SUPRASCAPULAR NERVE ENTRAPMENT

The brachial plexus is a collection of many nerves that arise in the neck and provide the main nerve supply to the shoulder, arm and hand. One of the branches, the suprascapular nerve, supplies two of the muscles of the rotator cuff, the supraspinatus and infraspinatus. The nerve has a rather complicated route, passing through a notch in the scapula (shoulder blade). The notch is made into a tunnel by a ligament (the transverse scapular ligament) which runs across the top of the notch. The space available for nerve in the tunnel is usually enough but for several reasons, the nerve can become compressed at the notch.

The nerve can be affected by a cyst from the labrum of the shoulder joint or the nerve itself can swell up. Other reasons can be that the nerve is injury by repetitive trauma or become stretched as part of a rotator cuff tear.

Arthroscopic scissors about to release the transverse ligament over the suprascapular nerve. (courtesy of Dr L Lafosse, Annecy, France)

WHAT ARE THE SYMPTOMS?

One of the main symptoms is pain and this is generally located across the upper part of the back of the shoulder. Weakness of the muscles supplied by the nerve (supraspinatus and infraspinatus) may be a symptom since if the muscle is not being stimulated to contract, the fibres will start to fade away (muscle wasting).

WHAT CAN BE DONE ABOUT IT?

It is important to determine the cause for the nerve compression and this may be done with a scan or EMG studies (electromyograghy). Sometimes it might be worthwhile attempting to inject a local anaesthetic (with or without steroid) around the nerve at the notch to see what effect it has. The effect of an injection may not be long lasting. If release of the ligament is necessary, this can be done arthroscopically (keyhole surgery). The nerve cannot be repaired by surgery but the pressure can be released.

Spire Elland Hospital

Elland Lane
Elland
HX5 9EB

For an appointment, telephone:
Clinic bookings on 01422 324 069
Self pay enquiries on 01422 229 597
Main Hospital on 01422 229 632

BMI The Huddersfield Hospital

Birkby Hall Road
Huddersfield
West Yorkshire
HD2 2BL

Reception: 01484 533 131

Department of Orthopaedics & Trauma

Calderdale and Huddersfield NHS Foundation Trust
Huddersfield Royal Infirmary
Acre Street
Lindley
Huddersfield
HD3 3EA

NHS Secretary:
Mrs Margaret Thomas
Tel 01484 342 343

NHS Clinics

Trauma:
Calderdale Royal Hospital (Halifax) and
Huddersfield Royal Infirmary

Elective Shoulder and Elbow problems:
Friday morning at Calderdale Royal Hospital, Halifax