Suprascapular Nerve Entrapment

Description

Suprascapular nerve entrapment is an uncommon nerve condition in the shoulder that can cause 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 through a groove in the shoulder blade (scapula), under a ligament, then under the supraspinatus muscle on the top of the shoulder, which it supplies, and then under another ligament; it then divides and supplies the infraspinatus muscle in the back of the shoulder. The nerve may be injured before it supplies the supraspinatus muscle, causing weakness of both the supraspinatus and infraspinatus, or after it supplies the supraspinatus, causing weakness of only the infraspinatus. As part of the rotator cuff, these muscles are important in stabilizing the shoulder and assisting in raising and rotating the shoulder and arm.

Common signs and symptoms

• Pain and discomfort, a burning or dull ache that is poorly localized, 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 by raising the arm overhead

• Weakness when raising the arm to the side or overhead or when rotating the shoulder outward

• Tenderness in the top or back of the shoulder

• Atrophy (shrinkage) of the supraspinatus or infraspinatus muscles

Causes

• Pressure on the supraspinatus nerve at the top or back of the shoulder, often by a cyst in 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 stretching injury to the nerve

Factors that increase risk

• Contact sports

• Sports that require repetitive overhead activity, such as baseball, volleyball, and tennis

• Poor physical conditioning (strength, flexibility)

Preventive measures

• Appropriately warm up and stretch before practice and competition.

• Maintain appropriate conditioning that includes shoulder flexibility, muscle strength, and endurance training.

Expected outcome

Suprascapular nerve entrapment usually resolves spontaneously. Sometimes, however, surgery is necessary, especially when one or more muscles are atrophied.

Possible complications

• Permanent weakness of the shoulder, particularly when rotating the arm outward and lifting the arm

• An inability to throw

• Persistent pain in the shoulder

• Increasing weakness of the extremity

• Disability and inability to compete

General treatment considerations

Initial treatment consists of rest from activities that cause symptoms and nonsteroidal antiinflammatory medications to help reduce inflammation and pain. Stretching exercises for the shoulder muscles are useful, and referral to physical therapy or an athletic trainer may be recommended for further treatment, which may include ultrasound and other modalities. After 3 to 6 months of failed conservative treatment, 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 correcting damage within the shoulder joint that may be the cause of the cyst. If muscle atrophy is significant, surgery may be recommended sooner. When surgery is necessary, it provides almost complete relief in most patients who undergo this operation, although the atrophy may not be reversible.

Medication

• Nonsteroidal antiinflammatory medications, such as aspirin and ibuprofen (do not take for 7 days before surgery), or other minor pain relievers, such as acetaminophen, are often recommended. Take these as directed by your physician, and contact your doctor immediately if any bleeding, stomach upset, or signs of an allergic reaction occur.

• Stronger pain relievers may be prescribed for you, but usually only after surgery. Use these only as directed, and take only as much as you need.

Figure 1

From Medich GF: Little league elbow. Sports Med Update 1989:4, 17.

Heat and cold

• Cold is used to relieve pain and reduce inflammation for acute and chronic cases. It should be applied for 10 to 15 minutes every 2 to 3 hours as needed and immediately after any activity that aggravates your symptoms. Use ice packs or an ice massage.

• Heat may be used before performing stretching and strengthening activities prescribed by your physician, physical therapist, or athletic trainer. Use a heat pack or a warm soak.

When to call your doctor

• Symptoms get worse or do not improve in 4 to 8 weeks despite treatment.

• New, unexplained symptoms develop. Drugs used in treatment may produce side effects.

Range of Motion and Stretching Exercises

Suprascapular Nerve Entrapment

These are some of the initial exercises you may use to start your rehabilitation program, until you see your physician, physical therapist, or athletic trainer again, or until your symptoms resolve. Please remember:

• Flexible tissue is more tolerant of the stresses placed on it.

• A gentle stretching sensation should be felt.

Range of motion scapular elevation, shrugs

1. Stand in a good, erect posture with your arms at your sides.

2. Gently shrug your shoulders up and back toward your ears.

3. Hold this position for ____ seconds, and slowly return to the starting position.

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