Traumatic neuropathy suprascapular nerve

Activities at risk are ones with overhead activity such as volleyball, baseball, weight lifting, wrestling, dancing and assembly line work. Its also caused by trauma (stab wounds above scapula), improper use of crutches, and rupture of the rotator cuff. Clinical presentation involves posterolateral shoulder pain, weakness of initiating abduction and external rotation of the shoulder, and muscle atrophy. Weakness of infrapinatus causes weakness in externally rotating arm at shoulder. The crossed adduction test is a provocative test that is positive when pain is produced through passive adduction of the extended arm across the chest. Sensory deficit can occur in the upper arm due to sensory branches. Evaluation is imaging of cervical spine and shoulder (films and/or MRI), EMG, or diagnostic nerve block of suprascapular nerve to verify the diagnosis. Conservative treatment is rest followed by PT; surgery is indicated if full recovery is not achieved within six months. Over-use and traction injuries responded equally to surgical/conservative therapy whereas ganglion cysts and compression neuropathies are best treated surgically. Anatomically the nerve passes through the supracapsular notch and the spinoglenoid notch. At the suprascapular notch the mechanism proposed is abnormal contact between the suprascapular nerve and the transverse ligament during shoulder abduction or adduction across the chest. Isolated painless weakness of the infraspinatus muscle occurs at the spinoglenoid notch; this occurs in volleyball players.