pathology: incisura-scapulae-syndrome / foramen-scapulae-syndrome / suprascapular nerve compression syndrome

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Definition

As an anatomical variety, the transverse scapular ligament is ossified or calcified, so that the ligament-covered incisura becomes a foramen scauplae. This can compress the suprascapular nerve and then leads to neurapraxis (pressure- or stretch-induced inactivity) with denervation oedema of the supplied muscles supraspinatus and infraspinatus and, in the chronic course, to their atrophy. More frequent external rotation of the shoulder blade exacerbates the problem, which predisposes overhead athletes, for example, as well as people with frequent overhead activities. Rarely, hypaesthesia develops over the dorsal shoulder.
In addition to the suprascapular notch, the spinogleoid is also a possible site of compression.

The disorder usually begins with a rather insidious, persistent, deep-seated, dull dorsal shoulder pain (rest pain), which can radiate into the arm or neck. Overhead movements of the arm and overhead activities intensify the symptoms, as does lying on the affected side. The tests suprascapular extension test n. Lafosse and cross arm adduction test n. Plancher utilise the effect that with transverse adduction and endorotation of the arm, the affected ligament comes under higher tension and the nerve is compressed more strongly. In addition, pain relief can be achieved with this disorder by injecting local anaesthetic into the suprascapular or spinoglenoid notch.

It is estimated that 1-2% of all disorders of the shoulder joint are due to this nerve compression.

Also known as suprascapular nerve compression syndrome
English: suprascapular neuropathy, suprascapular nerve neuropathy, suprascapular nerve entrapment syndrome, SNES

Diagnosis

  1. Nerve conduction in side-by-side comparison
  2. EMG can show signs of denervation (side-by-side comparison)
  3. Examination for muscle weakness, especially initial lateral abduction and exorotation
  4. Test and sign: suprascapular stretch test und der Cross arm adduction test (eigentlich vorrangig ein Test auf ACG-Pathologie).

Symptoms

  1. creeping, persistent, deep, dull pain in the upper back
  2. pain may radiate to the arm or neck

Therapy

  1. Initial attempt at therapy with discontinuation or reduction of overhead activities and PT, improvement of shoulder mobility and training of the periscapular muscles and the deltoid.
  2. Surgery, especially if significant muscle atrophy is already detectable or there is a risk of pressure atrophy

DD

  1. Muscular dystrophies
  2. Cervical spine events (e.g. disc hernia)
  3. Rotator cuff lesion
  4. Periarthropathia humeroscapularis
  5. Reversible pressure loads due to external pressure (load on the shoulder)

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