Nerve compression

Suprascapular Nerve Neuropathy

Nerve compression at the scapular notch or spinoglenoid notch. Infraspinatus atrophy.

Suprascapular neuropathy is a compression of this nerve at the suprascapular notch (under the superior transverse ligament) or the spinoglenoid notch. It accounts for 1-2% of shoulder pain but is probably underdiagnosed. The main causes are: paralabral cyst (associated with a SLAP lesion, 20% of cases), compression by the transverse ligament, repetitive traction in overhead athletes. Compression at the suprascapular notch affects the supraspinatus AND infraspinatus, while at the spinoglenoid notch only the infraspinatus is affected.

Characteristics

  • Posterosuperior shoulder pain, dull and deep. Visible infraspinatus fossa atrophy (infraspinatus wasting), a characteristic but late clinical sign.
  • Weakness of external rotation (infraspinatus) and/or initial abduction (supraspinatus) depending on the compression site. External rotation resistance test: weakness without pain.
  • EMG: confirms the diagnosis and localizes the compression (suprascapular notch vs spinoglenoid notch). Slowed conduction and denervation of target muscles.
  • MRI: search for paralabral cyst (associated SLAP lesion +++), assessment of atrophy and fatty degeneration of target muscles.

Medical and surgical management

  • Identifiable cause (paralabral cyst): arthroscopic cyst excision and repair of the causative SLAP lesion. Nerve recovery in 3-6 months.
  • Compression by the transverse ligament: surgical release (section of the superior transverse scapular ligament). Arthroscopic technique possible.
  • If no identifiable compressive cause: conservative treatment (physiotherapy, activity modification) for 6-12 months. EMG monitoring of recovery.

Physiotherapy rehabilitation

  • If compressive cause identified (cyst): post-operative rehabilitation after cyst excision + SLAP lesion repair.
  • Mechanical cause (overhead athlete): sports movement modification, scapular muscle strengthening to reduce nerve traction. Posterior capsule stretching.
  • Post-denervation muscle strength rehabilitation: progressive supraspinatus and infraspinatus work. External rotation and initial abduction exercises.
  • Electrostimulation of the suprascapular nerve to maintain muscle trophism during nerve recovery. Clinical follow-up and control EMG at 3-6 months.

Classification

  1. Suprascapular notch

    Supraspinatus and infraspinatus affected. Compression by transverse ligament or cyst.

  2. Spinoglenoid notch

    Isolated infraspinatus involvement. Paralabral cyst (SLAP) frequently the cause.

  3. Mixed compression

    Involvement of the supraspinatus and infraspinatus.

Average duration

8 to 16 weeks

Book appointment

Scientific sources

General information only: this content cannot provide a diagnosis or prescription. A healthcare professional must assess your situation.