Suprascapular nerve rotator cuff compression syndrome in volleyball players

doi:10.1016/S1058-2746(98)90205-1

Journal of Shoulder and Elbow Surgery

Volume 7, Issue 5, September–October 1998, Pages 516-521

https://doi.org/10.1016/S1058-2746(98)90205-1 Get rights and content

Abstract

Selective denervation of the infraspinatus muscle producing weakness and wasting has been reported in certain sports (eg, volleyball and baseball). Nerve kinking or friction caused by excessive infraspinatus motion and compression by superior or inferior transverse scapular ligament or ganglions have been proposed as possible causes. However, in extreme abduction with full external rotation of the shoulder, the medial tendinous margin between the infraspinatus and supraspinatus muscles impinges strongly against the lateral edge of scapular spine, compressing the intervening infraspinatus branch of the suprascapular nerve. Spinoglenoid notchplasty has been performed in 5 elite volleyball players with infraspinatus neuropathy, allowing recovery of shoulder function in all patients and correction of infraspinatus muscle wasting. All returned to the same or higher level of volleyball by 8 months after surgery. An alternative cause of infraspinatus compromise in volleyball players is proposed and has been treated surgically with satisfactory outcome. (J Shoulder Elbow Surg 1998;7:516-21.)

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Cited by (106)

Correlation of suprascapular notch morphology with suprascapular nerve palsy: a 3D-computed tomography study
2023, JSES International
The morphology of the suprascapular (SS) notch is a very important factor in treatment of suprascapular nerve (SSN) palsy. Several studies have reported SS notch morphology in cadavers or using a three-dimensional computed tomography (3D-CT); however, none has reported the distribution of SS notch morphology according to the age group. In addition, the correlation between SS notch morphology and SSN palsy remains unclear. The purposes of this study were to investigate the morphological distribution of the SS notch by age group in a large population and to assess the relationship between SS notch morphology and SSN palsy.
We studied the 3D-CT images of 1063 shoulders in 1009 patients (mean age, 60.8 years; age range, 14-96 years). There were 53 shoulders with SSN palsy and 1010 shoulders without SSN palsy. Morphology of the SS notch was classified by Rengachary’s classification (types I-VI). Shoulders with types I-IV were classified into the nonossified superior transverse scapular ligament (STSL) group (group N) and those with types V and VI into the ossified STSL group (group O).
The Rengachary’s classifications of the 1063 shoulders were as follows: type I: n = 113, 10.6%; type II: n = 313, 29.4%; type III: n = 383, 36.0%; type IV: n = 109, 10.3%; type V: n = 107, 10.0%; and type VI: n = 38, 3.6%. Mean age was significantly older in the ossified STSL group, and the age was <40 years for only two shoulders in this group. The Rengachary’s classifications of the SSN palsy cases were as follows: type I: 7.5%, II: 24.5%, III: 34.0%, IV: 15.1%, V: 13.2%, and VI: 5.7%. There was no statistical difference in age and sex, Rengachary type, or ossification between SSN palsy and non-SSN palsy cases.
Ossification of the STSL was significantly more common in older patients, which suggests age-related change. In addition, no relation was identified between narrow notch or ossification of the STSL with the onset of SSN palsy.
Suprascapular Neuropathy
2021, Operative Techniques in Sports Medicine
Suprascapular neuropathy is an increasingly recognized cause of shoulder pain and weakness in throwing athletes. Timely diagnosis and management are required to restore function, reduce pain, and allow the athlete to return to sport. We describe the pertinent anatomy and pathophysiology involved in suprascapular neuropathy, clinical evaluation, imaging and diagnostic testing, surgical indications, our preferred operative techniques, and a summary of the reported postoperative outcomes.
Suprascapular Nerve Release: Technique Based on Anatomic Landmarks
2021, Arthroscopy Techniques
Citation Excerpt :
In the setting of massive cuff tears, the rehabilitation program is usually harmonized to the repaired cuff. Dramis and Pimpalnerkar,2 as well as Sandow and Ilic,3 described SSN neuropathy in volleyball players, and the benefits of releasing the SSN were tackled. More recently, Tsikouris et al.4 compared athletes with cuff or labral tears treated by arthroscopic repair with or without SSN release and concluded that the release of the nerve improves outcomes and the return to sports.5
Dysfunction of the suprascapular nerve (SSN) is closely related to rotator cuff pathology; nerve dysfunction can lead to cuff disease and vice versa. Owing to repetitive microtrauma during overhead sports or massive cuff tears with significant tendon retraction, the SSN may suffer compression or traction neuropathy at the suprascapular notch. The SSN release technique has already been described. However, on the basis of the many hands-on cadaveric laboratories in which we have participated in the past 20 years, only a few instructors and almost none of the attendants have shown the experience and skill set needed to release the SSN at the suprascapular notch. Therefore, a review of the surgical technique following the anatomic descriptions of an expert anatomist (P.G.) of the shoulder girdle is quite valuable.
Suprascapular nerve decompression in addition to rotator cuff repair: a prospective, randomized observational trial
2020, Journal of Shoulder and Elbow Surgery
Tear and retraction of the supraspinatus (SS) and infraspinatus (IS) musculotendinous units and/or their repair may be associated with traction damage to the suprascapular nerve, potentially responsible for pain or weakness of the rotator cuff (RC). Arthroscopic release of the transverse scapular ligament at the suprascapular notch has been advocated to prevent or treat suprascapular nerve impairment associated with RC retraction and/or repair. The effect of this procedure on preoperative normal nerve function is, however, not well studied.We hypothesize that (1) decompression of the suprascapular nerve without preoperative pathologic neurophysiological findings will not improve clinical or imaging outcome and (2) suprascapular decompression will not measurably change suprascapular nerve function.
Nineteen consecutive patients with a magnetic resonance arthrography documented RC tear involving SS and IS but normal preoperative electromyography (EMG)/nerve conduction studies of the SS and IS were enrolled in a prospective, controlled trial involving RC repair with or without suprascapular nerve decompression at the suprascapular notch. Nine patients were randomized to undergo, and 10 not to undergo, a decompression of the suprascapular nerve. Patients were assessed clinically (Constant score, mobility, pain, strength, subjective shoulder value), with magnetic resonance imaging and neurophysiology preoperatively and at 3- and 12-month follow-up.
There was no clinically relevant difference between the release and the non-release group in any clinical parameter at any time point. At magnetic resonance imaging, there was a slightly greater increase of fatty infiltration of the IS in the release group without any other differences between the 2 groups. Electromyographically, there were no pathologic findings in the non-release group at any time point. Conversely, 3 of the 9 patients of the release group showed pathologic EMG findings at 3 months, of whom 2 had recovered fully and 1 only partially at 12 months.
In the presence of normal EMG findings, suprascapular nerve release added to arthroscopic RC repair is not associated with any clinical benefit, but with electromyographically documented, postoperative impairment of nerve function in 1 of 3 cases. Suprascapular nerve release does not therefore seem to be justified as an adjunct to RC repair if preoperative EMG findings document normal suprascapular nerve function. Based on these findings, the ongoing prospective randomized trial was terminated.
Hourglass-like constriction of the suprascapular nerve: a contraindication for minimally invasive surgery
2018, Journal of Shoulder and Elbow Surgery
Suprascapular nerve (SSN) entrapment is usually ascribed to static or dynamic compression. When no cause of compression is found, SSN entrapment is defined as idiopathic. Focal hourglass-like constriction (H-LC) of the SSN that results in muscle paralysis represents an unusual condition that may be misinterpreted and erroneously diagnosed as SSN entrapment or as neuralgic amyotrophy.
With the aim of finding clinical and surgical clues that could differentiate the traditional form of idiopathic SSN entrapment from the rare H-LC, a series of 6 cases of SSN palsy caused by H-LC is presented.
All but 1 supraspinatus muscle recovered M5 muscle strength. The Constant shoulder score was excellent in 3 patients, good in 1, fair in 1, and poor in 1.
If a diagnosis is not made in time, H-LC may evolve from mild to severe nerve torsion that may require a shift in surgical procedure from epineurotomy and external neurolysis to focal resection and suture. If an incorrect therapy is chosen, the chance of recovery might be definitively compromised with the persistence of muscle palsy. Conversely, when SSN palsy persists despite notch decompression, especially when it is performed with a limited open approach or arthroscopically, concerns about the real etiology and location of nerve compression responsible for the nerve palsy may arise.
When approaching SSN pathology, H-LC should be considered as a potential cause of nerve palsy, as it may represent a contraindication for a limited open approach or arthroscopic decompression.
Surgical Management of Capsulolabral and Rotator Cuff Injuries in Throwing Athletes
2018, Shoulder and Elbow Injuries in Athletes: Prevention, Treatment and Return to Sport
Surgical management of the throwing shoulder has unique challenges specific to the high demands of the overhead throwing motion. This chapter reviews the various rotator cuff and SLAP (superior labrum anterior and posterior) repair and instability and posterior release techniques used to return these athletes to the field. Successful return to competitive throwing after shoulder surgery requires a combination of thoughtful preoperative planning, meticulous surgical technique, and a comprehensive goal-oriented postsurgical rehabilitation program.

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^*: From the Department of Orthopaedics and Trauma, Royal Adelaide Hospital, North Terrace; and Wakefield Orthopaedic Clinic/SportsCare.

^**: Reprint requests: Michael J. Sandow, FRACS, Wakefield Orthopaedic Clinic, 270 Wakefield St, Adelaide, South Australia, Australia 5000.

^*: 32/1/88994

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Suprascapular nerve rotator cuff compression syndrome in volleyball players*,**,*

Abstract