Skip to main content

Nerve Entrapment Syndromes in the Shoulder: Diagnosis, Principles, and Different Techniques for Nerve Decompression

  • Reference work entry
  • First Online:
Sports Injuries

Abstract

Nerve injuries around the shoulder in athletes are uncommon causes of pain and dysfunction. Athletes involved in overhead sports appear to be at increased risk. Recognition of this uncommon and frequently misdiagnosed condition is important as delayed treatment may lead to irreversible changes and cause impairment in the athlete. The goal of this chapter is to review in a comprehensive form anatomy and pathophysiology of the nerve injury, describe the typical clinical scenario and physical exam, contemplate a differential diagnosis of sources of shoulder pain, and list the diagnostic tools available; nonoperative and operative treatment options are described with special attention to arthroscopic techniques.

The following nerve injuries and specific associated syndromes about the shoulder in athletes will be reviewed: axillary nerve and the suprascapular nerve.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 699.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Hardcover Book
USD 999.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  • Aagaard BD, Lazar DA, Lankerovich L, Andrus K, Hayes CE, Maravilla K, Kliot M (2003) High-resolution magnetic resonance imaging is a noninvasive method of observing injury and recovery in the peripheral nervous system. Neurosurgery 53(1):199–203; discussion 203–194

    Article  Google Scholar 

  • Agre JC, Ash N, Cameron MC, House J (1987) Suprascapular neuropathy after intensive progressive resistive exercise: case report. Arch Phys Med Rehabil 68(4):236–238

    CAS  Google Scholar 

  • Aiello I, Serra G, Traina GC, Tugnoli V (1982) Entrapment of the suprascapular nerve at the spinoglenoid notch. Ann Neurol 12(3):314–316

    Article  CAS  Google Scholar 

  • Ajmani ML (1994) The cutaneous branch of the human suprascapular nerve. J Anat 185(Pt 2):439–442

    Google Scholar 

  • Alnot JY, Valenti P (1991) Surgical repair of the axillary nerve. Apropos of 37 cases. Int Orthop 15(1):7–11

    Article  CAS  Google Scholar 

  • Apaydin N, Tubbs RS, Loukas M, Duparc F (2010) Review of the surgical anatomy of the axillary nerve and the anatomic basis of its iatrogenic and traumatic injury. Surg Radiol Anat 32(3):193–201

    Article  Google Scholar 

  • Bigliani LU, Dalsey RM, McCann PD, April EW (1990) An anatomical study of the suprascapular nerve. Arthroscopy 6(4):301–305

    Article  CAS  Google Scholar 

  • Blom S, Dahlback LO (1970) Nerve injuries in dislocations of the shoulder joint and fractures of the neck of the humerus. A clinical and electromyographical study. Acta Chir Scand 136(6):461–466

    CAS  Google Scholar 

  • Boykin RE, Friedman DJ, Zimmer ZR, Oaklander AL, Higgins LD, Warner JJ (2011) Suprascapular neuropathy in a shoulder referral practice. J Shoulder Elbow Surg 20(6):983–988

    Article  Google Scholar 

  • Burkhead WZ Jr, Scheinberg RR, Box G (1992) Surgical anatomy of the axillary nerve. J Shoulder Elbow Surg 1(1):31–36

    Article  Google Scholar 

  • Cahill BR, Palmer RE (1983) Quadrilateral space syndrome. J Hand Surg Am 8(1):65–69

    Article  CAS  Google Scholar 

  • Callahan JD, Scully TB, Shapiro SA, Worth RM (1991) Suprascapular nerve entrapment. A series of 27 cases. J Neurosurg 74(6):893–896

    Article  CAS  Google Scholar 

  • Clein LJ (1975) Suprascapular entrapment neuropathy. J Neurosurg 43(3):337–342

    Article  CAS  Google Scholar 

  • Coene LN, Narakas AO (1992) Operative management of lesions of the axillary nerve, isolated or combined with other nerve lesions. Clin Neurol Neurosurg 94(Suppl):S64–S66

    Article  Google Scholar 

  • Costouros JG, Porramatikul M, Lie DT, Warner JJ (2007) Reversal of suprascapular neuropathy following arthroscopic repair of massive supraspinatus and infraspinatus rotator cuff tears. Arthroscopy 23(11):1152–1161

    Article  Google Scholar 

  • Cummins CA, Messer TM, Nuber GW (2000) Suprascapular nerve entrapment. J Bone Joint Surg Am 82(3):415–424

    Article  CAS  Google Scholar 

  • Cummins CA, Messer TM, Schafer MF (2004) Infraspinatus muscle atrophy in professional baseball players. Am J Sports Med 32(1):116–120

    Article  Google Scholar 

  • Dramis A, Pimpalnerkar A (2005) Suprascapular neuropathy in volleyball players. Acta Orthop Belg 71(3):269–272

    Google Scholar 

  • Ebraheim NA, Whitehead JL, Alla SR, Moral MZ, Castillo S, McCollough AL, Yeasting RA, Liu J (2011) The suprascapular nerve and its articular branch to the acromioclavicular joint: an anatomic study. J Shoulder Elbow Surg 20(2):e13–e17

    Article  Google Scholar 

  • Ewald P (1909) Isolierte Neuritis des Nervus Suprascapularis nach. Trauma Med Klin 2:56–59

    Google Scholar 

  • Ferretti A, Cerullo G, Russo G (1987) Suprascapular neuropathy in volleyball players. J Bone Joint Surg Am 69(2):260–263

    Article  CAS  Google Scholar 

  • Francel TJ, Dellon AL, Campbell JN (1991) Quadrilateral space syndrome: diagnosis and operative decompression technique. Plast Reconstr Surg 87(5):911–916

    Article  CAS  Google Scholar 

  • Goutallier D, Postel JM, Bernageau J, Lavau L, Voisin MC (1994) Fatty muscle degeneration in cuff ruptures. Pre- and postoperative evaluation by CT scan. Clin Orthop Relat Res 304:78–83

    Article  Google Scholar 

  • Gumina S, Postacchini F (1997) Anterior dislocation of the shoulder in elderly patients. J Bone Joint Surg Br 79(4):540–543

    Article  CAS  Google Scholar 

  • Holzgraefe M, Kukowski B, Eggert S (1994) Prevalence of latent and manifest suprascapular neuropathy in high-performance volleyball players. Br J Sports Med 28(3):177–179

    Article  CAS  Google Scholar 

  • Ishima T, Usui M, Satoh E, Sakahashi H, Okamura K (1998) Quadrilateral space syndrome caused by a ganglion. J Shoulder Elbow Surg 7(1):80–82

    Article  CAS  Google Scholar 

  • Kim DH, Murovic JA, Tiel RL, Kline DG (2005) Management and outcomes of 42 surgical suprascapular nerve injuries and entrapments. Neurosurgery 57(1):120–127; discussion 120–127

    Article  Google Scholar 

  • Kopell HP, Thompson WA (1960) Peripheral entrapment neuropathies of the lower extremity. N Engl J Med 262:56–60

    Article  CAS  Google Scholar 

  • Lafosse L, Tomasi A, Corbett S, Baier G, Willems K, Gobezie R (2007) Arthroscopic release of suprascapular nerve entrapment at the suprascapular notch: technique and preliminary results. Arthroscopy 23(1):34–42

    Article  Google Scholar 

  • Lafosse L, Piper K, Lanz U (2011) Arthroscopic suprascapular nerve release: indications and technique. J Shoulder Elbow Surg 20(2 Suppl):S9–S13

    Article  Google Scholar 

  • Lajtai G, Pfirrmann CW, Aitzetmuller 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):1375–1383

    Article  Google Scholar 

  • Leclere LE, Shi LL, Lin A, Yannopoulos P, Higgins LD, Warner JJ (2014) Complete Fatty infiltration of intact rotator cuffs caused by suprascapular neuropathy. Arthroscopy 30(5):639–644

    Article  Google Scholar 

  • Lee S, Saetia K, Saha S, Kline DG, Kim DH (2011) Axillary nerve injury associated with sports. Neurosurg Focus 31(5):E10

    Article  Google Scholar 

  • Lester B, Jeong GK, Weiland AJ, Wickiewicz TL (1999) Quadrilateral space syndrome: diagnosis, pathology, and treatment. Am J Orthop (Belle Mead NJ) 28(12):718–722, 725

    CAS  Google Scholar 

  • Limbucci N, Rossi F, Salvati F, Pistoia LM, Barile A, Masciocchi C (2010) Bilateral suprascapular nerve entrapment by glenoid labral cysts associated with rotator cuff damage and posterior instability in an amateur weightlifter. J Sports Med Phys Fitness 50(1):64–67

    CAS  Google Scholar 

  • Linker CS, Helms CA, Fritz RC (1993) Quadrilateral space syndrome: findings at MR imaging. Radiology 188(3):675–676

    Article  CAS  Google Scholar 

  • Loomer R, Graham B (1989) Anatomy of the axillary nerve and its relation to inferior capsular shift. Clin Orthop Relat Res 243:100–105

    Article  Google Scholar 

  • Loukas M, Grabska J, Tubbs RS, Apaydin N, Jordan R (2009) Mapping the axillary nerve within the deltoid muscle. Surg Radiol Anat 31(1):43–47

    Article  Google Scholar 

  • Mallon WJ, Wilson RJ, Basamania CJ (2006) The association of suprascapular neuropathy with massive rotator cuff tears: a preliminary report. J Shoulder Elbow Surg 15(4):395–398

    Article  Google Scholar 

  • McAdams TR, Dillingham MF (2008) Surgical decompression of the quadrilateral space in overhead athletes. Am J Sports Med 36(3):528–532

    Article  Google Scholar 

  • McClelland D, Paxinos A (2008) The anatomy of the quadrilateral space with reference to quadrilateral space syndrome. J Shoulder Elbow Surg 17(1):162–164

    Article  Google Scholar 

  • Merrell GA, Barrie KA, Katz DL, Wolfe SW (2001) Results of nerve transfer techniques for restoration of shoulder and elbow function in the context of a meta-analysis of the English literature. J Hand Surg Am 26(2):303–314

    Article  CAS  Google Scholar 

  • Mochizuki T, Isoda H, Masui T, Ohkawa Y, Takahashi M, Takehara Y, Ichijo K, Kodaira N, Kitanaka H (1994) Occlusion of the posterior humeral circumflex artery: detection with MR angiography in healthy volunteers and in a patient with quadrilateral space syndrome. AJR Am J Roentgenol 163(3):625–627

    Article  CAS  Google Scholar 

  • Ozer D, Baltaci G, Leblebicioglu G (2007) Rehabilitation and shoulder function after suprascapular nerve entrapment operation in a volleyball player. Arch Orthop Trauma Surg 127(9):759–761

    Article  Google Scholar 

  • Parsonage MJ, Turner JW (1948) Neuralgic amyotrophy; the shoulder-girdle syndrome. Lancet 1(6513):973–978

    Article  CAS  Google Scholar 

  • Payne MW, Doherty TJ, Sequeira KA, Miller TA (2002) Peripheral nerve injury associated with shoulder trauma: a retrospective study and review of the literature. J Clin Neuromuscul Dis 4(1):1–6

    Article  Google Scholar 

  • Perlmutter GS (1999) Axillary nerve injury. Clin Orthop Relat Res 368:28

    Article  Google Scholar 

  • Perlmutter GS, Apruzzese W (1998) Axillary nerve injuries in contact sports: recommendations for treatment and rehabilitation. Sports Med 26(5):351–361

    Article  CAS  Google Scholar 

  • Perlmutter GS, Leffert RD, Zarins B (1997) Direct injury to the axillary nerve in athletes playing contact sports. Am J Sports Med 25(1):65–68

    Article  CAS  Google Scholar 

  • Petrucci FS, Morelli A, Raimondi PL (1982) Axillary nerve injuries–21 cases treated by nerve graft and neurolysis. J Hand Surg Am 7(3):271–278

    Article  CAS  Google Scholar 

  • Plancher KD, Peterson RK, Johnston JC, Luke TA (2005) The spinoglenoid ligament. Anatomy, morphology, and histological findings. J Bone Joint Surg Am 87(2):361–365

    Article  Google Scholar 

  • Plancher KD, Luke TA, Peterson RK, Yacoubian SV (2007) Posterior shoulder pain: a dynamic study of the spinoglenoid ligament and treatment with arthroscopic release of the scapular tunnel. Arthroscopy 23(9):991–998

    Article  Google Scholar 

  • Post M (1999) Diagnosis and treatment of suprascapular nerve entrapment. Clin Orthop Relat Res 368:92–100

    Article  Google Scholar 

  • Rengachary SS, Burr D, Lucas S, Hassanein KM, Mohn MP, Matzke H (1979) Suprascapular entrapment neuropathy: a clinical, anatomical, and comparative study. Part 2: anatomical study. Neurosurgery 5(4):447–451

    Article  CAS  Google Scholar 

  • Rochwerger A, Benaim LJ, Toledano E, Samson P, Legre R (2000) Surgical repair of the axillary nerve. Results of a five-year follow-up. Chir Main 19(1):31–35

    Article  CAS  Google Scholar 

  • Safran MR (2004) Nerve injury about the shoulder in athletes, part 1: suprascapular nerve and axillary nerve. Am J Sports Med 32(3):803–819

    Article  Google Scholar 

  • Sandow MJ, Ilic J (1998) Suprascapular nerve rotator cuff compression syndrome in volleyball players. J Shoulder Elbow Surg 7(5):516–521

    Article  CAS  Google Scholar 

  • Schilf E (1952) Unilateral paralysis of the suprascapular nerve. Nervenarzt 23(8):306–307

    CAS  Google Scholar 

  • Sunderland S (1990) The anatomy and physiology of nerve injury. Muscle Nerve 13(9):771–784

    Article  CAS  Google Scholar 

  • Thomas A (1936) La paralysie du muscle sous-epineux. Presse Med 64:1283–1284

    Google Scholar 

  • Tubbs RS, Oakes WJ, Blount JP, Elton S, Salter G, Grabb PA (2001) Surgical landmarks for the proximal portion of the axillary nerve. J Neurosurg 95(6):998–1000

    Article  CAS  Google Scholar 

  • Tubbs RS, Nechtman C, D’Antoni AV, Shoja MM, Mortazavi MM, Loukas M, Rozzelle CJ, Spinner RJ (2013) Ossification of the suprascapular ligament: a risk factor for suprascapular nerve compression? Int J Shoulder Surg 7(1):19–22

    Article  Google Scholar 

  • Uz A, Apaydin N, Bozkurt M, Elhan A (2007) The anatomic branch pattern of the axillary nerve. J Shoulder Elbow Surg 16(2):240–244

    Article  Google Scholar 

  • Vastamaki M, Goransson H (1993) Suprascapular nerve entrapment. Clin Orthop Relat Res 297:135–143

    Article  Google Scholar 

  • Westerheide KJ, Dopirak RM, Karzel RP, Snyder SJ (2006) Suprascapular nerve palsy secondary to spinoglenoid cysts: results of arthroscopic treatment. Arthroscopy 22(7):721–727

    Article  Google Scholar 

  • Witvrouw E, Cools A, Lysens R, Cambier D, Vanderstraeten G, Victor J, Sneyers C, Walravens M (2000) Suprascapular neuropathy in volleyball players. Br J Sports Med 34(3):174–180

    Article  CAS  Google Scholar 

  • Yan J, Horiguchi M (2000) The communicating branch of the 4th cervical nerve to the brachial plexus: the double constitution, anterior and posterior, of its fibers. Surg Radiol Anat 22(3–4):175–179

    Article  CAS  Google Scholar 

  • Zvijac JE, Sheldon DA, Schurhoff MR (2003) Extensive lipoma causing suprascapular nerve entrapment. Am J Orthop (Belle Mead NJ) 32(3):141–143

    Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Laurent Lafosse .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2015 Springer-Verlag Berlin Heidelberg

About this entry

Check for updates. Verify currency and authenticity via CrossMark

Cite this entry

Lafosse, L., Samitier, G., Petkin, K., Lafosse, T., Gupta, A. (2015). Nerve Entrapment Syndromes in the Shoulder: Diagnosis, Principles, and Different Techniques for Nerve Decompression. In: Doral, M.N., Karlsson, J. (eds) Sports Injuries. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-36569-0_27

Download citation

  • DOI: https://doi.org/10.1007/978-3-642-36569-0_27

  • Published:

  • Publisher Name: Springer, Berlin, Heidelberg

  • Print ISBN: 978-3-642-36568-3

  • Online ISBN: 978-3-642-36569-0

  • eBook Packages: MedicineReference Module Medicine

Publish with us

Policies and ethics