Suprascapular nerve syndrome is a neuropathy that most commonly results from compression/entrapment of the suprascapular nerve at its course through the suprascapular notch or from microtrauma due to traction. Its direct cause is shoulder pain and muscle weakness.
It is a relatively rare condition, with the most common etiology being compression caused by the development of a cyst, such as from damage to the joint lining, an enlarged transverse ligament, or compression of surrounding soft tissues resulting from damage to the rotator cuff tendons—either traumatic or from the presence of a vascular malformation. Microtrauma resulting from continuous overloading and generating an inflammatory state, such as in volleyball players, swimmers, or tennis players, is also a cause.
Symptoms of suprascapular nerve syndrome
Most commonly, patients present with weakness in the muscles of the shoulder joint, as well as pain and sensory disturbances in the posterior-lateral surface of the shoulder. Over time, atrophy of the supraspinatus and infraspinatus muscles occurs.
The standard diagnostic test for this condition is electromyography (EMG), which can determine the location of nerve damage. Additionally, magnetic resonance imaging (MRI) is performed to visualize the suprascapular nerve and any pathologies that may result from damage to surrounding soft tissues or the presence of compressive masses. MRI can also determine the extent of atrophy in the supraspinatus and infraspinatus muscles.
Treatment of suprascapular nerve syndrome
There are various treatment methods for suprascapular nerve syndrome:
- Conservative: The preferred treatment for conditions resulting from chronic inflammation and overuse. It involves lifestyle modifications, avoiding activities that require overhead motion. Rehabilitation is recommended, focusing on strengthening the shoulder girdle muscles and controlling scapular movement. Pain relief and anti-inflammatory medications are also used. Local injections of local anesthetics and anti-inflammatory steroids may be administered.
- Surgical: Indicated when there is no improvement with conservative treatment or an increased risk of worsening symptoms and muscular dysfunction with the continuation of the disease. The most common surgical treatment is arthroscopic decompression, which involves addressing intra-articular lesions causing secondary compression of the suprascapular nerve. These lesions may include reinsertion of the rotator cuff tendons or stabilization of the joint capsule. Another surgical approach is direct decompression, which involves arthroscopic visualization of the suprascapular nerve and its release, along with the removal of any tissues causing compression, such as cysts or ganglions.
In the case of direct decompression, postoperative immobilization in a splint for approximately one week is recommended, and rehabilitation can begin a few days after the procedure.
If the cause of the syndrome was damage to the rotator cuff or joint capsule, postoperative management is tailored to the type of stabilization used.
In MIRAI, the shoulder area is handled by:
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