eMedicine Specialties > Sports Medicine > Neurological

Suprascapular Neuropathy: Differential Diagnoses & Workup

Author: Jonathan C Reeser, MD, PhD, Department of Physical Medicine and Rehabilitation, Marshfield Clinic
Contributor Information and Disclosures

Updated: Apr 16, 2008

Differential Diagnoses

Cervical Disc Injuries
Cervical Radiculopathy
Rotator Cuff Injury
Shoulder Impingement Syndrome
Superior Labrum Lesions

Other Problems to Be Considered

Adhesive Capsulitis
Axillary neuropathy
Degenerative arthritis of the acromioclavicular or glenohumeral joints
Ganglion or cyst from the glenohumeral joint (which may compress the suprascapular nerve)
Idiopathic upper trunk brachial plexopathy (ie, Parsonage-Turner syndrome)
Stinger injury (ie, neurapraxic injury of the C6 nerve root or upper trunk of the brachial plexus)
Stress fractures of the first ribs or scapula
Subacromial bursitis
Tumors (including Pancoast tumor)

Workup

Imaging Studies

  • In infraspinatus syndrome, conventional radiographic findings in the shoulder girdle are typically unremarkable in the absence of bony trauma that may account for the condition (eg, fractured clavicle).
  • Conventional radiography of the cervical spine is warranted if concern exists about a possible radicular etiology for the patient’s symptoms.
  • Shoulder magnetic resonance imaging (MRI) may reveal supraspinatus or infraspinatus muscle edema in acute cases and atrophy with fatty replacement in more chronic cases.
  • MRI may also reveal a ganglion cyst or other mass with resultant suprascapular nerve compression.27,39,40
  • Ultrasonography is a reasonable, less expensive initial imaging option that can be used to screen for parascapular ganglia or masses.38

Other Tests

  • The clinical diagnosis may be confirmed with electrodiagnostic testing.
  • The normal distal motor latencies to the supraspinatus muscles during stimulation at the Erb point are 2.7 msec ± 0.5 and and to the infraspinatus muscles, 3.3 msec ± 0.5.
  • Side-to-side differences greater than 0.4 msec suggest focal entrapment of the SSN or other neural injury.
  • Electromyography may reveal the following:
    • Evidence of denervation, such as positive sharp waves and fibrillation potentials
    • Motor unit recruitment abnormalities, such as motor unit dropout in acute cases and polyphasic motor unit action potentials in cases of long-term neuropathy. (This latter finding suggests a degree of reinnervation.)
    • The physical examination and electrodiagnostic test results should enable the clinician to rule out underlying cervical radiculopathy, brachial plexopathy, or axillary neuropathy and to localize the site of SSN impairment (see Differentials and Other Problems to Be Considered).

Related eMedicine topics:
Electrophysiology
Motor Unit Recruitment in EMG

More on Suprascapular Neuropathy

Overview: Suprascapular Neuropathy
Differential Diagnoses & Workup: Suprascapular Neuropathy
Treatment & Medication: Suprascapular Neuropathy
Follow-up: Suprascapular Neuropathy
Multimedia: Suprascapular Neuropathy
References
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Further Reading

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Keywords

volleyball shoulder, suprascapular neuropathy, shoulder pain, infraspinatus muscle, rotator cuff tendinopathy, suprascapular nerve, infraspinatus syndrome

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Contributor Information and Disclosures

Author

Jonathan C Reeser, MD, PhD, Department of Physical Medicine and Rehabilitation, Marshfield Clinic
Jonathan C Reeser, MD, PhD is a member of the following medical societies: Alpha Omega Alpha, American Association of Neuromuscular and Electrodiagnostic Medicine, American College of Sports Medicine, American Medical Association, Association of Academic Physiatrists, Phi Beta Kappa, Physiatric Association of Spine, Sports and Occupational Rehabilitation, and State Medical Society of Wisconsin
Disclosure: Nothing to disclose.

Medical Editor

Leslie Milne, MD, Assistant Clinical Instructor, Department of Emergency Medicine, Harvard University School of Medicine
Leslie Milne, MD is a member of the following medical societies: American College of Sports Medicine
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

CME Editor

Jon B Whitehurst, MD, Clinical Instructor of Surgery, University of Illinois College of Medicine; Partner and Executive Board Member, Rockford Orthopedic Associates; Orthopedic Chairman, Rockford Memorial Hospital
Jon B Whitehurst, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Orthopaedic Society for Sports Medicine, and Arthroscopy Association of North America
Disclosure: Nothing to disclose.

Chief Editor

Sherwin SW Ho, MD, Associate Professor, Department of Surgery, Section of Orthopedic Surgery and Rehabilitation Medicine, University of Chicago
Sherwin SW Ho, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Orthopaedic Society for Sports Medicine, and Arthroscopy Association of North America
Disclosure: Nothing to disclose.

 
 
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