Ashton Fiona, Swaile Heather, Tambe Amol
Department of Trauma & Orthopaedics, Royal Derby Hospital, University Hospitals of Derby and Burton NHS Foundation Trust, Derby, UK.
Indian J Orthop. 2025 Mar 26;59(6):756-767. doi: 10.1007/s43465-024-01302-4. eCollection 2025 Jun.
The suprascapular nerve is inherently vulnerable to entrapment, as it is relatively constrained by its surrounding anatomy: proximally crossing the suprascapular notch; or more distally over the spinoglenoid notch. Despite this, suprascapular nerve entrapment is relatively uncommon, and has until recently been an underappreciated cause of shoulder pain and dysfunction.
Aetiology is typically due to traction or compression nerve injury, and a number of high-risk variants in anatomy have now been described. The symptoms are best investigated with magnetic resonance imaging and electrodiagnostic evaluation, with X-ray, ultrasound and CT scans useful in excluding common differential diagnoses, and possible future roles for MR neurography and diagnostic suprascapular nerve block.
The majority of patients respond well to non-operative management, with a multimodal non-operative approach thought to optimise outcomes. The role of neuromodulation in non-operative management continues to evolve, but has shown promising early results. For patients with a clear compressive structural lesion, or where symptoms are refractory to non-operative management, surgery is required. There are now well-established techniques for both arthroscopic and open approaches to suprascapular and spinoglenoid decompression. Outcomes from isolated suprascapular nerve decompression have been consistently impressive, but the use of suprascapular nerve decompression as an adjunct to associated rotator cuff repair or stabilisation procedures had been observed to attracted a relatively high rate of complication, prompting speculation that it may be advisable to maintain a high threshold for adjunct nerve decompression procedures: where there is known suprascapular nerve neuropathy or the presence of high-risk anatomical variants.
肩胛上神经天生容易受到卡压，因为它相对受到周围解剖结构的限制：在近端穿过肩胛上切迹；或在更远端越过冈下切迹。尽管如此，肩胛上神经卡压相对不常见，直到最近一直是肩部疼痛和功能障碍的一个未被充分认识的原因。
病因通常是牵拉或压迫性神经损伤，现在已经描述了一些解剖学上的高危变异。症状最好通过磁共振成像和电诊断评估来研究，X线、超声和CT扫描有助于排除常见的鉴别诊断，以及磁共振神经造影和诊断性肩胛上神经阻滞可能的未来作用。
大多数患者对非手术治疗反应良好，多模式非手术方法被认为能优化治疗效果。神经调节在非手术治疗中的作用仍在不断发展，但已显示出有希望的早期结果。对于有明确压迫性结构病变的患者，或症状对非手术治疗无效的患者，则需要手术治疗。现在有成熟的关节镜和开放手术技术用于肩胛上和冈下减压。单纯肩胛上神经减压的效果一直令人印象深刻，但观察到将肩胛上神经减压作为相关肩袖修复或稳定手术的辅助手段会引发相对较高的并发症发生率，这促使人们推测，对于辅助神经减压手术可能宜保持较高的阈值：即在已知存在肩胛上神经病变或存在高危解剖变异的情况下。
