(Kiosk 2) Pharmacist with Suprascapular Neuropathy: A Case Report

Case Diagnosis: Right suprascapular neuropathy at the suprascapular notch

Case Description or Program Description: A 36-year-old male pharmacist presents with a 5-month history of right shoulder pain and weakness. He performs repetitive overhead reaching as part of his occupation. History was not consistent with Parsonage-Turner Syndrome and there was no antecedent event, such as trauma, vaccination, or infection. Physical examination of the right shoulder revealed 3/5 strength in external rotation with atrophy of the right supraspinatus and infraspinatus muscles.

Setting: Outpatient PM&R musculoskeletal clinic

Assessment/Results: Electromyography (EMG) of the right upper extremity demonstrated a subacute-to-chronic right suprascapular neuropathy at the suprascapular notch. Neuromuscular ultrasound of the right supraspinatus and infraspinatus muscles showed atrophy and increased echogenicity consistent with chronic denervation. Magnetic Resonance Imaging (MRI) of the right shoulder showed no evidence of structural abnormality involving the suprascapular nerve and no full-thickness rotator cuff tear. The patient underwent right suprascapular nerve decompression at the suprascapular notch resulting in improvement in right shoulder pain and strength.

Discussion (relevance): There is a growing amount of suprascapular neuropathy cases reported in the medical literature. Many of these cases have no evidence of suprascapular nerve abnormalities on MRI. EMG remains the gold standard for diagnosing suprascapular neuropathy. Neuromuscular ultrasound is emerging as a useful imaging modality for diagnosis of suprascapular neuropathy. Traction and compression of the suprascapular nerve can occur with repetitive overhead activity as seen in this case. Early diagnosis and treatment of suprascapular neuropathy is critical and can lead to improved outcomes.

Conclusions: Our case describes the importance of considering suprascapular neuropathy in the differential diagnosis in patients presenting with shoulder pain and weakness. The case highlights the utility of EMG and neuromuscular ultrasound in facilitating a correct diagnosis to guide appropriate future management.