Physical Therapy: A Nonsurgical Treatment For Suprascapular Neuropathy

Supracapsular neuropathy—a cause of shoulder pain—occurs in athletes whose sports involve sideways movements or extending the arm over the head. Playing tennis, baseball, or volleyball puts you at higher risk of an overuse injury of the shoulder, particularly rotator cuff tears. But depending on the severity of the injury, treatment doesn't always require shoulder surgery to repair the rotator cuff or remove pressure on the suprascapular nerve–the nerve that runs along the back of the shoulder.

Even if you eventually need surgery, doctors generally first recommend nonoperative treatment approaches, such as taking nonsteroidal anti-inflammatory drugs and going to physical therapy. Understanding more about the suprascapular nerve, and the symptoms and diagnosis of suprascapular neuropathy can help you be better informed when discussing a treatment program with your doctor or physical therapist.

Suprascapular Nerve

The suprascapular nerve is the nerve that travels to the shoulder blade region from the bundle of nerves that exit the spine at the base of the neck. The trapezius–the pair of triangular muscles responsible for movement of the head and shoulder–lies over the nerve. Although suprascapular neuropathy is an uncommon nerve injury involving the shoulder, nerve compression or nerve entrapment can occur, affecting the motor and sensory functions of the shoulder and arm.

Symptoms

Suprascapular neuropathy can be a disabling nerve injury if left untreated. Symptoms may include:

• Dull, aching pain in the shoulder
• Pain that radiates down the arm
• Shoulder weakness and loss of muscle strength
• Reduced motor function that makes moving the arm difficult
• Muscle atrophy

Diagnosis

Suprascapular neuropathy isn't always easy to diagnose, especially since there are multiple factors that can cause the problem. Sometimes the condition is overlooked or misdiagnosed. Consequently, your doctor may begin with X-rays and an MRI (magnetic resonance imaging) scan to identify the cause of your symptoms. Although an MRI can show nerve damage, your doctor may need to order nerve conduction studies to measure how fast the nerves supplying the shoulder muscle can send electrical signals. In some cases, electromyography–a study doctors use to asses electrical activity the muscles produce–is needed to identify the location of nerve entrapment.

Treatment

Physical therapy that includes stretching and strengthening exercises of the shoulder muscles and surrounding muscles can help restore mobility when the suprascapular nerve gets stretched or compressed, affecting the muscles that the nerve supplies. Since improper movement patterns can stretch the nerve, a physical therapist will instruct you in proper movement patterns of the shoulder blade. Shoulder range-of-motion exercises also help to relieve shoulder pain by improving shoulder joint function.

Studies indicate that a program of physical therapy generally helps to improve symptoms associated with suprascapular neuropathy except when ligaments, bone, lesions, or cysts are putting pressure on the nerve. In that case, you may need surgery to prevent permanent nerve damage and serious disability. Otherwise, physical therapy normally produces effective results.

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