Summary Suprascapular neuropathy is compression of the suprascapular nerve that most commonly occurs at the suprascapular notch or spinoglenoid notch by a mass (i.e cyst). Diagnosis can be suspected clincally with weakness and atrophy of the infraspinatous or supraspinatous and confirmed with MRI studies showing cysts in the suprascapular notch or spinoglenoid notch. Treatment of suprascapular nerve compression at the suprascapular notch requires decompression of a cyst when present. Treatment of a spinoglenoid cyst requires either decompression or repair of an associated labral lesion (if present). Etology Pathophysiology suprascapular notch entrapment weakness of both supraspinatus and infraspinatus spinoglenoid notch entrapment weakness of infraspinatus only Associated conditions SLAP tears Anatomy Suprascapular nerve (C5,C6) emerges off superior trunk (C5,C6) of brachial plexus travels across posterior triangle of neck to scapula innervates supraspinatus infraspinatus Suprascapular ligament arises from medial base of coracoid and overlies suprascapular notch suprascapular artery runs above suprascapular nerve runs below Spinoglenoid ligament arises near spinoglenoid notch overlies distal suprascapular nerve Suprascapular notch entrapment Introduction proximal compression of suprascapular nerve in the suprascapular notch leads to weakness of both supraspinatus and infraspinatus Pathoanatomy compression can be from ganglion cyst (often associated with labral tears) transverse scapular ligament entrapment fracture callus Presentation symptoms deep, diffuse, posterolateral shoulder pain physical exam pain with palpation of suprascapular notch weakness of supraspinatus weakness seen with shoulder abduction to 90 degree, 30 degrees forward flexion, and with internal rotation (Jobe test positive) weakness of infraspinatus weakness to external rotation with elbow at side atrophy along the posterior scapula Evaluation MRI important to identify a compressive mass with associated cyst EMG/NCV diagnostic Treatment nonoperative activity modification and organized shoulder rehab program indications no structural lesion seen on MRI technique rehab should be performed for a minimum of 6 months operative surgical nerve decompression at suprascapular notch indications structural lesion seen on MRI (cyst) failure of extended nonoperative management (~ 1 year) Spinoglenoid notch entrapment Introduction distal compression of suprascapular nerve affects infraspinatus only Pathoanatomy compression can be due to posterior labral tears causing a cyst spinoglenoid ligament spinoglenoid notch ganglion traction injury (seen in 45% of volley ball players) transglenoid fixation lies 1.5cm medial to glenoid labrum Presentation symptoms deep, diffuse, posterolateral shoulder pain physical exam infraspinatus weakness weakness to external rotation with elbow at side infraspinatus atrophy along the posterior scapula supraspinatus strength is normal Evaluation MRI important to identify posterior labral lesions with associated cyst EMG/NCV diagnostic Treatment nonoperative activity modification and organized shoulder rehab program indications no structural lesion seen on MRI technique posterior shoulder capsule stretching operative labral repair with arthroscopic cyst decompression indications labral lesion with associated cyst seen on MRI spinoglenoid ligament release with nerve decompression indications no structural lesion seen on MRI and failure of extended nonoperative management (~ 1 year) technique posterior approach commonly utilized decompress nerve in spinoglenoid notch