Suprascapular neuropathy in pitchers

Abstract

The clinical features and preoperative and postoperative electrodiagnostic studies were reviewed in two professional pitchers with a suprascapular neuropathy. These studies demonstrate that denervation of the infraspinatus and/or supraspinatus muscle is not always due to entrapment of the nerve at the suprascapular or spinoglenoid notches, as is often proposed. Similar studies in healthy pitchers during spring training and again at midseason demonstrate that slowing of suprascapular nerve conduction is detectable in some cases as the season progresses. Sagittal sections of a cadaver with the arm fixed in the acceleration phase of the pitching motion demonstrate five possible sites of trauma to the suprascapular nerve. Mechanisms proposed to explain these progressive, but potentially reversible, changes include consideration of biomechanical factors as well as anatomical features. An alternative hypothesis to nerve trauma that explains this symptom complex is intimal damage to the axillary or suprascapular artery and subsequent production of microemboli which become trapped in the suprascapular nerve vasa nervorum.

Suprascapular nerve entrapment. A meta-analysis

“…We found 88 cases (83 patients) [2,3,4,5,6,7,8,10,11,12,13,14,15,16,18,19,20,21,23,24,25,26,27,28,29,30,31,32,33,34,35,36,37,38,39,40,41,42,43,44,45,46,47], which fulfilled the inclusion criteria. These cases were divided into two groups based on the cause of nerve entrapment.…”

“…However, when entrapment is caused by the ligament none of these imaging techniques will suffice. In advanced cases, electromyographic examination can give further information both when the entrapment is caused by a ganglion and by the ligament [4,33,41,43]. Ganglions compressing the suprascapular notch have been demonstrated to occur predominantly in male patients.…”

Suprascapular Nerve: Anatomical and Clinical Study

“…Researchers [24][25][26][27][28][29][30] found that if there is evidence of muscular atrophy or severe pain, not controlled by drugs, the operation should not be delayed beyond three months.…”

Relação anatômica do nervo supraescapular com o processo coracoide, articulação acromioclavicular e acrômio

“…É responsável por 70% da inervação sensitiva da articulação do ombro, inervando também os músculos supraespinhal e infraespinhal, componentes do manguito rotador (2)(3)(4) .…”

“…A literatura relata que o nervo supraescapular pode ser lesado em procedimentos cirúrgicos que necessitem de uma dissecção posterior da articulação do ombro, assim como avanços do manguito rotador, capsulorrafias, osteotomias para instabilidades posteriores, sutura transglenoide para instabilidade anterior, entre outros (2) . Além disso, descreve também mecanismos de compressão e tração deste nervo em atletas (4) , bem como uma real possibilidade de ser lesionado durante a realização dos acessos anteriores para abordagem de lesões da articulação acromioclavicular ou fraturas do processo coracoide (3) .…”