The suprascapular nerve arises from the upper trunk of the brachial plexus. The suprascapular nerve is the major sensory supply to the shoulder joint and motor supply to the supraspinatus and infraspinatus muscles. Loss of honey comb appearance secondary to swelling and edema. The entry point is 23 cm into the upper outer quadrant. The ligament on the shoulder blade can compress the nerve when it gets inflamed. Entrapment neuropathy is caused by the prolonged compression or irritation of a nerve plexus or peripheral nerve. We report the clinical features, radiological findings, arthroscopic management and outcome of three patients with suprascapular nerve compression caused by labral ganglion cyst associated with slap lesion. Entrapment of the ulnar nerve in cubital tunnel by free intraarticular. B ulnar nerve compression in the cubital tunnel, resulting from articular capsule distention arrow. Suprascapular nerve ssn entrapment by compression in its course through the suprascapular notch has been well documented. The needle is directed from the top to avoid deep entry into the suprascapular notch, which could risk pneumothorax from rathmell et al. After decompression in those few cases with refractory pain, a nerve neurostimulator can be applied. The suprascapular nerve can become compressed and entrapped, resulting in unpleasant suprascapular nerve entrapment symptoms. The suprascapular nerve passes through the suprascapular notch which is converted into foramen by superior transverse scapular ligament.
There was no relationship between suprascapular nerve latencies and the age, professional life, and number of hours worked daily by the subjects. A 15yearold girl described pain, reduced abduction, and external rotation of the left shoulder as well as intermittent paresthesia over the left scapula. Suprascapular nerve entrapment in newsreel cameramen. The class iv k laser increases metabolic reactions within the nerve to speed nerve regeneration and repair. In a recent study physical therapy was found to be effective in reducing pain severity and functional disability, and the addition of suprascapular nerve block to physical therapy improved functional status and pain levels in patients with adhesive capsulitis.
She recalled no trauma, and the symptoms were exacerbated by exercise and abated with rest. If the patients history reveals a trauma, it is more likely that the ligament is compromising the nerve. Suprascapular nerve block is a safe and effective treatment for chronic shoulder pain in arthritis, which can be performed either by direct imaging ct guided or in the clinic using anatomical landmarks to determine needle placement. Bilateral suprascapular nerve entrapment by ganglion cyst.
Tibial nerve entrapment can cause a v ariety of foot and heel. It involves compression of the suprascapular nerve at the top or back of the shoulder, usually caused by a ligament, a cyst from the shoulder, or excessive stretching. Kopell and thompson1 initially described suprascapular neuropathy at the suprascapular notch in 1959. Suprascapular nerve entrapment is an uncommon cause of shoulder pain that is being encountered more frequently in clinical practice with the increasing use of backpacks instead of briefcases. The suprascapular nerve is a mixed motor and sensory nerve that innervates the glenohumeral joint and the surrounding posterior shoulder girdle.
Suprascapular artery an overview sciencedirect topics. Apr 17, 20 pinched nerve in shoulder blade one shoulder higher than other cause and treatment barlates duration. Males are more likely to suffer from a ganglion compressing the nerve than females. Clinical presentation nonspecific posterior shoulder pain and weakne. Topographical anatomy of the suprascapular nerve and. Suprascapular neuropathy related to rotator cuff tears.
A nerve entrapment is caused when a peripheral nerve losses mobility, flexibility, or becomes compressed by surrounding tissues. We developed an animal model to investigate the mechanism underlying nerve transfer between branches of the spinal accessory nerve ac and suprascapular nerve ss in rats, so that we could observe. Suprascapular nerve entrapment in a canoeist neurology. Suprascapular nerve ssn entrapment is an uncommon cause of posterior shoulder pain. The condition may be more common than once thought as it is being diagnosed more frequently. Suprascapular nerve compression is a rare cause of shoulder pain. Patient information sheet suprascapular nerve blocks. A nerve entrapment can cause neuropathic neurogenic pain that can be either acute or chronic in nature. Suprascapular neuropathy radiology reference article. Athletes who participate regularly in overhead sports are more susceptible to developing suprascapular neuropathy. Suprascapular nerve compression should be considered in cases of shoulder pain and arm abduction weakness. Etiologies for suprascapular neuropathy may include repetitive overhead activities, traction from a rotator cuff tear, and compression from a spaceoccupying lesion at the suprascapular or spinoglenoid notch. Axillary motor nerve to the deltoid 2 long thoracic motor nerve to the serratus anterior 6 median nerve median motor nerve to the abductor pollicis brevis 10 median motor nerve to the flexor carpi radialis 18 median motor nerve anterior interosseous branch to the flexor pollicis longus 22 median motor nerve anterior interosseous branch.
Entrapment of the distal suprascapular nerve springerlink. Suprascapular nerve injury and rotator cuff tear both. Operative release for entrapment of the suprascapular nerve was carried out in 35 patients. Most cases of entrapment occur when the nerve passes through scapular ligament. Suprascapular neuropathy or suprascapular nerve entrapment occurs if the suprascapular nerve is compressed as it passes through the suprascapular notch or spinoglenoid notch. Peripheral nerve entrapment and injury in the upper extremity. The nerve passes through the notch deep to the transverse scapular ligament, whereas the artery passes over the ligament. The suprascapular nerve arises from the upper trunk of the brachial plexus which is formed by the union of the ventral rami of the fifth and sixth cervical nerves.
Twentyfive shoulders were dissected in cadavers in order to observe the presence of the inferior transverse ligament, the spinoglenoid ligament, and its relationship to the spinoglenoid notch and the suprascapular nerve. Seven patients with suprascapular nerve palsy are presented, and their evaluation, treatment, and outcome over a mean followup period of 24 months are described. Suprascapular nerve entrapment syndrome is caused by compression of the suprascapular nerve as it passes through the suprascapular notch. The most commonly encountered cause of this condition is a ganglion, usually arising from a posterior labral tear. Jul 31, 2015 causes of suprascapular nerve entrapment. To relieve these symptoms, suprascapular nerve decompression is performed through the resection of stsl. Suprascapular nerve an overview sciencedirect topics. Management and outcomes of 42 surgical suprascapular nerve. The final result is nerve dysfunction and chronic neuropathic pain in the innervation area of the affected nerve. Nerve compression syndrome or compression neuropathy, is a medical condition caused by direct pressure on a nerve. Nonpharmacologic treatment of peripheral nerve entrapment.
Peripheral nerve entrapment and their surgical treatment. Other causes of suprascapular neuropathy include traction injury at the level of the transverse scapular ligament or the spinoglenoid ligament and direct trauma to the nerve. It is known colloquially as a trapped nerve, though this may also refer to nerve root compression by a herniated disc, for example. This disturbance is not rare or unusual, but must be taken into consideration in evaluating patients suspected of having a tear in the rotator cuff. Suprascapular nerve entrapment at the spinoglenoid notch. Suprascapular nerve block is a safe and welltolerated method. Morphological and electromyogram analysis for the spinal.
Suprascapular nerve ssn entrapment neuropathy occurring at the transverse scapular notch was first described by thomas in 1936. The ligament on the shoulder blade can compress the nerve. The nerve can be compressed due to pressure from a cyst. Suprascapular nerve compression at the spinoglenoid notch was first recognized and described in 1981. Entrapment can be relieved arthroscopically in some cases. Sep 21, 2017 other rare nerve entrapment syndromes include the suprascapular nerve, which accounts for approximately 0. A line is drawn along the scapular spine and then bisected by a second line parallel to the vertebral spine. To compare a ct guided versus an anatomical landmark approach in a randomised, single blind trial examining the efficacy of suprascapular. The results of treatment are very good and should encourage surgeons to differentiate patients with suprascapular nerve entrapment from those with from cervical disease. Suprascapular nerve entrapment due to a stenotic foramen. Suprascapular nerve entrapment, a series of 27 cases.
The ligament was found to be absent in 50% of females and rudimentary in one female, but absent in only % of the male shoulders. Suprascapular nerve entrapment caused by the superior transverse scapular ligament stsl causes pain, and limitation of motion in the shoulder. This usually requires an open incision which must split the trapezius muscle. Carrying a heavy, mobile camera on the shoulder might cause suprascapular nerve entrapment in newsreel cameramen.
It causes varying degrees of supraspinatus andor infraspinatus atrophy, weakness of abduction and external rotation of the shoulder, and vague shoulder pain fig. Initially, your health care provider will embark upon conservative treatment for suprascapular neuropathy. Your ulnar nerve passes through the tunnel to supply sensation to your fingers, and. Compression of the suprascapular nerve by a ganglion cyst.
Introduction also known as scapular notch syndrome. With the advent of mri, suprascapular nerve compression is becoming increasingly recognised as a cause of shoulder pain in the orthopaedic,14 radiological,5 6 and sports medicine8 literature. Suprascapular nerve lesions at the spinoglenoid notch. Suprascapular nerve, nerve entrapment syndromes, rotator cuff. A series of 27 cases, the largest reported to date, is presented and examined as to the best and most appropriate method of diagnosis and treatment. Suprascapular nerve entrapment occurs when supraspinatous nerve is compressed or is entrapped in a space. Until recently, the diagnosis of suprascapular nerve entrapment was only considered after development of marked weakness and atrophy of the supraspinatus or infraspinatus muscles. The bone serves as a protector for many of the nerves of the back and arm that lie underneath it. However, we are unaware of any such reports in the rheumatological literature. Although isolated ssn neuropathy is a relatively rare phenomenon, its aetiology is thought to be related to traction or compression of the ssn 2,3,4,5. Suprascapular nerve block in chronic shoulder pain. Shoulder the suprascapular nerve is an underrecognized cause of shoulder pain and dysfunction. Introduction the suprascapular nerve is a mixed motor and sensory peripheral nerve arising from the 5th and 6th cervical nerves of the brachial plexus with variable contributions from the 4th cervical nerve roots. Entrapment of the suprascapular nerve is a rare but increasingly recognized disease entity that contributes to pain and.
The present publication relating to peripheral nerve entrapment is an attempt. Shoulder pain is the primary symptom of suprascapular nerve entrapment. Durandeau from the groupe hospitalier pellegrin, bordeaux, france operative release for entrapment of the suprascapular nerve was carried out in 35 patients. The suprascapular nerve, formed from the upper trunk of the brachial plexus, can be entrapped at the suprascapular notch and result in significant patient morbidity. Six months after operative excision of the cyst the patient had regained normal musculature strength. If entrapment occurs more distally along the course of the suprascapular nerve, innervation of the infraspinatus muscle only is affected. Ulnar nerve entrapment is a condition where the ulnar nerve becomes physically trapped or. Treatment for suprascapular nerve entrapment depends upon the cause, intensity, and duration of your symptoms and the amount of disability. The common peroneal nerve is located at the fibular neck, just to the outside of the knee. Symptoms include numbness, tingling andor pain in the arm, hand andor. Full text views reflects the number of pdf downloads, pdfs sent. Suprascapular nerve entrapment is rare and mainly occurs in patients under 40 years of age. Cubital tunnel syndrome oxford university hospitals.
Twentyseven masses were identified adjacent to the suprascapular nerve on magnetic resonance mr images of the. Infraspinatus muscle atrophy from suprascapular nerve. A mr imaging evaluation of suprascapular nerve entrapment. In 1982, aiello et al2 differentiated suprascapular nerve entrapment at the spinoglenoid notch. The nerve originates 3cm superior to the clavicle, then courses through the posterior triangle in the supraclavicular fossa deep to the omohyoid muscle. Furthermore, as the nerve heals, exercises to strengthen the weak muscles should be of benefit.
The suprascapular nerve is vulnerable to compression at the suprascapular notch as well as at the spinoglenoid notch. The suprascapular nerve passes in a groove in the shoulder blade. Suprascapular nerve entrapment is an uncommon nerve condition in the shoulder, causing pain and weakness. Technique for endoscopic release of suprascapular nerve. Class iv k cold laser is an excellent treatment for any nerve entrapment, especially for treating suprascapular nerve syndrome. Suprascapular nerve compression is a rare 8, 44 but important entity that is often missed in clinical practice. Suprascapular nerve entrapment faqs beacon orthopaedics and.
We have developed a new arthroscopic endoscopic technique of ssn decompression using 3 portals, including a new direct superior access to the suprascapular notch that have never been. Decreased mobility of the nerve at site of entrapment. Patient information sheet suprascapular nerve blocks what is the suprascapular nerve. Suprascapular nerve definition of suprascapular nerve by. Suprascapular nerve entrapment faqs beacon orthopaedics. The suprascapular nerve is responsible for the sensation in the back of the shoulder and upper arm. For many years, nerve transfer has been commonly used as a treatment option following peripheral nerve injury, although the precise mechanism underlying successful nerve transfer is not yet clear.
Median nerve compression by the transverse carpal ligament. Get a printable copy pdf file of the complete article. They were assessed at an average of 30 months 12 to 98 after operation using the functional. Specialists at the peripheral nerve center also treat people who have carpal tunnel syndrome, double crush syndrome, meralgia paresthetica, mortons neuroma, neurogenic pyriformis syndrome, peroneal nerve entrapment at the fibular head, and pudendal nerve entrapment. Sep 30, 2015 treatment for suprascapular nerve entrapment. Mri may also reveal a ganglion cyst or other mass such as a paralabral cyst with resultant suprascapular nerve compression. Each chapter covers a single nerve, or group of closely related nerves, and. Entrapment of the suprascapular nerve is frequently overlooked in the differential diagnosis of shoulder pain.
Pain and weakness were the presenting symptoms in 14 shoulders and pain alone in 8. They were assessed at an average of 30 months 12 to 98 after operation using the functional shoulder. The diagnosis is typically not considered until patients develop severe weakness secondary to atrophy of the spinatus spinous musculature that the nerve supplies. The suprascapular nerve is the only branch of the upper trunk c5 and c6 of the brachial plexus, supplying the supraspinatus and infraspinatus muscles and sensation to the acromioclavicular and glenohumeral joints. Intraop pics of a common peroneal nerve entrapment being released for acute dropfoot. Compression of the suprascapular nerve can occur at the suprascapular or. The nerve carries most of the pain receptors to the shoulder and rotator cuff muscles and passes through a small notch in the shoulder blade and to the back of the shoulder. Treatment at the peripheral nerve center nyu langone health. Suprascapular nerve entrapment is an acquired neuropathy secondary to compression of the nerve in the bony suprascapular notch. Oct 11, 2018 suprascapular neuropathy is a less common cause of shoulder pain in athletes but is seen particularly in those who participate in overhead activities. If the nerve is injured or damaged, it can cause a dropfoot due to paralysis of the muscles that it innervates. Documentation is made with electroneuromyographic testing. Entrapment at this level may result in denervation changes of both muscles.
Nerve becomes enlarged proximal to site of compression 24 cm nerve returns to normal caliber or size after entrapment area. The suprascapular nerve is a mixed nerve motor and sensory arising from the upper trunk of the brachial plexus with contributions from the c5 and c6 nerve roots occasionally c4. Suprascapular nerve ssn entrapment at the suprascapular notch is an uncommon cause of shoulder pathology that often presents with posterior shoulder pain and wasting of the supraspinatus ss and infraspinatus is muscles. Nerve compression syndrome, compression neuropathy, nerve entrapment, or a pinched peripheral nerve. After branching from the upper trunk, the nerve passes across the posterior triangle of the neck parallel to the inferior belly of the omohyoid muscle and deep to the trapezius muscle.
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