II. Pathophysiology

  1. Suprascapular nerve impingement (typically by ligament at the Scapular notch)

III. Causes

  1. Clavicle Fracture
    1. Suprascapular Nerve runs posterior to clavicle and subject to injury
  2. Repetitive overhead activity
    1. Risk of Stretching injury at the suprascapular notch and the spinoglenoid notch
  3. Glenoid Labrum Tear with secondary cyst formation
    1. May entrap and compress the suprascapular nerve

IV. Symptoms

  1. Infraspinatus weakness
    1. Weak external rotation at the Shoulder
  2. Supraspinatus weakness (variably involved)
    1. Weak arm elevation overhead

V. Differential Diagnosis

VI. Diagnostics

  1. MRI Shoulder
    1. Evaluate for Rotator Cuff Tear, Labral Tear
    2. Obtain early in course (i.e. first month)

VII. Management

  1. Referral to orthopedic surgery if Rotator Cuff Injury or space occupying lesion
  2. Peripheral Nerve Block
  3. Physical Therapy
    1. Shoulder Range of Motion Exercises
    2. Strengthen compensatory Muscles
  4. Avoid reinjury
    1. Avoid heavy lifting
    2. Avoid repetitive overhead activity

VIII. Course

  1. Anticipate 6-12 month course with therapy

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