What is suprascapular nerve entrapment?
Suprascapular nerve entrapment is an uncommon nerve condition in the shoulder, causing pain and weakness. It involves compression of the suprascapular nerve at the top or back of the shoulder, usually caused by a ligament, a cyst from the shoulder or excessive stretching. The suprascapular nerve passes in a groove in the shoulder blade (scapula), under a ligament, under the supraspinatus muscle (which it supplies) on the top of the shoulder, and then under another ligament before it divides and supplies the infraspinatus muscle in the back of the shoulder. The nerve may be injured before it supplies the supraspinatus muscle (thus causing weakness of both the supraspinatus and infraspinatus) or after it supplies the supraspinatus (causing weakness of only the infraspinatus). These muscles, which are part of the rotator cuff, are important in stabilizing the shoulder and assisting in raising and rotating the shoulder and arm.
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How does suprascapular nerve entrapment occur?
- Pressure on the supraspinatus nerve at the top or back of the shoulder, often by a cyst from the shoulder joint
- Pressure on the supraspinatus nerve at the top or back of the shoulder by one of two ligaments of the shoulder blade that the nerve passes beneath
- Repetitive stretch injury to the nerve
What increases the risk?
- Contact sports
- Sports that require repetitive overhead activity, such as baseball, volleyball or tennis
- Poor physical conditioning (strength and flexibility)
What are the symptoms of suprascapular nerve entrapment?
- Pain and discomfort (burning or dull ache) that is poorly localized (not confined to one location), often in the top or back of the shoulder
- Heaviness or fatigue of the shoulder and arm
- Pain that may be made worse by exercise or raising the arm over head
- Weakness raising the arm to the side or overhead or rotating the shoulder outward
- Tenderness in the top or back of the shoulder
- Atrophy (shrinkage) of the supraspinatus or infraspinatus muscle
How is suprascapular nerve entrapment treated?
Non-operative treatment: Initial treatment consists of rest from the offending activity and nonsteroidal anti-inflammatory medications to help reduce inflammation and pain. Stretching exercises of the shoulder muscles are useful. Referral to physical therapy or an athletic trainer may be recommended for further treatment, including ultrasound and other modalities.
Operative treatment: If three to six months of conservative treatment is not successful, surgery may be necessary to free the pinched nerve by cutting the ligaments where the nerve is being pinched. Surgery is also indicated to relieve pressure from the cyst either by removing the cyst or by removing damage within the shoulder joint that may be the cause of the cyst. Surgery may be recommended sooner if there is significant atrophy of the muscles. When surgery is necessary, it provides almost complete relief in most patients who undergo this operation, although the muscle atrophy may not be reversible.
What are the complications of treatment?
Possible complications of operative treatment include:
- Surgical complications not specifically associated with shoulder repair/reconstruction, such as pain, bleeding (uncommon), infection (<1percent), nerve injury (uncommon), stiffness, problems with anesthesia, and inability to return to previous level of pre-injury activity.
When can you return to your sport/activity?
This condition usually resolves spontaneously. Sometimes, however, surgery is necessary, especially when one or more muscles are atrophied (wasting or shrinkage).
How can suprascapular nerve entrapment be prevented?
- Appropriately warm up and stretch before practice or competition
- Maintain appropriate conditioning:
- Shoulder flexibility
- Muscle strength and endurance