Treatment of suprascapular nerve entrapment syndrome

Abstract

Suprascapular nerve entrapment syndrome (SNES) is an often-overlooked etiology of shoulder pain and weakness. Treatment varies depending on the location and etiology of entrapment, which can be described as compressive or traction lesions. In some cases, treating the primary cause of impingement (ie. rotator cuff tear, ganglion cyst, etc.) is sufficient to relieve pressure on the nerve. In other cases where impingement is caused by dynamic microtrauma (as seen in overhead athletes and laborers), treatment is often more conservative. Conservative first-line therapy includes rehabilitation programs, nonsteroidal anti-inflammatory drugs, and lifestyle modification. Physical therapy is targeted at strengthening the rotator cuff muscles, trapezius, levator scapulae, rhomboids, serratus anterior, and deltoid muscle(s). If non-operative treatment fails to relieve suprascapular neuropathy, minimally invasive treatment options exist, such as suprascapular nerve injection, neurostimulation, cryoneurolysis, and pulsed radiofrequency. Multiple treatment modalities are often used synergistically due to variations in shoulder anatomy, physiology, pain response, and pathology as a sole therapeutic option does not seem successful for all cases. Often patients can be treated with non-invasive measures alone; however, injuries refractory to conservative treatment may require either arthroscopic or open surgery, particularly if the patient has an identifiable and reversible cause of nerve compression. Indications for invasive treatment include, but are not limited to, refractory to non-operative treatment, have a space-occupying lesion, or show severe signs and symptoms of muscle atrophy. Open decompression has fallen out of favor due to the advantages inherent in the less invasive arthroscopic approach.

Accuracy of suprascapular notch cross-sectional area by MRI in the diagnosis of suprascapular nerve entrapment syndrome – a retrospective pilot study

“…Imaging studies also can be used to diagnose [14,15]. Ultrasound, X-ray, computed tomography and MRI provide information on suprascapular nerve and surrounding structures helping to diagnose SNES [15,25,26].…”

“…Ultrasound, X-ray, computed tomography and MRI provide information on suprascapular nerve and surrounding structures helping to diagnose SNES [15,25,26]. Nerve conduction velocity and electromyography are the gold standards for SNES diagnosis [14]. However, nerve conduction velocity or electromyography cannot be performed for all patients, because the efficacy of electromyography is low.…”

“…All rights reserved. cannot rule out SNES when clinical signs and symptoms are highly suspicious of SNES [14].…”

“…The diagnosis of SNES is typically based on physical examination, and interview [14,15]. Other additional examinations for the diagnosis of SNES include imaging modalities (ultrasonography, Xray and computed tomography) and electromyography and assessment of the conduction velocity from the neck nerve point to the supraspinatus muscles [10,[16][17][18][19].…”

Recovery of brachial plexus injury after bronchopleural fistula closure surgery based on electrodiagnostic study: A case report and review of literature

“…According to the Neuropathic Pain Special Interest Group guidelines and Canadian Pain Society guidelines, tricyclic antidepressants, gabapentin, and pregabalin are the first-line therapy for pain management, and opioid analgesics or tramadol are recommended as second- or third-line options[ 25 , 28 ]. If non-operative treatment fails, minimally invasive treatment can be attempted, and perineural injection using anesthetic medications with steroids, such as bupivacaine and methylprednisolone, help relieve symptoms, and glenohumeral joint hydrodilatation is helpful for patients with adhesive capsulitis[ 29 , 30 ].…”