suprascapular nerve injury

encoded search term (Suprascapular Neuropathy) and Suprascapular Neuropathy, Brachial Plexus Injury in Sports Medicine, Cervical Spine Acute Bony Injuries in Sports Medicine, Humeral Capitellum Osteochondritis Dissecans, Infographic: Vacation Destinations to Recharge Your Batteries, FDA OKs Suflave, a Lower-Volume Colonoscopy Prep Drink. The American journal of sports medicine. (17). Aszmann OC, Dellon AL, Birely BT, McFarland EG. Post ME, Mayer JO. Surgical procedures involving the shoulder (eg, Bankhart repair) can place the nerve at risk for either direct injury or indirect injury. 1999 Jan. 49(438):39-41. In addition, the suprascapular nerve provides a sensory supply for the joints of the scapula (glenohumeral and acromioclavicular joints)., This article will discuss the anatomy and function of the suprascapular nerve.. Report of two cases and review of the literature. Ferretti A. Volleyball injuries. J Bone Joint Surg Am. official website and that any information you provide is encrypted However, general agreement is that the suprascapular nerve may be vulnerable to injury due to compressive forces or repetitive distraction. Epidemiologic studies have demonstrated that athletes who participate in these and other overhead sports are at higher risk for overuse injuries of the shoulder in particular, including rotator cuff tendinopathy and injuries to the glenoid labrum. A complete physical exam of the shoulder is critical to identify a suprascapular nerve lesion and its underlying etiology. MRI of suprascapular neuropathy in a weight lifter. J Shoulder Elbow Surg. Clinical evaluation may demonstrate tenderness to palpation over the suprascapular notch, i.e., deep and posterior to the AC joint, between the spine of the scapula and clavicle. The growth of cysts resulting from superior glenoid labral tears may also compress the nerve. [QxMD MEDLINE Link]. Isolated atrophy of the infraspinatus suggests compression of the nerve at the spinoglenoid notch. The https:// ensures that you are connecting to the Suprascapular neuropathy or suprascapular nerve entrapment occurs if the suprascapular nerve is compressed as it passes through the suprascapular notch or spinoglenoid notch. [QxMD MEDLINE Link]. Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug ReferenceDisclosure: Received salary from Medscape for employment. Accessibility The inherent difficulty in assigning one cause for perioperative . Link, 12. Suprascapular nerve entrapment caused by supraglenoid cyst compression. Eur J Radiol. 2019 Feb 01;84(2):404-412. Rest from aggravating activities. The suprascapular nerve is a mixed nerve. AC joint, which connects the clavicle to the scapula (shoulder blade), Glenohumeral joint, which is the ball-and-socket joint of the shoulder, Nerve fibers from C4 (the fourth cervical nerve root) in addition to the usual C5 and C6, A sensory branch thats cutaneous (serves the skin) over a portion of the shoulder, Provides joint stability, which is especially important because the ball-and-socket design sacrifices stability in favor of an especially large range of motion, Works with the deltoid muscle to pull the arm in toward the shoulder and body, Also helps provide stability to the glenohumeral joint, Works with other muscles to rotate the shoulder joint away from the body, raise the arm out straight, and rotate the upper arm away from the body, Repetitive use, especially in athletes who perform a lot of overhead movements, Disease, especially those that cause inflammation, Minor lifestyle changes, such as not carrying a backpack on that shoulder, Physical therapy aimed at strengthening the muscles, In some cases, corticosteroid injections to help lessen inflammation. Bookshelf [QxMD MEDLINE Link]. Clinical orthopaedics and related research. J Bone Joint Surg Am. 92(13):2348-64. 1993 Mar. Matthew L Hall, DO Fellow in Primary Care Sports Medicine, St Francis Hospital/UConn Health Center, University of Connecticut School of Medicine Injury to the suprascapular nerve generally occurs. Copyright 2023, StatPearls Publishing LLC. The suprascapular nerve is a peripheral nerve of the shoulder and arm. Left handed versus right handed volleyball players. Albritton MJ, Graham RD, Richards II RS, Basamania CJ. But opting out of some of these cookies may affect your browsing experience. 1992 Jan;74(1):36-45. 2018 Jan. 27 (1):172-180. Within the supraspinous fossa, the suprascapular nerve sends two motor branches to the supraspinatus muscle and receives sensory branches from multiple surrounding structures, including the posterior aspect of the glenohumeral joint, the acromioclavicular joint, the subacromial bursa, the coracohumeral and coracoacromial ligaments, and the overlying skin. Journal of shoulder and elbow surgery. Please enable it to take advantage of the complete set of features! Journal of shoulder and elbow surgery. Clinically Oriented Anatomy (7th ed.). 1998 Sep-Oct. 7(5):516-21. Its main function is to provide motor supply for two of five muscles of the rotator cuff, including: On its course, the nerve gives off a sensory branch that provides sensory innervation for two joints: Do you want to know more about the organization and function of the most complex nerve plexus in the human body? Hill LJ, Jelsing EJ, Terry MJ, Strommen JA. [QxMD MEDLINE Link]. Posterior view of the scapula demonstrating the course of the suprascapular nerve through the suprascapular and spinoglenoid notches. Journal of shoulder and elbow surgery. 2013 Apr;22(4):463-70. doi: 10.1016/j.jse.2012.04.018. Diabetes. Difficulties with daily tasks like buttoning a shirt, typing or holding a pen. 84(6):1306-12. [QxMD MEDLINE Link]. J Shoulder Elbow Surg. Evaluation, treatment, and outcomes of suprascapular neuropathy: a 5-year review. (9) The clinical presentation includes posterior superior shoulder pain and weakness. 1998 Nov;26(6):759-63. To avoid confusion, the path of the suprascapular nerve differs from the suprascapular artery and vein, that course above the superior transverse scapular ligament., The nervous system is a nightmare for many. official website and that any information you provide is encrypted J Shoulder Elbow Surg. A Tale of Two Suprascapular Neuropathy Presentations: A Case ReportLearning Point of the Article. Physical and occupational therapy exercises can prevent nerve problems from recurring. 32(3):235238. 469(4):1056-60. Unauthorized use of these marks is strictly prohibited. They can lead to a pinched nerve and neuropathy (nerve damage). There, the nerve sends branches inward (toward the spine) to the supraspinatus muscle, which sits high on the scapula. eCollection 2020 Sep. Dtsch Arztebl Int. 1 2 3 32644577 Bookshelf ID: NBK559151 Excerpt There is increasing interest in the literature regarding the clinical delineation of suprascapular nerve (SSN) injuries. Am J Sports Med. [27] and is therefore often overlooked. [1][2][3][4] The latter are often readily grouped together with other clinical manifestations of SSN . Symptoms Symptoms vary depending on how, A rotator cuff strain is a tear to any of the four rotator cuff muscles in the shoulder. People who do certain jobs or activities that require repetitive joint movements also are more at risk. 5(2):134-6; discussion 136-7. [27]. [QxMD MEDLINE Link]. Anatomic landmarks for arthroscopic suprascapular nerve decompression. [QxMD MEDLINE Link]. Inability to move a limb, lift your hand or foot, or grasp or hold onto items. Several mechanisms have been proposed for suprascapular neuropathy. 51(1):125-9. Epub 2012 Jul 21. [QxMD MEDLINE Link]. Here, it passes beneath the superior transverse scapular ligament (STSL), which connects the two borders of the suprascapular notch, to enter the supraspinous fossa. Suprascapular neuropathy (SN) is defined as a demyelinating or axonal injury to the suprascapular nerve. Supraspinatus muscle helps in 0-15 arm abduction. Cummins CA, Messer TM, Nuber GW. The growth of cysts resulting from superior glenoid labral tears may also compress the nerve. Link. Chochole MH, Senker W, Meznik C, Breitenseher MJ. Patients typically complain of shoulder pain, weakness, paresthesia, and decreased range of motion. AJR Am J Roentgenol. Duke Orthopaedics: Wheeless' Textbook of Orthopaedics. PMC Link, 6. Inokuchi W, Ogawa K, Horiuchi Y. Curated learning paths created by our anatomy experts, 1000s of high quality anatomy illustrations and articles. Agre JC, Ash N, Cameron MC, House J. Suprascapular neuropathy after intensive progressive resistive exercise: case report. Some authors have proposed that individuals in whom the suprascapular nerve angles sharply around the spinoglenoid notch may be particularly prone to this mechanism of injury. Meister K. Injuries to the shoulder in the throwing athlete. Clinical outcomes of suprascapular nerve decompression. The suprascapular nerve will have the largest contribution, and block of this nerve alone has been attempted to control pain following shoulder surgery. (14) Conservative management can provide benefit. These can all cause a compression of the nerve. Giselle Aerni, MD Assistant Director, Sports Medicine Fellowship Program, Associate Director, Family Medicine Residency Program, York Hospital; Head Team Physician, Spring Grove Area High School; Team Physician, Gettysburg College; Head Team Physician, SkipJacks Hockey There is increasing interest in the literature regarding the clinical delineation of suprascapular nerve (SSN) injuries. Hosseini H, Agneskirchner JD, Trger M, Lobenhoffer P. Arthroscopy. The suprascapular nerve (root value C5, C6) originates from the superior trunk of the brachial plexus. Clin Orthop Relat Res. Hashimoto BE, Hayes AS, Ager JD. Boykin RE, Friedman DJ, Higgins LD, Warner JJ. Major trauma can result from a fractured scapula, a tear of the rotator cuff or shoulder arthrodesis. Ticker JB, Djurasovic M, Strauch RJ, et al. Does Weightlifting Improve Cardiovascular Mortality Risk for Older Aged Adults? Check out this demonstration of isolated strength testing for each rotator cuff muscle. Asami A, Sonohata M, Morisawa K. Bilateral suprascapular nerve entrapment syndrome associated with rotator cuff tear. Interestingly, suprascapular neuropathy has also been reported to occur after positioning patients for spinal surgery. The suprascapular nerve is a mixed nerve, meaning that it provides both sensory and motor supply for the suprascapular region. This site needs JavaScript to work properly. Bethesda, MD 20894, Web Policies Trojian TH Suprascapular Neuropathy Clinical Presentation. Lim et al. Initial management is usually nonoperative, consisting of activity modification, physical therapy, and nonsteroidal anti-inflammatory drugs. Thomas H Trojian, MD is a member of the following medical societies: American Academy of Family Physicians, American College of Sports Medicine, American Medical Society for Sports Medicine, Society of Teachers of Family MedicineDisclosure: Nothing to disclose. Your healthcare provider may ask you to hold onto items, pick up something or lift your foot or hand. J Clin Ultrasound. 2012 Sep 28;1(2):e187-92. The consequences of misdiagnosis can include inappropriate physical rehabilitation or surgical procedures. 2014 May;30(5):639-44. doi: 10.1016/j.arthro.2014.01.010. These symptoms may get worse when you do activities that pull or press on the nerve. [27, 7, 9, 11, 12, 13, 15, 18, 19, 31] This observation lends credence to the term volleyball shoulder., In addition to overhead athletes, some other higher risk populations for suprascapular neuropathy include patients with massive rotator cuff tears resulting in fatty infiltration of the muscle. J Shoulder Elbow Surg. Ulnar Nerve Entrapment at the Elbow (Cubital Tunnel Syndrome). Karatas GK, Ggs F. Suprascapular nerve entrapment in newsreel cameramen. 2003 Jul-Aug. 19(6):641-61. Physical examination may reveal atrophy of the supra- and infraspinatus muscles, and weakness of abduction and external rotation. 2007 Jan-Feb. 9(1):68-74. Scand J Rheumatol. Br J Sports Med. (1) The suprascapular nerve innervates the supraspinatus and infraspinatus muscles, providing shoulder abduction and external rotation, respectively. (1) The suprascapular nerve innervates the supraspinatus and infraspinatus muscles, providing shoulder abduction and external rotation, respectively. Moore, K. L., Dalley, A. F., & Agur, A. M. R. (2014). J Shoulder Elbow Surg. The medical term for supplying nerve function is innervating.. Netter, F. (2019). Ferretti A, De Carli A, Fontana M. Injury of the suprascapular nerve at the spinoglenoid notch. Arthrosc Tech. Disclosure: Adam Susmarski declares no relevant financial relationships with ineligible companies. Diagnostic. doi:10.1007/s00276-009-0597-5. 2010 Mar;32(3):277-84. doi: 10.1007/s00276-010-0631-7. government site. 1997 Jun. According to the literature, most cases respond favorably to either conservative treatment programs or, when indicated, surgical intervention. [Full Text]. Jacob PJ, Arun K, Binoj R. Suprascapular Nerve Entrapment Syndrome. Moen TC, Babatunde OM, Hsu SH, Ahmad CS, Levine WN. Accessibility 1997 Sep-Oct. 6(5):455-62. Although sports-related overuse mechanisms of suprascapular nerve injury are the most common causes, the SSN can also be damaged as a result of directtraumaas well as iatrogenic factors. Reviewer: . [6]. One mechanism is a traction injury that overhead athletes can be susceptible to, given the great amount of motion at the shoulder. [Full Text]. Nerve injuries after orthopedic surgery can be related to surgical, patient, and anesthetic-related factors, or a combination of the three, and in many cases, it may be challenging to determine the causative factor. Introduction. [QxMD MEDLINE Link]. Read more. There is increasing interest in the literature regarding the clinical delineation of suprascapular nerve (SSN) injuries. This includes: Symptoms of nerve compression syndromes tend to come on gradually. sharing sensitive information, make sure youre on a federal Suprascapular nerve: want to learn more about it? 13. Our engaging videos, interactive quizzes, in-depth articles and HD atlas are here to get you top results faster. Roberto Grujii MD Suprascapular neuropathy usually occurs as a result of traction damage to the suprascapular nerve, causing an aching or burning pain at the back and or side of the shoulder joint. You can find out more about our use, change your default settings, and withdraw your consent at any time with effect for the future by visiting Cookies Settings, which can also be found in the footer of the site. Pathology Etiology 1996 Sep. 330:202-7. Get useful, helpful and relevant health + wellness information. Bhatia S, Chalmers PN, Yanke AB, Romeo AA, Verma NN. Note that the cords of the brachial plexus are called the infraclavicular branches of the brachial plexus, while the nerves that branch off from the cords are the terminal branches of the brachial plexus. Link, 2. While the underlying etiology of SSN neuropathy remains elusive, multiple compression, traction, and inflammatory pathophysiologic cascades have been previously considered. When needed, decompression surgery to take pressure off of the nerve often helps. All material on this website is protected by copyright, Copyright 1994-2023 by WebMD LLC. Its nerve roots are C5 and C6. 14. The Neurological Institute is a leader in treating and researching the most complex neurological disorders and advancing innovations in neurology. An official website of the United States government. 1985 Feb;6(4):254-8. The anatomically tortuous course of the SSN predisposes it to direct mechanical compression at the suprascapular and spinoglenoid notches. Gross anatomy Origin. Atlas of Human Anatomy (7th ed.). Some authors suggest that the nerve may also receive contributions from the fourth cervical nerve root in as many as 25% of people. You may experience: Your healthcare provider will perform different tests during a physical exam to evaluate your symptoms. Arthroscopic management of suprascapular neuropathy of the shoulder improves pain and functional outcomes with minimal complication rates. and transmitted securely. To understand the pathophysiology, it is imperative to have a good knowledge of the anatomy ( Fig. Because of its location and origin (C6-C7), it is subject to occasional injury caused by chutes or other objects cattle run into forcefully or are abruptly stopped by, as pressure is placed against the caudal cervical . J Bone Joint Surg Am. The relationship of the nerve to the clavicle makes it vulnerable to injury after a clavicular fracture occurs. suprascapular nerve is the lateral branch of the superior trunk of the brachial plexus . Tissue swelling or damage puts pressure on the nerve, causing symptoms. Surgical intervention is considered for patients with nerve compression by an external source or for symptoms refractory to conservative measures. The inset depicts the clinical appearance in an individual with predominantly right-sided atrophy of the infraspinatus muscle due to suprascapular neuropathy. From its origin, the suprascapular nerve courses laterally, passing superior to the brachial plexus and through the posterior triangle of neck. Here it connects to the Supraspinatus and Infraspinatus muscles. The spinoglenoid ligament and its relationship to the suprascapular nerve. Am J Phys Med Rehabil. Vad VB, Southern D, Warren RF, Altchek DW, Dines D. Prevalence of peripheral neurologic injuries in rotator cuff tears with atrophy. Epub 2010 Feb 21. 2010 Oct 6. Arq Neuropsiquiatr. Ahlawat S, Wadhwa V, Belzberg AJ, Batra K, Chhabra A. [1, 4, 7, 9, 11, 12, 13, 15, 18, 19, 21, 29, 30, 31] It occurs primarilyin persons aged younger than 40 years. Br J Sports Med. Here we explain the symptoms, causes and treatment. Brown DE, James DC, Roy S. Pain relief by suprascapular nerve block in gleno-humeral arthritis. Read more. This pain pattern coincides with the diffuse sensory contribution of the suprascapular nerve, as it carries sensory afferents from up to 70% of the shoulder. Magnetic resonance imaging in the diagnosis of suprascapular nerve syndrome. Suprascapular neuropathy. [QxMD MEDLINE Link]. [12, 15], Another mechanism of injured is due direct compression on the nerve by a space-occupying lesion. J Shoulder Elbow Surg. Share cases and questions with Physicians on Medscape consult. 2004 Apr-May. Zeiss J, Woldenberg LS, Saddemi SR, Ebraheim NA. 2003 Sep 1;12(5):497-500. (1) While early anatomical studies did not recognize a cutaneous branch, more recent dissections have identified sensory innervation to the lateral deltoid region. Knee Surg Sports Traumatol Arthrosc. [QxMD MEDLINE Link]. Suprascapular neuropathy (SN) is defined as a demyelinating or axonal injury to the suprascapular nerve. In: StatPearls [Internet]. Suprascapularneuropathy is a less common cause of shoulder pain in athletes but is seen particularly in those who participate in overhead activities. 1987 Oct(223):126-36. National Library of Medicine Shi LL, Freehill MT, Yannopoulos P, Warner JJ. Please enable it to take advantage of the complete set of features! (https://orthoinfo.aaos.org/en/diseases--conditions/burning-thigh-pain-meralgia-paresthetica/), (https://orthoinfo.aaos.org/en/diseases--conditions/carpal-tunnel-syndrome/). Suprascapular nerve anatomy The suprascapular nerve is a mixed motor and sensory peripheral nerve that arises from the upper trunk of the brachial plexus. Use a wrist rest with your keyboard and mouse pad. Treatment varies depending on the location and etiology of entrapment, which can be described as compressive or traction lesions. More often than not, the pain (when present) is described as a deep, dull, aching discomfort. 2003 Sep-Oct;12(5):497-500. Link, 8. [QxMD MEDLINE Link]. 1990 Jan-Feb. 18(1):80-6. Sonography of entrapment neuropathies in the upper limb (wrist excluded). 516985. doi:10.1155/2012/516985. Diagnosis and treatment. Unable to load your collection due to an error, Unable to load your delegates due to an error. Am J Sports Med. 2004 Nov-Dec. 32(9):438-50. Careers. [QxMD MEDLINE Link]. [QxMD MEDLINE Link]. Gaithersburg, Md: Aspen Publishers; 1998. (4-8) Although suprascapular nerve dysfunction is relatively uncommon, accounting for 2-4% of all shoulder pain, the condition is present in up to 8% of patients with a full thickness rotator cuff tear. Knowing any alternate nerve routes is especially crucial during surgery, so the surgeon can avoid accidentally damaging the nerve. [QxMD MEDLINE Link]. [Full Text]. (https://orthoinfo.aaos.org/en/diseases--conditions/ulnar-nerve-entrapment-at-the-elbow-cubital-tunnel-syndrome/), (https://www.assh.org/handcare/condition/cubital-tunnel-syndrome), (https://www.ncbi.nlm.nih.gov/books/NBK555929/), (https://www.ncbi.nlm.nih.gov/books/NBK544272/), (https://www.merckmanuals.com/home/bone,-joint,-and-muscle-disorders/hand-disorders/carpal-tunnel-syndrome), (https://www.merckmanuals.com/home/bone,-joint,-and-muscle-disorders/hand-disorders/cubital-tunnel-syndrome), (https://www.merckmanuals.com/home/bone,-joint,-and-muscle-disorders/foot-problems/tarsal-tunnel-syndrome), (https://www.ncbi.nlm.nih.gov/books/NBK547683/). [QxMD MEDLINE Link]. Patients should avoid excessive scapular protraction, cross body adduction and overhead movements. 204 (3):589-601. Suprascapular neuropathy: what does the literature show?. The case emphasizes the importance of considering local trauma of the posterior triangle of the neck in case of shoulder weakness with electrophysiologic evidence of combined spinal accessory and suprascapular . When you visit the site, Dotdash Meredith and its partners may store or retrieve information on your browser, mostly in the form of cookies. See a sports injury professional or Doctor who can diagnose your injury with the use of an MRI scan. Link, 18. Ferretti, who has written extensively about volleyball shoulder, hypothesized that the mechanism of selective injury to the terminal portion of the suprascapular nerve in volleyball players is traction on the nerve due to repetitive, sudden, eccentric activation of the infraspinatus during the deceleration phase of the floater serve. 1996 Sep. 30(3):256-9. Dont rest your elbows on an office chair or a desk for an extended period. 17. Damage to the suprascapular nerve, depending on its location, can impair the movement of one or both of the muscles it innervates and can reduce sensation to the AC and glenohumeral joints. Gosk J, Urban M, Rutowski R. Entrapment of the suprascapular nerve: anatomy, etiology, diagnosis, treatment [Polish, English]. Activities that involve overhead motions or sport-specific skills may exacerbate symptoms. guided suprascapular nerve block guided suprascapular nerve block decrease from 6.8 + / 1.5 baseline to 3.7 + / 1.3 at 12 weeks. In the case of nerves, they also may not be the same on both sides of your body. Click to share on Twitter (Opens in new window), Click to share on Facebook (Opens in new window), Essentials of Physical Medicine and Rehabilitation, Other mononeuritis of unspecified upper limb, Unspecified mononeuritis of unspecified upper limb, Unspecified mononeuritis of right upper limb, Unspecified mononeuritis of left upper limb. By Adrienne Dellwo Adrienne Dellwo is an experienced journalist who was diagnosed with fibromyalgia and has written extensively on the topic. Its important for doctors to know what anatomical variations are possible so they can diagnose and treat nerve problems in people who have these variations. Try out nervous system quizzes and diagrams and soon you will see theres nothing to be afraid of!. Unable to load your collection due to an error, Unable to load your delegates due to an error. Treatment typically includes rest with avoidance of activities that place sustained or repetitive stress on the nerve. Syndromes that affect your upper limbs include: Nerve compression syndromes that affect the lower limbs include: Nerve compression often affects nerves that travel through small openings (called tunnels or canals) in your joints. Electrodiagnostic studies are the gold standard test for confirming the diagnosis of SN and grading the injury severity, but an image-guided diagnostic suprascapular nerve block can also assist with diagnosis. 1994 Sep. 13(9):671-4. 1994 Sep. 28(3):177-9. The nerve then travels through the spinoglenoid notch around the outer edge of the scapula and into the infraspinous fossa and sends terminal branches to the infraspinatus muscle, which is below the supraspinatus muscle. Sandow MJ, Ilic J. Suprascapular nerve rotator cuff compression syndrome in volleyball players. Medical alternatives include steroid injections and surgical decompression in cases of persistent symptomatology or muscle atrophy. Clin Orthop Relat Res. The Minimum Effective Analgesic Volume of 0.5% Bupivacaine for Ultrasound-Guided Anterior Suprascapular Nerve Block.