Suprascapular neuropathy - Variability in the diagnosis, treatment, and outcome

The functional outcome of operative and nonoperative treatment of suprascap ular neuropathy was compared to determine the preferred method of treatment for each etiology of nerve injury. The predictive value of preoperative el ectromyography also was studied. Fifty-three patients were evaluated at lea st 1 year (average, 28 months) from the time of operative (n = 36) or nonop erative (n = 17) treatment. A modified American Shoulder and Elbow Surgeons self-assessment score was obtained at presentation and at final followup, Electromyography data were obtained at initial presentation. Minimal electr omyographic changes associated with denervation were associated with a limi ted response to treatment, especially in patients with nerve compression se condary to spinoglenoid notch cysts. Pretreatment electromyographic finding s, therefore, were predictive of treatment response. Overall, operative and nonoperative treatment of these suprascapular nerve injuries resulted in s ignificant functional improvement, but the results varied depending on the etiology of the injury. Spinoglenoid notch cysts responded significantly be tter to operative treatment, with the results for open surgery being the sa me as the results for arthroscopic decompression. In addition, compressive lesions attributable to suprascapular notch entrapment had the best improve ment with surgical decompression. Traumatic lesions, including traction and direct closed injuries, had an equal response to operative and nonoperativ e treatment. Overuse injuries did not improve with operative treatment. Vir al neuritis improved with nonoperative treatment and never was treated with surgery. Overall, traumatic injuries resulted in significantly worse final outcomes than any other etiologic processes. In the nonoperative group, ne uropathy secondary to spinoglenoid cysts resulted in significantly worse fu nction. The outcome of treatment is dependent on the severity and etiology of the nerve injury, and the method of treatment.