What is the recommended treatment for left suprascapular neuropathy at the spinoglenoid notch?

Treatment of Left Suprascapular Neuropathy at the Spinoglenoid Notch

Initial conservative management with physical therapy, activity modification, and NSAIDs should be attempted for 3-6 months, followed by arthroscopic surgical decompression if symptoms persist, as this approach provides significant functional improvement with minimal complications.

Initial Conservative Management (First-Line Treatment)

• Begin with activity modification, physical therapy focusing on scapular stabilization, and NSAIDs for 3-6 months 1, 2.
• Avoid overhead activities and repetitive motions that may cause traction injury to the nerve 1, 2.
• Consider acetaminophen or ibuprofen for pain relief if no contraindications exist 3.
• Physical therapy should emphasize strengthening of the infraspinatus and external rotation exercises 1.

Diagnostic Confirmation

• Obtain MRI to assess for ganglion cysts (present in only 20.7% of cases), muscle atrophy, and concomitant rotator cuff pathology 4.
• Perform EMG and nerve conduction studies as the gold standard for diagnosis, though nerve pain may occur even with negative EMG 1, 2.
• Look for isolated infraspinatus atrophy and weakness in external rotation (typically 3/5 or 4/5 strength) on physical examination 4.
• Note that a ganglion cyst is NOT necessary for nerve compression at the spinoglenoid notch to occur 4.

Surgical Intervention (When Conservative Treatment Fails)

Proceed to arthroscopic suprascapular nerve decompression at the spinoglenoid notch if symptoms persist beyond 3-6 months of conservative management 1, 2, 5.

Surgical Outcomes and Expectations:

• 79% of patients show improved external rotation strength within 1 week of surgery 4.
• All patients improve by at least one full strength grade, with 66% regaining full external rotation strength 4.
• Mean ASES scores improve from 48 to 75 postoperatively (p<0.05) 4.
• At mean 4.8-year follow-up, significant improvements occur in ASES (64.9 to 83.5), QuickDASH (28.7 to 12.7), and SANE scores (64.3 to 80.8) 5.
• No complications or revisions were reported in recent arthroscopic series 5.

Special Surgical Considerations:

• If a ganglion cyst is present, all patients regain full external rotation strength within mean 6 weeks 4.
• The arthroscopic approach detaches no muscle and allows rapid recovery 4.
• If concomitant posterosuperior massive rotator cuff tear is present, repair the rotator cuff alone first—adding nerve decompression does NOT improve functional outcomes 6.

Critical Pitfalls to Avoid

• Do not assume a ganglion cyst must be present—compression can occur without a space-occupying lesion 4.
• Do not perform isolated suprascapular nerve block as definitive treatment—while it may reduce pain temporarily, surgical decompression is needed for persistent cases 3.
• Avoid opioids as first-line treatment; reserve strictly for rescue analgesia 7.
• Do not delay surgical referral beyond 6 months of failed conservative treatment, as prolonged denervation may compromise muscle recovery 2.

Algorithm for Decision-Making

1. Confirm diagnosis: Clinical exam showing isolated infraspinatus weakness + MRI + EMG/NCS 1, 2, 4.
2. Trial conservative management: 3-6 months of PT, activity modification, NSAIDs 1, 2.
3. If symptoms persist: Refer for arthroscopic surgical decompression 2, 4, 5.
4. If massive rotator cuff tear present: Repair rotator cuff alone; nerve decompression adds no benefit 6.
5. Postoperative: Expect strength improvement within 1 week; full recovery by 6 weeks if cyst present 4.