Qué está sintiendo¶
La neuropatía suprascapular significa que el nervio encargado de inervar dos de los músculos del hombro se ha irritado o comprimido. El dolor suele localizarse en la parte posterior del hombro, cerca del borde externo del omóplato. Muchas personas lo describen como un dolor sordo que se extiende por todo el hombro, en lugar de un dolor agudo en un punto concreto.
Este dolor suele aparecer de forma gradual y se concentra en una zona: aproximadamente a un ancho de mano por encima y detrás de la articulación del hombro. Las actividades que implican movimientos por encima de la cabeza son un desencadenante frecuente; lanzar, servir o estirar el brazo para alcanzar algo en una repisa alta pueden provocar o empeorar los síntomas. Algunas personas también notan chasquidos, sensación de “traba” o bloqueo en el hombro junto con el dolor.
Si el nervio permanece irritado durante mucho tiempo, los músculos que inerva pueden atrofiarse. Es posible que note una zona hundida o aplanada en la parte posterior del hombro, por encima o por debajo de la espina del omóplato. Esto no ocurre en todas las personas y depende de cómo el nervio se ramifique hacia esos músculos en su cuerpo.
En la vida cotidiana, la debilidad y el dolor suelen manifestarse en tareas que requieren levantar o extender el brazo. Alcanzar un recipiente pesado en una repisa alta, colgar la ropa para secar o ponerse un suéter por la cabeza pueden resultar más difíciles que antes. Los deportes que implican movimientos por encima de la cabeza suelen ser lo primero que genera molestias.
El nervio puede comprimirse en uno de dos pasajes estrechos cercanos al omóplato; esta compresión es frecuente en personas que practican deportes con movimientos por encima de la cabeza. También puede estirarse debido a actividades repetitivas en esa posición, o irritarse tras una lesión. En ocasiones no existe ninguna causa evidente y el nervio simplemente deja de funcionar adecuadamente por sí solo.
Si algo de lo anterior le resulta familiar, merece la pena que le evalúen el hombro para determinar la causa exacta.
¿Qué está ocurriendo realmente?¶
El nervio supraescapular es una rama de una red nerviosa más grande que va desde el cuello hasta el hombro. Inerva dos músculos situados en la parte posterior del omóplato, encargados de elevar y rotar el brazo. En su trayecto, el nervio debe pasar por dos espacios estrechos cercanos al omóplato, como si fuera un cable que atraviesa ranuras muy ajustadas en el hueso.
En cada uno de esos espacios, una pequeña banda de tejido se extiende sobre el nervio; este discurre por debajo, mientras que un vaso sanguíneo lo hace por encima. Si el nervio se comprime en el primer espacio, se ven afectados ambos músculos del hombro; si la compresión ocurre en el segundo espacio, más adelante, solo se afecta uno de ellos. Además, un quiste lleno de líquido producido por una rotura en la membrana del hombro también puede ejercer presión sobre el nervio en cualquier punto de su trayecto.
La presión no es el único problema: el nervio también puede estirarse, lo cual sucede tras años de practicar deportes que requieren levantar los brazos por encima de la cabeza o cuando una gran rotura tendinosa en el hombro desplaza los tejidos. En algunas personas no hay compresión ni estiramiento alguno; simplemente el nervio se encuentra inflamado. Esto es importante porque muchas personas a quienes se creía que tenían un problema en uno de esos espacios estrechos, en realidad presentan signos de una irritación nerviosa más generalizada, lo cual modifica la forma de evaluar y tratar la afección.
Los síntomas descritos anteriormente son consecuencia directa de todo lo anterior. Cuando el nervio no puede transmitir adecuadamente sus señales, ambos músculos se debilitan y, con el tiempo, pueden atrofiarse. El dolor en la parte posterior del hombro se debe a la irritación del propio nervio.
Qué podemos hacer al respecto¶
El Dr. Kieran Hirpara, cirujano de extremidades superiores en el Mater Private Hospital Rockhampton, comienza con las opciones menos invasivas que se adapten a su condición. Por lo general, los pacientes son derivados a nuestra clínica por su médico de cabecera; si un fisioterapeuta le ha sugerido que nos consulte, igualmente necesitará una derivación de su médico de cabecera para poder acceder al reembolso de Medicare. En su primera visita, tomamos su historia clínica, examinamos su hombro y solicitamos estudios de imagen si son necesarios para confirmar la causa del problema.
El primer paso suele ser el reposo y un cambio en la forma en que utiliza el hombro. Reducir las actividades por encima de la cabeza disminuye la presión sobre el nervio. Los medicamentos antiinflamatorios pueden aliviar el dolor mientras el hombro se recupera. La fisioterapia tiene como objetivo mantener el movimiento normal del hombro y fortalecer los músculos que rodean la escápula. Su fisioterapeuta le guiará en ejercicios para estabilizar la escápula y fortalecer los músculos que la controlan. Por lo general, damos a este enfoque una oportunidad razonable antes de considerar otras opciones. Si el nervio está siendo comprimido por algo como un quiste, o si los músculos posteriores del hombro ya han comenzado a atrofiarse, mantenemos esta fase breve, no más de 3 meses, para evitar daños permanentes en los músculos.
Si estos pasos no logran aliviar el dolor o la debilidad, podría considerarse la cirugía. La operación se denomina descompresión nerviosa; consiste en liberar el nervio que está comprimido en uno de los espacios estrechos cercanos a la escápula. En la mayoría de los casos se realiza mediante cirugía laparoscópica, y cualquier otro problema interno del hombro puede ser evaluado y tratado al mismo tiempo.
Qué esperar¶
En la mayoría de las personas, esta afección no desaparece por sí sola si el nervio sigue comprimido. Si no hay nada que ejerza presión sobre el nervio, el primer paso es un tratamiento sin cirugía: fisioterapia, medicamentos antiinflamatorios y cambios en la forma de usar el hombro. Muchas personas se conforman con este enfoque. No obstante, si algún cuerpo extraño como un quiste está comprimiendo el nervio, o si el dolor y la debilidad siguen empeorando, generalmente se considera una cirugía para liberar el nervio.
La recuperación depende de cuánto tiempo haya estado irritado el nervio. Si los músculos no han sufrido atrofia, liberar el nervio suele aliviar el dolor y permitir que la función del hombro vuelva a la normalidad. Si los músculos ya se han atrofiado, es posible que esos cambios no se reviertan por completo, aunque la fuerza y la comodidad pueden mejorar. La cirugía mínimamente invasiva para liberar el nervio ha permitido aliviar el dolor, mejorar las respuestas musculares en las pruebas y restablecer la función del hombro en quienes se la realizaron. El pronóstico a largo plazo tras este tipo de cirugía parece favorable; además, la fisioterapia posterior ayuda a mantener el buen funcionamiento del hombro y a prevenir su debilidad.
Si también presenta un desgarro tendinoso importante en el hombro, la situación es distinta. Reparar el tendón a veces permite que el nervio se recupere por sí solo. No obstante, añadir una liberación nerviosa a dicha reparación no ha demostrado mejorar los resultados, y conlleva un pequeño riesgo de empeorar la función nerviosa en lugar de mejorarla. Su cirujano evaluará cuidadosamente este aspecto junto con usted.
Algunas advertencias importantes: el nervio discurre cerca de los vasos sanguíneos en las zonas estrechas donde se libera, y la hemorragia en esas áreas es un riesgo conocido que su cirujano procura evitar. En un número reducido de personas a quienes se liberó el nervio mediante una incisión abierta, fue necesaria una cirugía adicional años después. Por último, si el nervio parece normal en las pruebas previas a una cirugía de reparación tendinosa, liberarlo no aporta ningún beneficio.
Nada de lo anterior constituye una garantía respecto a sus resultados personales. Se trata de una descripción realista de lo que suele ocurrir, para que pueda planificar su trabajo, sus actividades deportivas y su vida cotidiana con expectativas claras.
Cuándo consultar a un especialista¶
Acuda a su médico de cabecera si experimenta dolor en la parte posterior del hombro que persiste durante más de unas pocas semanas, especialmente si practica deportes o realiza trabajos que requieren levantar los brazos por encima de la cabeza con frecuencia. Solicite una evaluación especializada si el dolor viene acompañado de debilidad al levantar o extender el brazo, o si nota que los músculos de la parte posterior del hombro parecen hundidos o aplanados. También pregunte si su hombro hace clics, se traba o se bloquea junto con el dolor, o si la zona situada a un ancho de mano por encima y detrás de la articulación resulta sensible al tacto. Estos signos indican que el nervio podría estar comprimido o irritado; cuanto antes se realice la evaluación, mayores serán las posibilidades de proteger esos músculos antes de que se atrofien.
En mayor profundidad¶
Esta sección profundiza más de lo necesario para que usted tome sus propias decisiones terapéuticas. La neuropatía suprascapular merece una lectura adicional, pues este mismo nervio desempeña dos funciones muy distintas: una como causa de dolor y debilidad en el hombro, y otra como objetivo para el alivio del dolor. La calidad de la evidencia científica en cada uno de estos dos casos es muy diferente.
La descompresión es eficaz, con una salvedad respecto a su atribución¶
En los puntos donde el nervio está comprimido, liberarlo resulta efectivo. En 730 pacientes, la descompresión del nervio supraescapular mejora significativamente los resultados reportados por los pacientes, es no inferior a procedimientos similares realizados sin descompresión, y se asocia con altas tasas de retorno a la práctica deportiva y tasas relativamente bajas de eventos adversos [1].
La frase clave aquí es “no inferior a procedimientos similares sin descompresión”. Con frecuencia, el nervio se libera durante una operación realizada por otro motivo, como una reparación del manguito rotador o la extirpación de un ganglio en el omóplato; por ello, resulta difícil atribuir la mejora exclusivamente a la descompresión en sí. Lo cierto es que esta ayuda, y no empeora el procedimiento que se realiza simultáneamente.
¿Por qué el nivel de compresión modifica el cuadro clínico?¶
El nervio atraviesa dos puntos estrechos al rodear el omóplato; el hecho de cuál de ellos se ve afectado determina el cuadro clínico.
La compresión en el surco supracoracoideo, situado más arriba, afecta tanto al músculo supraespinoso como al infraspinoso, provocando debilidad para levantar el brazo y para la rotación externa, además de dolor. La compresión en el surco espinoglenooideo, más abajo, afecta únicamente al músculo infraspinoso, generando debilidad en la rotación externa y atrofia visible en la zona hundida bajo la espina del omóplato; con frecuencia, este cuadro va acompañado de poco o ningún dolor.
El cuadro caracterizado por atrofia aislada es el que más se pasa por alto, ya que no produce mucho dolor. La causa más frecuente en ese nivel es un quiste ganglionar originado a partir de un desgarro del labrum; por ello, al observar este patrón clínico se debe buscar el quiste y el desgarro subyacente, pues tratar la causa resolverá el problema del nervio.
En cuanto a su uso como bloqueo analgésico, la evidencia disponible es más escasa de lo que su uso sugiere¶
Este mismo nervio se bloquea frecuentemente con anestésicos locales para tratar el dolor en el hombro, tanto después de cirugías como en casos crónicos. Tras analizar los efectos adversos en 4,142 pacientes, se concluyó que este bloqueo presenta un bajo riesgo de causar daños físicos. No obstante, los autores señalan heterogeneidad en la técnica de aplicación y evidencia de baja calidad, por lo que abogan por una evaluación y notificación más rigurosas de los posibles daños [2].
La afirmación de que “existe bajo riesgo de daños, aunque con evidencia de baja calidad” es específica y limitada. Confirma que este procedimiento es razonablemente seguro; sin embargo, no indica cuán eficaz es, y no debe interpretarse como tal.
La distinción que merece ser recordada¶
Existen dos entidades que comparten el mismo nombre y no deben confundirse. La neuropatía es un problema estructural en el que el nervio queda comprimido; a menudo se puede realizar una descompresión, y sus signos característicos son la atrofia muscular y la debilidad. El bloqueo nervioso, por su parte, es un tratamiento sintomático que interrumpe la transmisión del dolor desde la articulación, sin modificar en absoluto la estructura nerviosa.
La debilidad y la atrofia visible apuntan a la primera condición. El dolor por sí solo, sin estos signos, suele indicar otra patología; en ese caso, el bloqueo nervioso proporciona alivio del dolor, pero no confirma un diagnóstico.
Referencias¶
[1] Sandler AB, Wells ME, Tran C, Arakawa R, Klahs KJ, Scanaliato JP, et al. Altas tasas de retorno al deporte tras la descompresión del nervio supraescapular: una revisión sistemática. JSES Rev Rep Tech. 2024;4(4):654-61. https://doi.org/10.1016/j.xrrt.2024.05.007
[2] Annison DR, Smith N, Salt E, Noblet T, Rangan A, McDaid C. Daños físicos asociados a las intervenciones de bloqueo del nervio supraescapular: una revisión sistemática. Shoulder Elbow. 2024;17(3):236-53. https://doi.org/10.1177/17585732241255679
Evidence & references
This is the clinical evidence summary written for health professionals. It is technical, and it lists the research this page was built from. You do not need to read it to understand your treatment or to make a decision about it.
Overview¶
- The exact association and etiology of suprascapular neuropathy in patients with rotator cuff pathology remain unclear [1].
- Shoulder surgeons should consider electrophysiologic evaluation of patients with clinical or radiographic signs of suprascapular neuropathy [2].
- Shoulder surgeons should be cognizant of the parameters that constitute an abnormal electrophysiologic study for suprascapular neuropathy [2].
- Suprascapular neuropathy has been described with complete neurogenic fatty replacement in patients with intact rotator cuff tendons in the absence of traction or compression mechanisms [3].
- Preoperative suprascapular nerve injuries do not have a significant clinical impact [4].
- Preoperative suprascapular nerve injuries do not predispose to an acute postoperative lesion [4].
- In a young, active cohort, suprascapular neuropathy presented with one of two distinct primary presenting complaints: pain or weakness [5].
- Arthroscopic suprascapular nerve decompression for suprascapular neuropathy at the suprascapular and/or spinoglenoid notch in the absence of major concomitant glenohumeral pathology results in good functional outcomes [6].
- Arthroscopic suprascapular nerve decompression for suprascapular neuropathy at the suprascapular and/or spinoglenoid notch in the absence of major concomitant glenohumeral pathology results in significant improvements from before to after surgery [6].
- In the absence of a well-defined lesion producing mechanical compression of the suprascapular nerve, suprascapular neuropathy should be treated non-operatively [7].
- Initial treatment of isolated suprascapular neuropathy is typically nonoperative, consisting of physical therapy, nonsteroidal anti-inflammatory drugs, and activity modification [8].
- Open or arthroscopic operative intervention is warranted for isolated suprascapular neuropathy when there is extrinsic nerve compression or progressive pain and/or weakness [8].
- Decompression of the suprascapular nerve at the spinoglenoid notch did not lead to a better functional outcome compared to repair alone in patients with posterosuperior massive rotator cuff tears and suprascapular neuropathy [9].
- No recommendations regarding suprascapular nerve release in conjunction with rotator cuff repair can be made at this time [10].
- Further research is necessary to better delineate the indications for suprascapular nerve release in conjunction with rotator cuff repair [10].
- Combined arthroscopic release of the superior transverse scapular ligament and rotator cuff repair in patients with large/massive rotator cuff tears and suprascapular neuropathy did not produce statistically significant improved outcomes compared with repair of the rotator cuff alone [22].
Anatomy & Pathophysiology¶
Nerve Course and Entrapment Sites¶
- The suprascapular nerve courses from the upper trunk of the brachial plexus to its motor insertion on the supraspinatus and, more distally, the infraspinatus [13].
- The superior transverse scapular ligament arises from the medial base of the coracoid overlying the suprascapular notch [32].
- The suprascapular artery runs superior to the superior transverse scapular ligament, while the nerve runs deep to it [32].
- Entrapment of the suprascapular nerve at the suprascapular notch causes denervation of both the supraspinatus and the infraspinatus [32].
- The spinoglenoid ligament overlies the suprascapular nerve at the spinoglenoid notch [32].
- Entrapment, traction, or compression of the suprascapular nerve at the spinoglenoid notch causes denervation of the infraspinatus [32].
- Anatomical variations at the suprascapular notch, including abnormally oriented subscapularis muscle fibers, anterior coracoscapular ligament, and calcified superior transverse scapular ligament, are predisposing factors for suprascapular nerve entrapment [47].
- The distances from the posterolateral corner of the acromion to the suprascapular and spinoglenoid notches were approximately 43 and 32 mm, respectively, regardless of height and sex [46].
Etiology and Mechanisms¶
- Suprascapular nerve neuropathy occurs when the nerve is injured along its course from the upper trunk of the brachial plexus to its motor insertion on the supraspinatus and infraspinatus [13].
- Nerve injury can occur from either compression or traction [13].
- Cystic lesions arising from a labral or capsular tear can compress the nerve along its course over the scapula [13].
- Nerve traction is theorized to arise from chronic overhead athletics or due to a retracted rotator cuff tear [13].
- Suprascapular neuropathy with complete neurogenic fatty replacement has been described in patients with intact rotator cuff tendons in the absence of traction or compression mechanisms [3].
- A lipoma can cause suprascapular nerve entrapment [11].
- A large hematoma of the scapula can cause suprascapular nerve entrapment [16].
- Malpositioned superior screws from reverse shoulder arthroplasty can cause suprascapular nerve entrapment [28].
- Placement of the superior and posterior screws in the glenoid baseplate during reverse total shoulder arthroplasty risks injury to the suprascapular nerve [48].
Pathophysiology and Tissue Changes¶
- Suprascapular nerve injury is an underlying mechanism leading to compromise of the rotator cuff enthesis structure [12].
- Suprascapular nerve injury may cause severe fatty changes and inhibition of postoperative tendon healing in large rotator cuff tears [51].
- Decompression provides reliable pain relief, but recovery of shoulder function and restoration of atrophied muscle tissue may be incomplete [18].
Classification¶
- Suprascapular neuropathy can present secondary to various etiologies including entrapment or compression [13].
- Entrapment of the suprascapular nerve usually occurs at the suprascapular or spinoglenoid notch [19].
- Suprascapular nerve entrapment has been reported secondary to a lipoma [11].
- Varicose veins at the spinoglenoidal notch have been identified as an unusual cause of suprascapular nerve compression [19].
- Suprascapular neuropathy is associated with rotator cuff tendon tears and fatty degeneration [1].
- Chronic rotator cuff tendon tears and suprascapular neuropathy are both associated with fatty infiltration and muscle atrophy of the rotator cuff muscles, but the pattern of fatty infiltration is markedly different in the two situations [14].
- Suprascapular nerve injury can occur after reverse total shoulder arthroplasty, with correlation to screw out of vault penetration [4].
Clinical Presentation¶
- Suprascapular neuropathy is a potential source of shoulder pain and functional limitation [13].
- Suprascapular nerve entrapment syndrome was first described and correctly interpreted by André Thomas in 1936, predating the commonly credited work of Kopell and Thompson [21].
Investigations¶
- Shoulder surgeons should consider electrophysiologic evaluation for patients with clinical or radiographic signs of suprascapular neuropathy [2].
- High-resolution magnetic resonance imaging is recommended to evaluate complex cases of nerve entrapment [49].
- MRI-documented spontaneous resolution of a spinoglenoid notch cyst and associated suprascapular nerve palsy has been reported [52].
- Surgical treatment for a spinoglenoid notch cyst and associated suprascapular nerve palsy could be withheld if patients show signs of clinical recovery, provided they are followed closely [52].
- A complete history and physical, careful attention to auxiliary tests, and treatment of multiple diagnoses in the same shoulder avoids missed pathologic features and necessity for revision operations [11].
- The pattern of fatty infiltration is markedly different in patients with chronic rotator cuff tendon tears compared to those with suprascapular neuropathy [14].
- Chronic rotator cuff tendon tears and suprascapular neuropathy are both associated with fatty infiltration and muscle atrophy of the rotator cuff muscles [14].
- The axillary view taken with the arm in the functional position of elevation in the plane of the scapula is oriented so that both the spinoglenoid notch and the scapular neck are visible [24].
- Standardized plain films are almost always sufficient to garner the information needed for shoulder evaluation [24].
- The temptation to "overimage" should be resisted, obtaining only the scans or reconstructions that are necessary for the care of the patient [24].
- CT scans may offer a few degrees of increased precision in the measurement of glenoid version, but this precision does not improve the quality of the surgery or the clinical outcome [24].
- The purpose of imaging of the shoulder is to help establish the diagnosis, determine the severity of the pathoanatomy, assist in surgical planning, and enable the surgeon to illustrate the condition of the shoulder to the patient [24].
- At least two X-ray views should be obtained: an anteroposterior in the plane of the glenoid and an axillary projection with the arm in abduction to show the relationship of the humeral head to the glenoid [37].
- Magnetic resonance imaging is useful to identify osteonecrosis of the humeral head, or a bone tumour [37].
- Magnetic resonance imaging can identify labral tears and rotator cuff tears, although the accuracy for these is enhanced by combining the scan with arthrography [37].
- Computed tomography is helpful for planning fracture surgery and shoulder joint replacement [37].
- Ultrasound is a simple and accurate test for identifying rotator cuff tears and calcific tendinitis [37].
- Ultrasound can be useful in guiding injections or barbotage (aspirating calcific deposits in the rotator cuff) [37].
- Arthroscopy is useful for diagnosing and treating subacromial impingement, intra-articular lesions, detachment of the glenoid labrum and rotator cuff tears [37].
- The shoulder is a three-dimensional structure that cannot be represented by a single planar view [39].
- Critical relationships—such as the degree of centering of the humeral head—change with the position of the arm [39].
- Shoulder pathology may be found in a large number of different bones and soft tissues [39].
- Overlying and superimposed structures as well as metallic implants may complicate imaging the structures of interest [39].
- Surgeons need to develop a judicious approach to imaging that yields the information necessary to treat the patient while avoiding the tendency to "over-image" [39].
Treatment¶
Non-Operative¶
- Nonoperative treatment should include a period of rest and activity modification, and antiinflammatory medication followed by a supervised physical therapy program [41].
- The focus of physical therapy is to preserve the normal physiologic range of motion of the shoulder and strengthen the shoulder girdle [41].
- Physical therapy exercises include scapular stabilization, and resistive strength straining of the trapezius, rhomboids, and serratus musculature [41].
- When a space occupying lesion is present or there is visible atrophy of the infraspinatus, the course of nonoperative treatment should be minimal (maximum 3 months) to avoid irreversible damage to the infraspinatus [41].
Operative¶
- Open or arthroscopic operative intervention is warranted when there is extrinsic nerve compression or progressive pain and/or weakness [8].
- The primary indications for arthroscopic decompression of the suprascapular nerve and the spinoglenoid notch are a prolonged course of symptoms, most commonly a chronic ache in the posterolateral aspect of the shoulder, and a failed minimum 6 month course of nonoperative treatment [41].
- Arthroscopic SSN decompression for suprascapular neuropathy at the suprascapular and/or spinoglenoid notch in the absence of major concomitant glenohumeral pathology results in good functional outcomes with significant improvements from before to after surgery [6].
- Arthroscopic release of the suprascapular nerve can be performed safely and effectively, with all patients showing improvement in postoperative electromyographic findings and marked improvement in pain relief and function [44].
- Arthroscopic release of the suprascapular nerve and transverse ligament is a safe and effective treatment for competitive swimmers with suprascapular neuropathy, allowing return to sport with resolution of pain and improvement in function [45].
- Release of the spinoglenoid ligament with resultant suprascapular nerve decompression may result in relief of pain and a return of normal shoulder function [15].
- Decompression gives reliable pain relief, but recovery of shoulder function and restoration of atrophied muscle tissue may be incomplete [18].
- Combined arthroscopic release of the superior transverse scapular ligament and rotator cuff repair in patients with large/massive RCTs and suprascapular neuropathy did not produce statistically significant improved outcomes compared with repair of the rotator cuff alone [22].
- No recommendations regarding suprascapular nerve release in conjunction with rotator cuff repair can be made at this time, and further research is necessary to better delineate the indications in the future [10].
Postoperative Rehabilitation¶
- In cases of isolated suprascapular nerve palsy at the spinoglenoid notch, patients were placed in a simple sling with immediate initiation of pendulum exercises and passive range of motion [42].
- Patients were seen again at 1 week after surgery to assess strength and begin physical therapy, which consisted of passive range-of-motion and isometric exercises [42].
- If significant infraspinatus atrophy was present, electrical stimulation was used [42].
- Resistance and overhead exercises started at 4 to 8 weeks postoperatively in cases of isolated suprascapular nerve decompression at the spinoglenoid notch [42].
Complications¶
- Preoperative suprascapular nerve injuries do not have a significant clinical impact and do not predispose to an acute postoperative lesion [4].
Recovery¶
- Arthroscopic suprascapular nerve decompression for suprascapular neuropathy at the suprascapular and/or spinoglenoid notch in the absence of major concomitant glenohumeral pathology results in good functional outcomes with significant improvements from before to after surgery [6].
- Full recovery of shoulder function was achieved following treatment for suprascapular nerve entrapment caused by a large hematoma of the scapula [16].
Key Evidence¶
- [L3] The exact association and etiology of suprascapular neuropathy in patients with rotator cuff pathology remain unclear. [1] (10.1016/j.jse.2013.06.011)
- [L4] Shoulder surgeons should consider electrophysiologic evaluation of patients with clinical or radiographic signs of suprascapular neuropathy and be cognizant of the parameters that constitute an abnormal study. [2] (10.1016/j.jse.2010.10.039)
- [L4] This is the first description of suprascapular neuropathy with complete neurogenic fatty replacement in patients with intact rotator cuff tendons in the absence of traction or compression mechanisms. [3] (10.1016/j.arthro.2014.01.010)
- [L1] Preoperative suprascapular nerve injuries do not have a significant clinical impact and do not predispose to an acute postoperative lesion. [4] (10.1016/j.jse.2023.06.026)
- [L4] In this young, active cohort, suprascapular neuropathy presented with one of two distinct primary presenting complaints: pain or weakness. [5] (10.1177/2325967123s00003)
- [L4] Arthroscopic SSN decompression for suprascapular neuropathy at the suprascapular and/or spinoglenoid notch in the absence of major concomitant glenohumeral pathology results in good functional outcomes with significant improvements from before to after surgery. [6] (10.1016/j.arthro.2020.10.020)
- [L4] In the absence of a well-defined lesion producing mechanical compression of the suprascapular nerve, suprascapular neuropathy should be treated non-operatively. [7] (10.2106/00004623-199708000-00007)
- [L5] Initial treatment of isolated suprascapular neuropathy is typically nonoperative, consisting of physical therapy, nonsteroidal anti-inflammatory drugs, and activity modification; however, open or arthroscopic operative intervention is warranted when there is extrinsic nerve compression or progressive pain and/or weakness. [8] (10.2106/jbjs.i.01743)
- [L3] Decompression of the suprascapular nerve at the spinoglenoid notch did not lead to a better functional outcome compared to repair alone in patients with posterosuperior massive rotator cuff tears and suprascapular neuropathy. [9] (10.1186/s12891-021-04075-1)
- [L4] No recommendations regarding suprascapular nerve release in conjunction with rotator cuff repair can be made at this time, and further research is necessary to better delineate the indications in the future. [10] (10.1016/j.jse.2011.11.033)
- [L4] A complete history and physical, careful attention to auxiliary tests, and treatment of multiple diagnoses in the same shoulder avoids missed pathologic features and necessity for revision operations. [11] (10.1097/01.blo.0000063791.32430.59)
- [L5] This study identifies suprascapular nerve injury as an underlying mechanism leading to compromise of the rotator cuff enthesis structure. [12] (10.1016/j.jse.2019.12.028)
- [L5] [13] (10.5435/jaaos-d-19-00526)
- [L4] Chronic rotator cuff tendon tears and suprascapular neuropathy are both associated with fatty infiltration and muscle atrophy of the rotator cuff muscles, but the pattern of fatty infiltration is markedly different in the two situations. [14] (10.1016/j.jse.2013.01.028)
- [L4] Release of the spinoglenoid ligament with resultant suprascapular nerve decompression may result in relief of pain and a return of normal shoulder function. [15] (10.1177/03635465990270062101)
- [Case_report] Full recovery of shoulder function was achieved. [16] (10.1186/s12891-023-06723-0)
- [L5] Decompression gives reliable pain relief, but recovery of shoulder function and restoration of atrophied muscle tissue may be incomplete. [18] (10.5435/00124635-199911000-00002)
- [L4] Entrapment of the suprascapular nerve usually occurs at the suprascapular or spinoglenoid notch. [19] (10.1016/j.jse.2011.05.022)
- [L4] Suprascapular nerve entrapment syndrome was first described and correctly interpreted by André Thomas in 1936, predating the commonly credited work of Kopell and Thompson. [21] (10.2106/00004623-200108000-00018)
- [L1] Combined arthroscopic release of the superior transverse scapular ligament and rotator cuff repair in patients with large/massive RCTs and suprascapular neuropathy did not produce statistically significant improved outcomes compared with repair of the rotator cuff alone. [22] (10.1177/03635465211021834)
- [Case_report] This case is the first report of malpositioned superior screw from reverse shoulder arthroplasty causing suprascapular nerve entrapment. [28] (10.1016/j.jse.2009.10.004)
- [L4] [41] (10.1016/j.xrrt.2021.04.004)
- [L4] [42] (10.1016/j.jse.2013.03.009)
- [L4] Arthroscopic release of the suprascapular nerve can be performed safely and effectively, with all patients showing improvement in postoperative electromyographic findings and marked improvement in pain relief and function. [44] (10.1016/j.arthro.2006.10.003)
- [L4] Arthroscopic release of the suprascapular nerve and transverse ligament is a safe and effective treatment for competitive swimmers with suprascapular neuropathy, allowing return to sport with resolution of pain and improvement in function. [45] (10.1177/0363546513477383)
- [L4] Regardless of height and sex, the distances from the posterolateral corner of the acromion to the suprascapular and spinoglenoid notches were approximately 43 and 32 mm, respectively. [46] (10.1016/j.jseint.2022.04.002)
- [L4] Anatomical variations at the suprascapular notch, including abnormally oriented subscapularis muscle fibers, anterior coracoscapular ligament, and calcified superior transverse scapular ligament, are predisposing factors for suprascapular nerve entrapment. [47] (10.1007/s00167-003-0378-3)
- [L5] Placement of the superior and posterior screws in the glenoid baseplate during rTSA risks injury to the SSN. [48] (10.1016/j.jse.2020.07.008)
- [L5] They recommend high-resolution magnetic resonance imaging to evaluate complex cases of nerve entrapment. [49] (10.1007/s11552-014-9652-8)
- [L5] In clinical settings, SN injury may cause severe fatty changes and inhibition of postoperative tendon healing in large RCTs. [51] (10.5397/cise.2022.01207)
- [Case_report] The authors report the first MRI-documented spontaneous resolution of a spinoglenoid notch cyst and associated suprascapular nerve palsy, proposing that surgical treatment could be withheld if patients show signs of clinical recovery, provided they are followed closely. [52] (10.1016/j.jse.2006.06.014)
References¶
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