Suprascapular nerve is a mixed (sensory and motor) nerve that arises from the upper trunk of the brachial plexus. The nerve travels through the suprascapular notch beneath the superior transverse scapular ligament (STSL) of the shoulder and supplies the supraspinatus and infraspinatus muscles.Both the muscles are part of a group of muscles called the “rotator cuff”. The primary function of these muscles is to help arm movements at the shoulder joint.
Any injury or trauma to the suprascapular nerve results in suprascapular neuropathy.
Suprascapular Neuropathy is a condition of shoulder pain associated with weakness.It is a common problem in overhead athletes who perform repetitive overhead motions or throwingsuch as swimming, volley ball, tennis, and weightlifting.
Signs and symptoms
- Shoulder pain and weakness
- Atrophy (shrinkage) of upper shoulder muscles
- Heaviness of shoulder and arm
- Radiating pain to the neck, back or arm
- Discomfort in shoulder and upper back
- Entrapmentof the nerve at the suprascapular and spinoglenoid notch
- Sometimes, an underlying ganglion cystmay exert pressure on the nerve
- Nerve compression due to traction injuryof the nerve from blunt trauma, broken scapula bones, and a rotator cuff tear
- Repetitivestretching of the nerve
- Rarely, virus infection or vaccine administration
The diagnosis of suprascapular neuropathy is based on medical history and physical examination. Your doctor may order a few tests to rule out other causes of shoulder pain. These include
- Electrodiagnostic tests such as EMG (Electromyogram)and NCS (Nerve Conduction Studies) to evaluate the nerve and muscle functions
- MRI scansdemonstrate the size and location of the ganglion cyst and detect muscle atrophy
- Activity modification: Avoid triggering activities that precipitate the symptoms
- Your doctor may prescribe medications to help reduce pain and inflammation
- Physical therapy exercises to improve the shoulder strength and range of motion
- Arthroscopic decompression of the suprascapular nerve is a surgical procedure in which the compressed nerve is released to relieve pain
Suprascapular Nerve Decompression can be performed surgically with an arthroscopic technique under general anesthesia.
Arthroscope is a small fiber-optic viewing instrument made up of a tiny lens, light source and a video camera. The camera attached to the arthroscope displays the image of the joint on a monitor, allowing the surgeon to view the nerve and ligament.
The approach for surgery is from the front (anterior) aspect of the shoulder. The surgeon makes small incisions on the top of the shoulder. In one incision, the arthroscope is introduced to view the suprascapular nerve, artery and STSL. Other portal is used for the insertion of surgical instruments. The surgeon dissects the nerve and artery from the STSL. The ligament is sectioned and the nerve is decompressed.
The benefits of arthroscopy are smaller incisions, faster healing, a more rapid recovery, shorter rehabilitation period, and less scarring. It is often performed on an outpatient basis and the patient is able to return home on the same day.
It is much less traumatic to the muscles, ligaments and tissues than the traditional method of surgically opening the shoulder with long incisions (open techniques).
After the surgery
Following the surgery, your surgeon may recommend you follow certain measures for a successful outcome:
- Your doctor will prescribe medications to relieve pain
- Appling ice-packs wrapped in a towel over the operated area for about 20 minutes, 3-4 times a day helps reduce post-operative swelling
- You will have to wear a shoulder sling for 2-3 weeks following surgery
- Keep a pillow under the operated arm while sleeping to support the shoulder
- Your surgeon will develop a rehabilitation program after surgery to improve the shoulder strength and range of motion
- Return to normal activities once you feel comfortable and a follow-up appointment should be scheduled 8-10 days after surgery to examine your progress
Complications of surgery include infection, bleeding, damage to nerve or blood vessel or delayed healing.