Imaging Studies

When suprascapular neuropathy is suspected, radiography should be performed. In addition to standard views, suprascapular notch and Stryker views can be ordered.^{[27, 28]}In suprascapular neuropathy, 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 MRI may reveal supraspinatus or infraspinatus muscle edema in acute cases and atrophy with fatty replacement in more chronic cases.^[43]

MRI may also reveal a ganglion cyst or other mass such as a paralabral cyst with resultant suprascapular nerve compression.^{[29, 44, 45]}

3T magnetic resonance neurography has been shown to be a valuable diagnostic tool in clinically suspected suprascapular neuropathy. It can demonstrate the nerve abnormality and any secondary muscle denervation changes.^{[46, 47]}

Ultrasonography is a reasonable, less expensive initial imaging option.^[43]The suprascapular nerve can be identified under ultrasound, and can be used to screen for parascapular ganglia or masses.^[41]Spinoglenoid notch cysts can be identified with ultrasound, particularly in a lean athletic population.^[42]

Other Tests

The clinical diagnosis may be confirmed with electrodiagnostic testing and has been the criterion standard for diagnosis of suprascapular neuropathy. Electromyography and nerve conduction velocity tests have from 70% to more than 90% sensitivity in detecting muscle fiber denervation.^{[32, 48]}

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).

Treatment & Management

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Media Gallery

Clinically relevant anatomy of the suprascapular 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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Author

Thomas H Trojian, MD Professor of Family Medicine, Sports Medicine Fellowship Director, Department of Family Medicine, Associate Chief, Division of Sports Medicine, Drexel University College of Medicine; Lead Team Physician, Drexel Athletics

Thomas H Trojian, MD is a member of the following medical societies: American Academy of Family Physicians, American College of Sports Medicine, American Medical Society for Sports Medicine, Society of Teachers of Family Medicine

Disclosure: Nothing to disclose.

Coauthor(s)

Matthew L Hall, DO Fellow in Primary Care Sports Medicine, St Francis Hospital/UConn Health Center, University of Connecticut School of Medicine

Matthew L Hall, DO is a member of the following medical societies: American Academy of Family Physicians, American College of Sports Medicine, American Medical Society for Sports Medicine, American Osteopathic Association

Disclosure: Nothing to disclose.

Giselle Aerni, MD Assistant Director, Sports Medicine Fellowship Program, Associate Director, Family Medicine Residency Program, York Hospital; Head Team Physician, Spring Grove Area High School; Team Physician, Gettysburg College; Head Team Physician, SkipJacks Hockey

Giselle Aerni, MD is a member of the following medical societies: American College of Sports Medicine, American Medical Society for Sports Medicine

Disclosure: Nothing to disclose.

Specialty Editor Board

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

Disclosure: Received salary from Medscape for employment. for: Medscape.

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, Arthroscopy Association of North America, Herodicus Society, American Orthopaedic Society for Sports Medicine

Disclosure: Received consulting fee from Biomet, Inc. for speaking and teaching; Received grant/research funds from Smith and Nephew for fellowship funding; Received grant/research funds from DJ Ortho for course funding; Received grant/research funds from Athletico Physical Therapy for course, research funding; Received royalty from Biomet, Inc. for consulting.

Additional Contributors

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.

Acknowledgements

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.