Suprascapular neuropathy is an underappreciated cause of shoulder girdle weakness and pain. The clinical and electrophysiologic techniques of diagnosis can be easily learned. Advances in correlation of nerve conduction study results with treatment choices and outcomes provide a motor-based prognostic model for suprascapular neuropathy. Both nonoperative and operative treatments are successful when properly chosen. In this update, new data regarding diagnostic modalities, etiologies, risk factors, and treatments of suprascapular neuropathy are summarized.
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• Suprascapular neuropathy should be considered in patients with shoulder pain, weakness, and supraspinatus and infraspinatus muscle atrophy.
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• Suprascapular neuropathy could be common in patients with a history of shoulder trauma, rotator cuff tear, and in overhead sport players.
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• 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. Suprascapular neuropathy is a more common cause of shoulder pain and weakness than is generally believed (82; 92). 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 (73).
Shoulder girdle neuropathy was reported as early as 1879 (47), and in 1909, isolated "neuritis" of the suprascapular nerve was described (26). In 1926, 16 cases of suprascapular neuropathy were published in a review of war injuries, and an additional case was discussed in 1936 (34; 88).
In Parsonage and Turner's classic publication of Neuralgic Amyotrophy in 1948, 4 cases of isolated suprascapular neuropathy are described (75).
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 (53; 54).
Gassel was the first to publish nerve conduction study techniques for the suprascapular nerve, and Kraft further defined these methods (37; 56). A report of isolated infraspinatus involvement in suprascapular neuropathy was described in 1982 (02). Increasing attention to the importance of the various presentations and treatments of suprascapular neuropathy has continued to the present.