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Suprascapular Neuropathy

Dr. Romeo or a member of his immediate family has received royalties from, is a member of a speakers’ bureau or has made paid presentations on behalf of, and serves as a paid consultant to or is an employee of Arthrex; has received research or institutional support from Arthrex, Athletico, DJ Orthopaedics, Miomed, and Smith & Nephew; and has stock or stock options held in, and has received nonincome support (such as equipment or services), commercially derived honoraria, or other non–research-related funding (such as paid travel) from, Arthrex. Dr. Bach or a member of his immediate family has received research or institutional support from Arthrex, Athletico, DJ Orthopaedics, Miomed, Ossur, Scheck & Siress, and Smith & Nephew. Dr. Nicholson or a member of his immediate family has received royalties from Innomed and Zimmer; has served as a paid consultant to or is an employee of Zimmer; has received research or institutional support from EBI; and has stock or stock options held in Zimmer. Neither Dr. Piasecki nor a member of his immediate family has received anything of value from or owns stock in a commercial company or institution related directly or indirectly to the subject of this article.

Dr. Piasecki is Attending Surgeon, Sports Medicine Division, OrthoCarolina, Charlotte, NC. Dr. Romeo is Section Head, Shoulder and Elbow, Division of Sports Medicine, and Professor of Orthopaedics, Rush University Medical Center, Chicago, IL. Dr. Bach is Claude N. Lambert, MD–Helen S. Thomson Professor of Orthopaedics and Director, Divison of Sports Medicine, Department of Orthopaedics, Rush University Medical Center. Dr. Nicholson is Associate Professor of Orthopaedics, Department of Orthopaedics, Rush University Medical Center

Reprint requests: Dr. Romeo, Division of Sports Medicine, Department of Orthopaedics, Rush University Medical Center, Suite 1063, 1725 West Harrison Street, Chicago, IL 60612.

Suprascapular neuropathy is a relatively uncommon but significant cause of shoulder pain and dysfunction. The suprascapular nerve follows a tortuous course from the neck to the posterior shoulder. There are several potential causes of nerve entrapment along this path, particularly at the vulnerable suprascapular and spinoglenoid notches, where nerve excursion is limited by bony and ligamentous constraints. Additional extrinsic compression may be caused by glenohumeral joint–related ganglion cysts or soft-tissue masses. Traction neuropathy may occur following excessive nerve excursion during overhead sports or as a result of massive, retracted rotator cuff tears in older patients. Diagnosis is based on a careful history, physical examination, focused imaging, and electrodiagnostic studies. In the absence of a clear structural compression or overtensioning of the nerve, treatment initially should be nonsurgical, with activity modification and physical therapy. Discrete nerve compression or failure of nonsurgical measures warrants early surgical intervention. Arthroscopic alternatives to the traditional open suprascapular and/or spinoglenoid notch decompressions have the benefit of simultaneously diagnosing and addressing intra-articular and/or subacromial pathology while minimizing morbidity. In most patients, both open and arthroscopic approaches provide reliable pain relief and improvements in function; return of strength and muscle bulk is less predictable.