Suprascapular neuropathy caused by heterotopic ossification after clavicle shaft fracture: a case report

  • Soo-Hwan Kang
  • Il-Jung Park
  • Changhoon Jeong
Up-to date Review and Case Report


Suprascapular neuropathy is a rare peripheral neuropathy that can be easily overlooked in the differential diagnosis of shoulder pain and dysfunction. The suprascapular nerve may be injured as a result of repetitive overuse, constriction due to anatomic variants, compression due to space occupying lesions, retraction due to a massive rotator cuff tear and iatrogenic or traumatic lesions. Trauma-related suprascapular neuropathies are often caused by glenohumeral joint dislocations, scapular fractures, proximal humeral fractures, penetrating injuries and displaced clavicle fractures. Although many causes of suprascapular neuropathy have been described, there have been few reports of suprascapular neuropathy caused by heterotophic ossification after trauma around shoulder. Heterotophic ossification is the formation of bone in non-skeletal tissue, usually between the muscle and joint capsule. It usually occurs following trauma, surgery, burns, fractures, dislocation or soft tissue trauma. The spectrum of heterotophic ossification ranges from incidental radiographic findings to severe functional limitations. The range of motion can be decreased, resulting in soft tissue contractures. It can also cause peripheral neuropathy by impinging adjacent nerves. Management of heterotopic ossification is aimed at limiting its progression and maximizing function of the affected joint. Nonsurgical treatment is appropriate for early heterotopic ossification; however, surgical excision should be considered in cases of joint ankylosis or significant complications. We report a very unusual case of suprascapular neuropathy that resulted from heterotophic ossification after clavicle shaft fracture. This case was treated by open excision of the heterotophic ossification and external neurolysis of the suprascapular nerve. Although the incidence is very low, the heterotophic ossification should be considered as a possible cause of suprascapular neuropathy.


Suprascapular neuropathy Heterotopic ossification Clavicle shaft fracture 


Conflict of interest

No funds were received in support of this study.


  1. 1.
    Lajtai G, Pfirrmann CW, Aitzetmüller G, Pirkl C, Gerber C, Jost B (2009) The shoulders of professional beach volleyball players: high prevalence of infraspinatus muscle atrophy. Am J Sports Med 37(7):1375–1383PubMedCrossRefGoogle Scholar
  2. 2.
    Arboleya L, García A (1993) Suprascapular nerve entrapment of occupational etiology: clinical and electrophysiological characteristics. Clin Exp Rheumatol 11(6):665–668PubMedGoogle Scholar
  3. 3.
    Cummins CA, Anderson K, Bowen M, Nuber G, Roth SI (1998) Anatomy and histological characteristics of the spinoglenoid ligament. J Bone Jt Surg Am 80(11):1622–1625Google Scholar
  4. 4.
    Bayramoğlu A, Demiryürek D, Tüccar E, Erbil M, Aldur MM, Tetik O, Doral MN (2003) Variations in anatomy at the suprascapular notch possibly causing suprascapular nerve entrapment: an anatomical study. Knee Surg Sports Traumatol Arthrosc 11(6):393–398PubMedCrossRefGoogle Scholar
  5. 5.
    Hazrati Y, Miller S, Moore S, Hausman M, Flatow E (2003) Suprascapular nerve entrapment secondary to a lipoma. Clin Orthop Relat Res 411:124–128PubMedCrossRefGoogle Scholar
  6. 6.
    Semmler A, von Falkenhausen M, Schröder R (2008) Suprascapular nerve entrapment by a spinoglenoid cyst. Neurology 70(11):890PubMedCrossRefGoogle Scholar
  7. 7.
    Albritton MJ, Graham RD, Richards RS 2nd, Basamania CJ (2003) An anatomic study of the effects on the suprascapular nerve due to retraction of the supraspinatus muscle after a rotator cuff tear. J Should Elb Surg 12(5):497–500CrossRefGoogle Scholar
  8. 8.
    Cummins CA, Messer TM, Nuber GW (2000) Suprascapular nerve entrapment. J Bone Jt Surg Am 82(3):415–424Google Scholar
  9. 9.
    Kaplan FS, Hahn GV, Kasloff MA (1994) Heterotopic ossification: two rare forms and what they can teach us. J Am Acad Orthop Surg 2(5):288–296PubMedGoogle Scholar
  10. 10.
    Tanner MW, Cofield RH (1983) Prosthetic arthroplasty for fractures and fracture-dislocations of the proximal humerus. Clin Orthop Relat Res 179:116–128PubMedCrossRefGoogle Scholar
  11. 11.
    Huang KC, Tu YK, Huang TJ, Hsu RW (2005) Suprascapular neuropathy complicating a Neer type I distal clavicular fracture: a case report. J Orthop Trauma 19(5):343–345PubMedGoogle Scholar
  12. 12.
    Mallon WJ, Bronec PR, Spinner RJ, Levin LS (1996) Suprascapular neuropathy after distal clavicle excision. Clin Orthop Relat Res 329:207–211PubMedCrossRefGoogle Scholar
  13. 13.
    Yoon TN, Grabois M, Guillen M (1981) Suprascapular nerve injury following trauma to the shoulder. J Trauma 21(8):652–655PubMedCrossRefGoogle Scholar
  14. 14.
    Visser CP, Coene LN, Brand R, Tavy DL (2001) Nerve lesions in proximal humeral fractures. J Should Elb Surg 10(5):421–427CrossRefGoogle Scholar
  15. 15.
    Cipriano CA, Pill SG, Keenan MA (2009) Heterotopic ossification following traumatic brain injury and spinal cord injury. J Am Acad Orthop Surg 17(11):689–697PubMedGoogle Scholar
  16. 16.
    Brown TD, Bigliani LU (2000) Complications with humeral head replacement. Orthop Clin North Am 31(1):77–90PubMedCrossRefGoogle Scholar
  17. 17.
    Iorio R, Healy WL (2002) Heterotopic ossification after hip and knee arthroplasty: risk factors, prevention, and treatment. J Am Acad Orthop Surg 10(6):409–416PubMedGoogle Scholar

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© Springer-Verlag 2011

Authors and Affiliations

  1. 1.Department of Orthopaedic SurgerySt. Paul’s Hospital, The Catholic University of KoreaDongdaemun-gu, SeoulKorea
  2. 2.Department of Orthopaedic SurgeryBucheon St. Mary’s Hospital, The Catholic University of KoreaWonmi-gu, BucheonKorea

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