Suprascapular nerve entrapment: experience with 28 cases

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✓ Suprascapular nerve entrapment (SNE) in the suprascapular notch is a rare entity that must be considered in the differential diagnosis of radicular pain, as well as that of shoulder discomfort.

Over a period of 10 years (1985–1995), the authors treated 28 cases of SNE in 27 patients by surgical decompression of the nerve. One patient underwent operation bilaterally within 5 years. Five patients presented with a history of trauma to the shoulder region. In three patients, a ganglion cyst was the origin of the nerve lesion. In 16 patients, the nerve problem was primarily related to athletic activities. Eight of these patients were professional volleyball players. In the remaining three patients, there was no relationship between the nerve lesion and trauma or athletic activities.

Twenty-one patients (22 cases) complained of pain located over the suprascapular notch. Seventeen patients had paresis and atrophy of both the supraspinatus (SS) and infraspinatus (IS) muscles. In 10 patients only the IS muscle was involved. One patient exhibited a sensory deficit over the posterior portion of the shoulder. Electromyography was performed in all cases.

The mean follow-up period in the 25 cases (24 patients) that could be evaluated was 20.8 months (range 3–70 months). Nineteen of 22 cases with preoperative pain could be evaluated. Sixteen of these patients were completely free of pain after surgery and three patients found their pain had improved. Motor function in the SS muscle improved in 86.7% and motor function in the IS muscle in 70.8% of cases. Atrophy of the SS muscle resolved in 80.7% and atrophy of the IS muscle in 50% of cases.

Surgical treatment of SNE is indicated after failed conservative treatment and in cases of atrophy of the SS and IS muscles. The authors recommend the posterior approach, which minimizes risks and complications and produces good postoperative results.

Article Information

Address reprint requests to: Gregor Antoniadis, M.D., Department of Neurosurgery, University of Ulm, Ludwig-Heilmeyer-Straβe 2, 89312 Guenzburg, Germany.

© AANS, except where prohibited by US copyright law.

Headings

Figures

  • View in gallery

    Photograph showing the back of a patient with atrophy of the right supraspinatus (small arrow) and infraspinatus (large arrow) muscles.

  • View in gallery

    Photograph showing a patient placed prone for the posterior approach. A skin incision (arrow) is made above the spine of the scapula (SSC). C = clavicle; SC = scapula.

  • View in gallery

    Intraoperative photograph displaying the right suprascapular nerve (N) after the superior transverse scapular ligament (L) has been transected. D = distal portion of nerve; P = proximal portion of nerve.

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