February 15, 2018
Suprascapular nerve entrapment is a rare condition that can be easily misdiagnosed or even go unnoticed by those who are affected. Let’s get to the bottom of this condition and talk about who could be affected, what body parts are involved, and what are the symptoms, causes and treatments of this potentially “silent” condition of the shoulder.
Dr. Robert Rolf, a board certified orthopaedic surgeon at Beacon Orthopaedics and Sports Medicine, has compiled a collection of frequently asked questions concerning suprascapular nerve entrapment below.
What is the suprascapular nerve?
Suprascapular nerve (SSN) is a sensory and motor (mixed) nerve that arises from the superior trunk of the brachial plexus with contributions primarily from the anterior primary rami of the C5 and C6 nerve roots, and supplies the supraspinatus and infraspinatus muscles. Both of these muscles are part of the rotator cuff muscle group—these muscles help perform and stabilize arm movements at the shoulder joint.
How can this nerve get injured?
- Vascular micro-trauma
- Irreparable related rotator cuff tears
- Fractures of the scapula (shoulder blade)
- Fractures to the clavicle (collar bone)
- Dislocation of the shoulder
- Gunshot/stab injuries to the shoulder
- Injury that results in stretching of the nerve
- Compression of the nerve caused by
- Tumors or ganglion cysts
- Thickened or calcified suprascapular ligament
- Congenital structural changes of the scapular bone
- SSN being fixed at two points (sling effect)
What is supracapular neuropathy?
Suprascapular neuropathy, or suprascapular nerve entrapment, is a condition which is due to irritation and damage to the suprascapular nerve (SSN). This condition can result in pain, weakness, or both depending on the cause. It is a relatively rare chronic condition that is commonly not diagnosed until other more common causes of shoulder pain have already been ruled out, such as:
- Rotator cuff tear
- Acromioclavicular joint disease
- Cervical spine (neck) disc disease
In fact, it often occurs that some patients end up getting surgery for the above conditions but recover and continue to have shoulder pain due to an unrecognized SSN irritation.
Is suprascapular neuropathy common?
Suprascapular neuropathy is generally believed to be a rare condition and probably accounts for less than 0.4% of shoulder diagnoses in patients with shoulder pain.
What are the signs and symptoms of suprascapular neuropathy?
The signs and symptoms of suprascapular neuropathy include:
- Shoulder/arm weakness or heaviness
- Radiating/burning pain to the neck, back or arm
- Pain that worsens with shoulder movement
- Loss of shoulder function
- Discomfort in shoulder and upper back
- Atrophy, wasting or shrinkage of upper shoulder muscles
- Denervation of the infraspinatus muscle
What causes suprascapular neuropathy?
The most common cause is the repetitive stretching of the SSN—generally due to consistent and exaggerated overhead movements of the shoulder. This is why the most common patients exhibiting symptoms of suprascapular neuropathy are athletes. Especially athletes who play baseball, volleyball, swimming, weightlifting and tennis (sports that require a lot of overhead activity).
However, other possible causes of this condition can include:
- Weak muscles controlling the scapula
- Falling on to the arm
- Broken scapula
- Torn rotator cuff
- Abnormal bone morphology of the scapular incisure
- Anomalies of the transverse ligament of the scapula
- Paralabral or ganglion cysts (nerve compression)
- Lesions due to traction
- Some surgical procedures like a Bankart Repair
What increases your risk of injury?
- Contact sports
- Poor strength and flexibility
- Repetitive overuse
How diagnosis for suprascapular neuropathy is found
Diagnosis for this condition remains largely a “diagnosis of exclusion”—where all other possible diagnoses are considered (and potentially treated) prior to this condition. This is, unless the physician remains alert to the diagnostic possibility of suprascapular neuropathy when the affected patient initially presents for consultation.
Tests that may prove helpful to confirm diagnosis:
- Electromyography/Nerve conduction study (EMG/NCV)
- Fluoroscopic x-ray
- Fluoroscopic ultrasound
- Radiological study
- 3T Magnetic Resonance Neurography
What are the treatment options for suprascapular neuropathy?
Conservative Treatment Options
When the evidence of suprascapular neuropathy is confirmed but the conditions does not cause any pain or limitation of activity to the patient, then physical therapy exercises could be a possible solution provided by your physician. Exercises that encourage scapular/shoulder stabilization, mobilization, and flexibility could prove to be enough for relieving symptoms and resolve the condition, given proper time.
If the patient experiences pain intense enough to want medication, nonsteroidal anti-inflammatory medications (such as aspirin and ibuprofen) or other minor pain relievers, such as acetaminophen, will often be recommended. Prescription pain relievers will only be given if deemed necessary by your physician.
Applying ice the affected area will relieve pain and reduce inflammation. As your physician will state, cold treatments should be applied for 10 to 15 minutes every 2 to 3 hours for inflammation and pain while at rest. For active patients, cold treatments are suggested to be applied immediately after any activity that aggravates your symptoms.
Heat treatments are most affective prior to the stretching and strengthening activities prescribed by your physician or physical therapist.
Surgical Treatment Options
If symptoms persist longer than 6 months despite conservative treatments listed above, then surgery may be recommended to the patient in order to release the entrapped nerve.
Arthroscopic decompression of the suprascapular nerve is a non-invasive surgical procedure in which the compressed nerve is released to relieve pain. Your physician will approach this surgery from the front (anterior) aspect of the shoulder, and access the nerve via a small incision on the top of the shoulder. Using the arthroscope, your physician will more easily view and decompress the nerve and have you out of the hospital and home ready to heal later that same day.
When should I seek medical care?
You should schedule an appointment with a physician if:
- Conservative treatment offers no benefit, or your symptoms get worse.
- Prescribed medications produce adverse side effects.
- Any complications from surgery occur:
- Pain, numbness, or coldness in the shoulder or arm.
- Discoloration of the nail beds (they become blue or gray) of the hands.
- Signs of infections (fever, pain, inflammation, redness, or persistent bleeding).
When You’re Not Sure, Consult a Shoulder Specialist
Suprascapular neuropathy is an uncommon condition. Because of its rarity, your symptoms might go unnoticed or be misdiagnosed. But, Dr. Rolf and the specialists at Beacon Orthopaedics won’t overlook any symptom without considering all the possible outcomes and causes.
Why do we focus on all of the details? Because when it comes to conditions such as suprascapular neuropathy, diagnosis can be a grey area. You need a physician who can be clear and confident in not only your diagnosis, but also your treatment plan.
If you think you might be experiencing symptoms of suprascapular neuropathy, schedule an appointment immediately. Dr. Rolf will talk through all of your symptoms and treatment options, and get you feeling better faster.