Suprascapular Neuropathy Treatment & Management

  • Author: Jonathan C Reeser, MD, PhD; Chief Editor: Sherwin SW Ho, MD   more...
 
Updated: Nov 28, 2011
 

Acute Phase

Rehabilitation Program

Physical Therapy

The treatment for infraspinatus syndrome depends on the cause, severity, and duration of the symptoms; degree of functional disability; and patient preference. In the absence of specific compressive lesions, conservative initial treatment for infraspinatus syndrome is recommended. The natural history of idiopathic suprascapular neuropathy is typically favorable, and most cases respond to conservative care within 6 months.

In athletes without pain or limitations in the performance of sport-specific skills, a simple program of exercises for scapular stabilization and rotator cuff strengthening is probably reasonable. Such a program should prevent not only progression of the condition, but also secondary impingement of the rotator cuff.

A similar program is recommended in symptomatic athletes; however, activity modification to limit symptoms during the acute phase is warranted. The athlete should then progress through a series of functionally oriented exercises designed to restore flexibility and proprioception, scapular control, and balanced rotator cuff strength and endurance. This program should culminate in the resumption of sport-specific skills.

The use of passive modalities (eg, superficial or deep heat application, iontophoresis) and/or injection procedures for pain relief (see Other Treatment) may help symptomatic athletes make the transition to such exercise programs.

Surgical Intervention

Should conservative care fail to resolve the symptoms and allow the athlete to return to the sport activity, surgical intervention may be therapeutic. A degree of controversy exists in the literature because some authors believe that early surgical intervention is the treatment of choice.

Described surgical treatment procedures for suprascapular neuropathy unrelated to a space-occupying lesion include simple widening of the spinoglenoid notch or suprascapular notch, depending on the site of nerve injury. In one retrospective review of 3 cases of idiopathic infraspinatus syndrome refractory to conservative care, subsequent surgery was beneficial in 2 cases.

Some authors argue that documented compressive lesions of the SSN (eg, ganglia) should be promptly resected because of the high failure rate of nonsurgical care in this situation. Any accompanying labral pathology can be simultaneously repaired, if indicated. Both open and arthroscopic procedures have been described.

In general, surgical outcomes reported in the literature are good. Patients in whom the condition is diagnosed promptly and treated with early surgical decompression seem to have a better likelihood of regaining full muscular strength and bulk.[43] The patient should participate in a postoperative program of rehabilitation and/or functional restoration to ensure the return of balanced strength and flexibility.

Other Treatment

In addition to the approaches discussed above (see Physical therapy and Surgical intervention), other nonsurgical treatment options include SSN blocks.[44, 45, 46] Because such blocks have been used to manage perioperative shoulder pain and adhesive capsulitis in addition to other painful shoulder conditions, the diagnostic utility and specificity of such blocks is debatable. Nevertheless, blocks may provide symptomatic relief, thereby permitting the patient to more fully participate in a rehabilitation program.

The injection of an anesthetic and/or corticosteroid admixture into the suprascapular notch may provide temporary benefit. In select cases, radiofrequency SSN ablative procedures may provide longer symptomatic relief. Several injection approaches to minimize the inherent risk of pneumothorax are described. However, such interventions are purely palliative, and they do not alter or address the underlying mechanism of suprascapular neuropathy.

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Recovery Phase

Rehabilitation Program

Physical Therapy

The goal of the recovery phase of a rehabilitation program is to maintain active range of motion in the shoulder girdle while helping the athlete progress through a strengthening program designed to improve scapular stabilization and strengthen the rotator cuff. Interventions include concentric and eccentric isotonic exercises that emphasize sport-specific movement patterns. Eventually, the patient can progress to upper limb plyometric exercises.

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Maintenance Phase

Rehabilitation Program

Physical Therapy

On the basis of reports in the available literature, nonsurgical care should result in a satisfactory outcome in most idiopathic cases within 6-8 months. Most reports indicate that patients who are treated conservatively are generally able to resume their previous level of function, including high-level sports participation.

Longitudinal follow-up findings suggest that muscular atrophy is generally not reversible to a significant extent, although symptoms of pain may improve with time. The athlete may return to play when he or she is able to perform appropriate skills without provoking symptoms.

Ideally, the rehabilitation program should extend beyond the mere resolution of symptoms to address the other facets of Kibler's "vicious cycle." This program should include an analysis of the athlete's technique to determine if any flaws or compensatory biomechanical changes need to be corrected to minimize the risk of recurrent injury or overload of other soft tissues further down the kinetic chain. (A formal discussion of the vicious cycle is beyond the scope of this article. For further information, the reader is referred to Kibler WB, Herring SA, Press JM, Lee PA, eds. Functional Rehabilitation of Sports and Musculoskeletal Injuries. Gaithersburg, Md: Aspen Publishers; 1998.[3] )

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Contributor Information and Disclosures
Author

Jonathan C Reeser, MD, PhD  Office of Research Integrity and Protections, Marshfield Clinic Research Foundation

Jonathan C Reeser, MD, PhD is a member of the following medical societies: Alpha Omega Alpha, American College of Sports Medicine, American Medical Association, Association of Academic Physiatrists, Phi Beta Kappa, and State Medical Society of Wisconsin

Disclosure: Nothing to disclose.

Specialty Editor Board

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.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Jon B Whitehurst, MD  Clinical Instructor of Surgery, University of Illinois College of Medicine; Partner, 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 Division of the Biological Sciences, The Pritzker School of Medicine

Sherwin SW Ho, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Orthopaedic Society for Sports Medicine, Arthroscopy Association of North America, and Herodicus Society

Disclosure: Breg, Inc. Consulting fee Consulting; Biomet, Inc. Consulting fee Consulting; GMV, Inc. Arthroscopy Simulator Evaluation and teaching; Smith and Nephew Grant/research funds Fellowship funding; DJ Ortho Grant/research funds Course funding; Athletico Physical Therapy Grant/research funds Course, research funding

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Clinically relevant anatomy of the subscapular nerve (SSN) and the structures it innervates. The SSN is vulnerable to entrapment at the superior scapular notch and the spinoglenoid notch, beneath the inferior transverse scapular ligament. The inset depicts the clinical appearance in an individual with predominantly right-sided atrophy of the infraspinatus muscle due to suprascapular neuropathy.
 
 
 
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