Chapter 20 - Suprascapular Neuropathy

Abstract

Once considered a diagnosis of exclusion, suprascapular neuropathy (SN) is now becoming a well-recognized condition stemming from traction or compression of the suprascapular nerve. The indirect course of the nerve, as well as its passage through two notches, makes it particularly vulnerable to injury from anatomic variation or local pathology. Dynamic forms of SN are often seen with overhead athletes such as volleyball players and throwing athletes. Patients typically complain of shoulder pain, weakness, paresthesia, and decreased range of motion. Physical examination may reveal atrophy of the supra- and infraspinatus muscles, and weakness of abduction and external rotation. Functional limitations will vary significantly depending on the patient’s activity level. 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. Treatment initially focuses on physical therapy to strengthen scapular stabilizers and rotator cuff. Surgery can be considered if conservative measures fail. Overall, SN has a positive prognosis with the majority of patients improving with conservative or operative treatment.