DYNAMIC SUPRASCAPULAR NERVE NEUROPATHY – «PAIN IN THE SCAPULAR AND SHOULDER». MANUAL DIAGNOSTICS AND TREATMENT

Dynamic suprascapular nerve neuropathy is a cause of shoulder pain and weakness that is often overlooked. The difficulty in diagnosing the nerve dynamic damages is conditioned by the fact that the symptoms are provoked by physical exertion(s) or a certain position of the limb due to compression and(or) overstretching as well as violations of the longitudinal and transverse sliding of the nerve. These symptoms subside when the provoking factor ceases to act and return when movements repeat. Neurologic examinations and nerve conduction studies performed at rest usually show no change. The suprascapular nerve dysfunction is closely related to rotator cuff pathology. The nerve damage is often caused by a dynamic microtrauma during repetitive arm movements over the head with maximum deflection and external rotation of the arm. Suprascapular neuropathy can be caused by the nerve compression or traction in the suprascapular notch or spinoglenoid region. The nerve damage in the suprascapular notch causes weakness in both the supraspinatus and infraspinatus muscles, while damage under the spinoglenoid ligament affects only the infraspinatus muscle. Diagnostics should include manual testing of the supraspinatus and infraspinatus muscles with a neutral position of the arm and neck of the patient being examined and during provocative neurodynamic tests of stretching the suprascapular nerve. Therapeutic measures should be directed to all interdependent components of the peripheral nervous system in the following sequence: osteopathic treatment of the nerve trunk interface (tissues surrounding the nerve trunk); osteopathic treatment of the innervated tissue; osteopathic treatment of the connective tissue of the suprascapular nerve.