未进行减压的类似手术”。在因其他原因(如肩袖修复或肩胛骨处囊肿切除)进行的手术中,神经经常被顺带松解,因此将改善归因于减压本身较为困难。减压术有帮助,且不会使伴随的手术变得更糟。

为什么压迫水平会改变临床表现

神经在绕过肩胛骨时经过两个狭窄点,受累的具体位置决定了临床表现。

位于较高位置的肩胛上切迹处的压迫会影响冈上肌和冈下肌,导致抬举和外旋无力以及疼痛。位于更下游的肩胛冈切迹处的压迫仅影响冈下肌,导致外旋无力以及肩胛骨棘下方凹陷处的可见肌肉萎缩,通常伴有轻微疼痛。

孤立性萎缩的表现容易被漏诊,因为其疼痛不明显。该水平最常见的原因是源于盂唇撕裂的腱鞘囊肿,这意味着发现这种模式时应促使寻找囊肿及其后方的撕裂,因为治疗病因即可解决神经问题。

作为神经阻滞,其证据薄弱程度远超其应用所暗示的水平

同一条神经在肩痛管理中(无论是术后还是慢性病症)均被广泛使用局部麻醉进行阻滞。在对4,142例患者的身体伤害进行回顾性分析后,该阻滞具有较低的身体伤害风险,但作者指出干预措施存在异质性且证据质量较低,并呼吁对伤害进行更完善的评估和报告 [2]。

“基于低质量证据的低伤害风险”是一项具体且有限的论断。它支持该阻滞术相对安全的结论;但这并非关于其疗效的陈述,也不应被解读为疗效声明。

值得铭记的区分

有两类情况共用该神经的名称,不应混淆。神经病变是一种结构性问题,表现为神经受压,通常可通过减压手术处理,其典型特征为肌肉萎缩和肌力减弱。神经阻滞是一种对症治疗,通过阻断来自关节的疼痛信号来缓解症状,但不改变任何结构性问题。

肌力减弱和可见的肌肉萎缩提示前者。若仅有疼痛而无上述体征,通常提示病因在别处;此时,能缓解疼痛的神经阻滞提供的是镇痛作用,而非确诊依据。

参考文献

[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)

References

[1] Association of suprascapular neuropathy with rotator cuff tendon tears and fatty degeneration. Journal of Shoulder and Elbow Surgery. 2014. DOI: 10.1016/j.jse.2013.06.011

[2] Suprascapular neuropathy in a shoulder referral practice. Journal of Shoulder and Elbow Surgery. 2011. DOI: 10.1016/j.jse.2010.10.039

[3] Complete Fatty Infiltration of Intact Rotator Cuffs Caused by Suprascapular Neuropathy. Arthroscopy. 2014. DOI: 10.1016/j.arthro.2014.01.010

[4] Suprascapular nerve injury after reverse total shoulder arthroplasty: correlation with screw out of vault penetration and functional situation: prospective study. Journal of Shoulder and Elbow Surgery. 2023. DOI: 10.1016/j.jse.2023.06.026

[5] Paper 03: Suprascapular Neuropathy: Two Distinct Presentations and Outcomes of Decompression. Orthopaedic Journal of Sports Medicine. 2023. DOI: 10.1177/2325967123s00003

[6] Clinical Outcomes of Arthroscopic Suprascapular Nerve Decompression for Suprascapular Neuropathy. Arthroscopy. 2020. DOI: 10.1016/j.arthro.2020.10.020

[7] Suprascapular Neuropathy. Results of Non-Operative Treatment. The Journal of Bone & Joint Surgery*. 1997. DOI: 10.2106/00004623-199708000-00007

[8] Suprascapular Neuropathy. Journal of Bone and Joint Surgery. 2010. DOI: 10.2106/jbjs.i.01743

[9] Comparison of clinical outcome of decompression of suprascapular nerve at spinoglenoid notch for patients with posterosuperior massive rotator cuff tears and suprascapular neuropathy. BMC Musculoskeletal Disorders. 2021. DOI: 10.1186/s12891-021-04075-1

[10] Suprascapular neuropathy: what does the literature show?. Journal of Shoulder and Elbow Surgery. 2012. DOI: 10.1016/j.jse.2011.11.033

[11] Suprascapular Nerve Entrapment Secondary to a Lipoma. Clinical Orthopaedics & Related Research. 2003. DOI: 10.1097/01.blo.0000063791.32430.59

[12] Effect of suprascapular nerve injury on rotator cuff enthesis. Journal of Shoulder and Elbow Surgery. 2020. DOI: 10.1016/j.jse.2019.12.028

[13] The Evaluation and Management of Suprascapular Neuropathy. Journal of the American Academy of Orthopaedic Surgeons. 2020. DOI: 10.5435/jaaos-d-19-00526

[14] A comparative analysis of fatty infiltration and muscle atrophy in patients with chronic rotator cuff tears and suprascapular neuropathy. Journal of Shoulder and Elbow Surgery. 2013. DOI: 10.1016/j.jse.2013.01.028

[15] Suprascapular Nerve Entrapment at the Spinoglenoid Notch in a Professional Baseball Pitcher. The American Journal of Sports Medicine. 1999. DOI: 10.1177/03635465990270062101

[16] Suprascapular nerve entrapment caused by a large hematoma of the scapula: a case report. BMC Musculoskeletal Disorders. 2023. DOI: 10.1186/s12891-023-06723-0

[18] Suprascapular Neuropathy. Journal of the American Academy of Orthopaedic Surgeons. 1999. DOI: 10.5435/00124635-199911000-00002

[19] Varicose veins at the spinoglenoidal notch: an unusual cause of suprascapular nerve compression. Journal of Shoulder and Elbow Surgery. 2011. DOI: 10.1016/j.jse.2011.05.022

[21] Who Really First Described and Explained the Suprascapular Nerve Entrapment Syndrome?. The Journal of Bone and Joint Surgery-American Volume. 2001. DOI: 10.2106/00004623-200108000-00018

[22] Outcomes of Arthroscopic Nerve Release in Patients Treated for Large or Massive Rotator Cuff Tears and Associated Suprascapular Neuropathy: A Prospective, Randomized, Double-Blinded Clinical Trial. The American Journal of Sports Medicine. 2021. DOI: 10.1177/03635465211021834

[24] Rockwood And Matsen S The Shoulder. Arthroscopic Management of Prearthritic and Arthritic Conditions of the Shoulder and the Postarthroplasty Shoulder > Radiographic Evaluation.

[28] Suprascapular neuropathy secondary to reverse shoulder arthroplasty: A case report. Journal of Shoulder and Elbow Surgery. 2010. DOI: 10.1016/j.jse.2009.10.004

[32] Aaos Comprehensive Orthopaedic Review 3. Anatomy of the Shoulder, Arm, and Elbow > I. Shoulder.

[37] Apley And Solomon S Concise System Of Orthopaedics And Trauma. INVESTIGATION.

[39] Rockwood And Matsen S The Shoulder. Developmental Anatomy of the Shoulder and Anatomy of the Glenohumeral Joint > SENIOR EDITOR COMMENTARY.

[41] Endoscopic/arthroscopic decompression of the suprascapular nerve at the spinoglenoid notch: indications and surgical technique. JSES Reviews, Reports, and Techniques. 2021. DOI: 10.1016/j.xrrt.2021.04.004

[42] Suprascapular nerve entrapment isolated to the spinoglenoid notch: surgical technique and results of open decompression. Journal of Shoulder and Elbow Surgery. 2013. DOI: 10.1016/j.jse.2013.03.009

[44] Arthroscopic Release of Suprascapular Nerve Entrapment at the Suprascapular Notch: Technique and Preliminary Results. Arthroscopy. 2007. DOI: 10.1016/j.arthro.2006.10.003

[45] Suprascapular Neuropathy as a Cause of Swimmer’s Shoulder. The American Journal of Sports Medicine. 2013. DOI: 10.1177/0363546513477383

[46] An anatomical study for the location of suprascapular and spinoglenoid notches using three-dimensional computed tomography images of scapula. JSES International. 2022. DOI: 10.1016/j.jseint.2022.04.002

[47] Variations in anatomy at the suprascapular notch possibly causing suprascapular nerve entrapment: an anatomical study. Knee Surgery, Sports Traumatology, Arthroscopy. 2003. DOI: 10.1007/s00167-003-0378-3

[48] Risk of suprascapular nerve injury during glenoid baseplate fixation for reverse total shoulder arthroplasty: a cadaveric study. Journal of Shoulder and Elbow Surgery. 2021. DOI: 10.1016/j.jse.2020.07.008

[49] Subclavius Posticus: An Anomalous Muscle in Association with Suprascapular Nerve Compression in an Athlete. HAND. 2014. DOI: 10.1007/s11552-014-9652-8

[51] Effect of suprascapular nerve injury on muscle and regenerated enthesis in a rat rotator cuff tear model. Clinics in Shoulder and Elbow. 2023. DOI: 10.5397/cise.2022.01207

[52] Spontaneous resolution of a spinoglenoid notch cyst and associated suprascapular nerve palsy: A case report. Journal of Shoulder and Elbow Surgery. 2007. DOI: 10.1016/j.jse.2006.06.014