Suprascapular Neuropathy: This is a painful pathological condition of the shoulder in which there is traction damage to the suprascapular nerve resulting in pain in the shoulder. This is usually not very common but it can be caused due to excessive nerve deviation like when performing sporting activities which require frequent overhead positioning of the arms.
In this article, we will read about:
- Causes of Suprascapular Neuropathy
- Symptoms of Suprascapular Neuropathy
- Treatments rendered for Suprascapular Neuropathy
How Do We Define Suprascapular Neuropathy?
Suprascapular Neuropathy typically occurs due to some sort of traction injury to the suprascapular nerve resulting in pain in the shoulders. There can be many reasons for nerve entrapment, especially at the suprascapular and spinoglenoid notches where nerve deviation is limited by bony and ligamentous structures. Additional compression may result due to ganglion cysts related to glenohumeral joint. This condition may also occur as a result of overuse of the arms such as in sporting activities which require frequent overhead positioning of the arms like tennis and volleyball. Suprascapular Neuropathy may also be caused in the elderly population due to a large rotator cuff tear.
Causes of Suprascapular Neuropathy
As stated, sporting activities like tennis which require frequent overhead positioning of the arm may cause Suprascapular Neuropathy. The exact location of the entrapment of the nerve determines whether supraspinatus as well as infraspinatus muscles are involved or just the infraspinatus muscle is involved.
Even though sporting activities are the main cause of Suprascapular Neuropathy but this condition can also be developed due to a direct trauma to the arm such as when falling on to the arm or other overuse type activities. Some surgical procedures of the shoulders may also damage the Suprascapular Nerve like a Bankart Repair which can injure the Suprascapular Nerve. There have been rare cases of Suprascapular Neuropathy in people who have undergone spinal surgery as a result of their positioning.
Symptoms Of Suprascapular Neuropathy
The main symptom of a Suprascapular Neuropathy is burning and aching pain on the back and side of the shoulders. The onset of the pain is spontaneous and gradual and will be deep set in the shoulders. The pain also radiates to the arms. Affected people also experience weakness of the shoulders when lifting things. As time goes by, there is observation of muscle wasting of the supraspinatus and infraspinatus muscles as well.
Diagnosis of Suprascapular Neuropathy
If Suprascapular Neuropathy is suspected, the first course of action is to get a radiological study to look at the structures. Along with standard views, the suprascapular notch and Stryker views are also taken. In cases of Suprascapular Neuropathy, radiographic findings are usually unremarkable unless there is a trauma to account for this condition.
Apart from x-rays, an MRI of the shoulder may also be done which may reveal muscle edema along with muscle atrophy. It may also reveal presence of a ganglion cyst with resultant compression of the Suprascapular Nerve.
Another important diagnostic tool is the 3T Magnetic Resonance Neurography in cases of Suprascapular Neuropathy, as it helps in identifying any nerve abnormalities or any denervation changes in the muscles.
Ultrasound is also an important tool in identifying Suprascapular Neuropathy as it quite an affordable option and has the capability to give precise information.
Apart from the above mentioned radiological tests, electrodiagnostic study is also very helpful in diagnosing Suprascapular Neuropathy. EMG may reveal positive sharp waves and fibrillation potentials suggestive of denervation. There may also be motor unit recruitment abnormalities observed during the study.
Treatment For Suprascapular Neuropathy
Suprascapular Neuropathy can be treated with conservative measures, surgical procedures, or even nerve blocks for which studies have shown to be quite beneficial.
Conservative Measures: In cases where Suprascapular Neuropathy does not cause any pain or limitation of activity then physical therapy exercises in the form of scapular stabilization and mobilization is enough for relieving symptoms if any and resolving the condition. Th treatment period may last for a month. The exercise program is designed in such a way to prevent progression of the medical condition and also prevent impingement of the rotator cuff. Physical therapy is also recommended for individuals who have symptoms but in addition to the exercises activity modification of activities also becomes imperative by way of limiting the amount of work they do, especially during the acute phase of the disease. The individual then goes through an exercise program which is designed to improve flexibility and stability of the shoulders
Surgical Measures: In case if conservative treatments fail to relieve symptoms then the next route taken is a surgical approach to treat the condition, although there are contradictory theories in the literature in which some studies suggest that surgery should be the treatment of choice for Suprascapular Neuropathy.
The surgical treatment is designed to free up the space for the nerve by widening of the suprascapular or the supraglenoid notch depending on where the nerve is getting compressed.
Nerve Blocks: Apart from conservative and surgical approaches, nerve blocks can also be used to treat Suprascapular Neuropathy. These blocks provide significant albeit temporary relief of symptoms.