Suprascapular neuropathy

Sameera Salman Ghauri MBBS (Dr. Ghauri of University of Texas Houston Health Science Center has no relevant financial relationships to disclose.)
Kazim Sheikh MD (Dr. Sheikh of University of Texas Houston Health Science Center has no relevant financial relationships to disclose.)
Randolph W Evans MD, editor. (Dr. Evans of Baylor College of Medicine received honorariums from Allergan and DepoMed for speaking engagements.)
Originally released June 1, 2001; last updated January 22, 2017; expires January 22, 2020

This article includes discussion of suprascapular neuropathy, suprascapular nerve injury, suprascapular mononeuropathy, suprascapular nerve entrapment, and infraspinatus muscle atrophy. The foregoing terms may include synonyms, similar disorders, variations in usage, and abbreviations.

Overview

Suprascapular neuropathy is an underrecognized cause of shoulder girdle weakness and pain. The clinical and electrophysiologic techniques of diagnosis are easily learned. Both nonoperative and operative treatments are successful when properly chosen. Advances in correlation of nerve conduction study results with treatment choice and outcomes provide a motor-based prognostic model for suprascapular neuropathy. In this update, new data regarding diagnostic modalities, etiologies, and treatments of suprascapular neuropathy are summarized.

Key points

 

• Suprascapular neuropathy is 1 of the causes that should be considered in patients with shoulder pain.

 

• Suprascapular neuropathy could be common in some overhead sport players, especially volleyball.

 

• The gold standard for the diagnosis of suprascapular neuropathy is electrodiagnostic testing.

Historical note and terminology

Suprascapular neuropathy connotes injury to the suprascapular nerve anywhere in its course, from the origin at the brachial plexus to its termination in the infraspinatus muscle. Despite its relatively low prevalence, it must be kept in mind as a potential cause of shoulder pain, particularly in patients where the history, physical examination, and imaging studies do not adequately explain a patient's symptoms or disability (Moen et al 2012).

Suprascapular neuropathy is a more common cause of shoulder pain and weakness than is generally believed (Rengachary et al 1979a; Vastamaki and Goransson 1993). Though over 300 cases have been published, primarily in the surgical literature, this entity may often be clinically overlooked. Suprascapular neuropathy "deserves more than a modest place in the rare diagnoses" of upper extremity nerve injuries (Mestdagh et al 1981).

Shoulder girdle neuropathy was reported in 1879 (Joffroy 1879), but in 1909, isolated "neuritis" of the suprascapular nerve was described (Ewald 1909). In 1926, 16 cases of suprascapular neuropathy were published in a review of war injuries, and an additional case was discussed in 1936 (Foster 1926; Thomas 1936).

In Parsonage and Turner's classic publication of Neuralgic Amyotrophy in 1948, 4 cases of isolated suprascapular neuropathy are described (Parsonage and Turner 1948).

In the late 1950s, Kopell and Thompson were the first to define a suprascapular neuropathy syndrome. In a series of publications, they defined pathophysiology, clinical characteristics, and treatment approaches for suprascapular nerve entrapment at the suprascapular notch (Kopell and Thompson 1959; Kopell and Thompson 1963; Thompson and Kopell 1959).

Gassel was the first to publish nerve conduction study techniques for the suprascapular nerve, and Kraft further defined these methods (Gassel 1964; Kraft 1972). A report of isolated infraspinatus involvement in suprascapular neuropathy was described in 1982 (Aiello et al 1982). Increasing attention to the importance of the various presentations and treatments of suprascapular neuropathy has continued to the present.

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