Abstract
Neuropathies are a potential source of shoulder pain and may result from trauma, neoplasia, infection, neuropathy, autoimmune disease, and iatrogenic conditions. Entrapment neuropathies of the shoulder are also an important potential cause of pain; however they are likely underestimated. Commonly affected nerves in the shoulder include the suprascapular, axillary, long thoracic, cervical accessory, and dorsal scapular nerves. This chapter provides a review of anatomic structures and landmarks of relevant nerves around the shoulder and will outline pathologic conditions causing entrapment neuropathies such as compression, stretching, or iatrogenic lesions. Further, the role of several diagnostic imaging modalities is discussed. Familiarity with nerve abnormalities about the shoulder and their imaging findings should allow for a more comprehensive evaluation of painful syndromes and appropriate clinical or surgical management.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
References
Kamath S, Venkatanarasimha N, Walsh M, Hughes P. MRI appearance of muscle denervation. Skelet Radiol. 2008;37:397–404.
Blum A, Lecocq S, Louis M, Wassel J, Moisei A, Teixeira P. The nerves around the shoulder. Eur J Radiol. 2013;82:2–16.
Boykin RE, Friedman DJ, Higgins LD, Warner JJ. Suprascapular neuropathy. J Am Acad Orthop Surg. 2010;92:2348–64.
Lorei MP, Hershman EB. Peripheral nerve injuries in athletes. Sports Med. 1993;16:130–47.
Ludig T, Walter F, Chapuis D, Molé D, Roland J, Blum A. MR imaging evaluation of suprascapular nerve entrapment. Eur Radiol. 2001;11:2161–9.
Bencardino JT, Rosenberg ZS. Entrapment neuropathies of the shoulder and elbow in the athlete. Clin Sports Med. 2006;25:465–87.
Aiello I, Serra G, Traina G, Tugnoli V. Entrapment of the suprascapular nerve at the spinoglenoid notch. Ann Neurol. 1982;12:314–6.
Bigliani LU, Dalsey RM, McCann PD, April EW. An anatomical study of the suprascapular nerve. Arthroscopy. 1990;6:301–5.
Warner J, Krushell R, Masquelet A, Gerber C. Anatomy and relationships of the suprascapular nerve. J Bone Joint Surg Am. 1992;74:36–45.
Brown D, James D, Roy S. Pain relief by suprascapular nerve block in gleno-humeral arthritis. Scand J Rheumatol. 1988;17:411–5.
Matsumoto D, Suenaga N, Oizumi N, Hisada Y, Minami A. A new nerve block procedure for the suprascapular nerve based on a cadaveric study. J Shoulder Elb Surg. 2009;18:607–11.
Ritchie ED, Tong D, Chung F, Norris AM, Miniaci A, Vairavanathan SD. Suprascapular nerve block for postoperative pain relief in arthroscopic shoulder surgery: a new modality? Anesth Analg. 1997;84:1306–12.
Tubbs RS, Tyler-Kabara EC, Aikens AC, et al. Surgical anatomy of the axillary nerve within the quadrangular space. J Neurosurg. 2005;102:912–4.
Apaydin N, Tubbs RS, Loukas M, Duparc F. Review of the surgical anatomy of the axillary nerve and the anatomic basis of its iatrogenic and traumatic injury. Surg Radiol Anat. 2010;32:193–201.
McClelland D, Paxinos A. The anatomy of the quadrilateral space with reference to quadrilateral space syndrome. J Shoulder Elb Surg. 2008;17:162–4.
Safran MR. Nerve injury about the shoulder in athletes, part 2: long thoracic nerve, spinal accessory nerve, burners/stingers, thoracic outlet syndrome. Am J Sports Med. 2004;32:1063–76.
Wiater JM, Bigliani LU. Spinal accessory nerve injury. Clin Orthop. 1999;368:5–16.
Pecina M, Krmpotic-Nemanic J, Markiewitz A. Tunnel syndromes in the upper extremities; 1991. p. 11–84.
Ho E, Cofield RH, Balm MR, Hattrup SJ, Rowland CM. Neurologic complications of surgery for anterior shoulder instability. J Shoulder Elb Surg. 1999;8:266–70.
Lynch NM, Cofield RH, Silbert PL, Hermann RC. Neurologic complications after total shoulder arthroplasty. J Shoulder Elb Surg. 1996;5:53–61.
Small NC. Complications in arthroscopic surgery performed by experienced arthroscopists. Arthroscopy. 1988;4:215–21.
Rodeo SA, Forster RA, Weiland AJ. Neurological complications due to arthroscopy. J Bone Joint Surg Am. 1993;75:917–26.
Segmüller HE, Alfred SP, Zilio G, Saies AD, Hayes MG. Cutaneous nerve lesions of the shoulder and arm after arthroscopic shoulder surgery. J Shoulder Elb Surg. 1995;4:254–8.
Boardman ND, Cofield RH. Neurologic complications of shoulder surgery. Clin Orthop. 1999;368:44–53.
Marecek GS, Saltzman MD. Complications in shoulder arthroscopy. Orthopedics. 2010;33:492.
Piasecki DP, Romeo AA, Bach BR Jr, Nicholson GP. Suprascapular neuropathy. J Am Acad Orthop Surg. 2009;17:665–76.
Budzik J, Wavreille G, Pansini V, Moraux A, Demondion X, Cotten A. Entrapment neuropathies of the shoulder. Magn Reson Imaging Clin N Am. 2012;20:373–91.
Bianchi S, Martinoli C. Shoulder. In: Anonymous ultrasound of the musculoskeletal system. Berlin: Springer; 2007. p. 189–331.
Canella C, Demondion X, Abreu E, Marchiori E, Cotten H, Cotten A. Anatomical study of spinal accessory nerve using ultrasonography. Eur J Radiol. 2013;82:56–61.
Kim S, Hong SH, Jun WS, et al. MR imaging mapping of skeletal muscle denervation in entrapment and compressive neuropathies. Radiographics. 2011;31:319–32.
Beltran J, Rosenberg ZS. Diagnosis of compressive and entrapment neuropathies of the upper extremity: value of MR imaging. AJR Am J Roentgenol. 1994;163:525–31.
Petchprapa CN, Rosenberg ZS, Sconfienza LM, Cavalcanti CFA, La Rocca Vieira R, Zember JS. MR imaging of entrapment neuropathies of the lower extremity: part 1. The pelvis and hip 1. Radiographics. 2010;30:983–1000.
Yamabe E, Nakamura T, Oshio K, Kikuchi Y, Ikegami H, Toyama Y. Peripheral nerve injury: diagnosis with MR imaging of denervated skeletal muscle—experimental study in rats 1. Radiology. 2008;247:409–17.
Goutallier D, Postel JM, Bernageau J, Lavau L, Voisin MC. Fatty infiltration of disrupted rotator cuff muscles. Rev Rhum Engl Ed. 1995;62:415–22.
Ferretti A, Cerullo G, RUsso G. Suprascapular neuropathy in volleyball players. J Bone Joint Surg Am. 1987;69:260–3.
Holzgraefe M, Kukowski B, Eggert S. Prevalence of latent and manifest suprascapular neuropathy in high-performance volleyball players. Br J Sports Med. 1994;28:177–9.
Ringel SP, Treihaft M, Carry M, Fisher R, Jacobs P. Suprascapular neuropathy in pitchers. Am J Sports Med. 1990;18:80–6.
Witvrouw E, Cools A, Lysens R, et al. Suprascapular neuropathy in volleyball players. Br J Sports Med. 2000;34:174–80.
Lee BC, Yegappan M, Thiagarajan P. Suprascapular nerve neuropathy secondary to spinoglenoid notch ganglion cyst: case reports and review of literature. Ann Acad Med Singap. 2007;36:1032.
Semmler A, von Falkenhausen M, Schroder R. Suprascapular nerve entrapment by a spinoglenoid cyst. Neurology. 2008;70:890.
Yi JW, Cho NS, Rhee YG. Intraosseous ganglion of the glenoid causing suprascapular nerve entrapment syndrome: a case report. J Shoulder Elb Surg. 2009;18:e25–7.
Solheim LF, Roaas A. Compression of the suprascapular nerve after fracture of the scapular notch. Acta Orthop Scand. 1978;49:338–40.
Travlos J, Goldberg I, Boome RS. Brachial plexus lesions associated with dislocated shoulders. J Bone Joint Surg Br. 1990;72:68–71.
Visser C, Coene L, Brand R, Tavy D. The incidence of nerve injury in anterior dislocation of the shoulder and its influence on functional recovery a prospective clinical and EMG study. J Bone Joint Surg Br. 1999;81:679–85.
Yoon TN, Grabois M, Guillen M. Suprascapular nerve injury following trauma to the shoulder. J Trauma. 1981;21:652–5.
Mallon WJ, Wilson RJ, Basamania CJ. The association of suprascapular neuropathy with massive rotator cuff tears: a preliminary report. J Shoulder Elb Surg. 2006;15:395–8.
Lajtai G, Pfirrmann CW, Aitzetmuller G, Pirkl C, Gerber C, Jost B. The shoulders of professional beach volleyball players: high prevalence of infraspinatus muscle atrophy. Am J Sports Med. 2009;37:1375–83.
Cummins CA, Anderson K, Bowen M, Nuber G, Roth SI. Anatomy and histological characteristics of the spinoglenoid ligament. J Bone Joint Surg Am. 1998;80:1622–5.
Plancher KD, Luke TA, Peterson RK, Yacoubian SV. Posterior shoulder pain: a dynamic study of the spinoglenoid ligament and treatment with arthroscopic release of the scapular tunnel. Arthroscopy. 2007;23:991–8.
Demirhan M, Imhoff AB, Debski RE, Patel PR, Fu FH, Woo SL. The spinoglenoid ligament and its relationship to the suprascapular nerve. J Shoulder Elb Surg. 1998;7:238–43.
Bayramoğlu A, Demiryürek D, Tüccar E, et al. Variations in anatomy at the suprascapular notch possibly causing suprascapular nerve entrapment: an anatomical study. Knee Surg Sports Traumatol Arthrosc. 2003;11:393–8.
Cummins CA, Messer TM, Nuber GW. Current concepts review-suprascapular nerve entrapment*. J Bone Joint Surg. 2000;82:415–24.
Rengachary SS, Neff JP, Singer PA, Brackett CE. Suprascapular entrapment neuropathy: a clinical, anatomical, and comparative study: part 1: clinical study. Neurosurgery. 1979;5:441–6.
Ticker JB, Djurasovic M, Strauch RJ, et al. The incidence of ganglion cysts and other variations in anatomy along the course of the suprascapular nerve. J Shoulder Elb Surg. 1998;7:472–8.
Abboud JA, Silverberg D, Glaser DL, Ramsey ML, Williams GR. Arthroscopy effectively treats ganglion cysts of the shoulder. Clin Orthop. 2006;444:129–33.
Fehrman DA, Orwin JF, Jennings RM. Suprascapular nerve entrapment by ganglion cysts: a report of six cases with arthroscopic findings and review of the literature. Arthroscopy. 1995;11:727–34.
Moore TP, Fritts HM, Quick DC, Buss DD. Suprascapular nerve entrapment caused by supraglenoid cyst compression. J Shoulder Elb Surg. 1997;6:455–62.
Tirman PF, Feller JF, Janzen DL, Peterfy CG, Bergman AG. Association of glenoid labral cysts with labral tears and glenohumeral instability: radiologic findings and clinical significance. Radiology. 1994;190:653–8.
Westerheide KJ, Dopirak RM, Karzel RP, Snyder SJ. Suprascapular nerve palsy secondary to spinoglenoid cysts: results of arthroscopic treatment. Arthroscopy. 2006;22:721–7.
Tung GA, Entzian D, Stern JB, Green A. MR imaging and MR arthrography of paraglenoid labral cysts. Am J Roentgenol. 2000;174:1707–15.
O'Connor EE, Dixon LB, Peabody T, Stacy GS. MRI of cystic and soft-tissue masses of the shoulder joint. Am J Roentgenol. 2004;183:39–47.
Van Es H. MRI of the brachial plexus. Eur Radiol. 2001;11:325–36.
Martinoli C, Bianchi S, Pugliese F, et al. Sonography of entrapment neuropathies in the upper limb (wrist excluded). J Clin Ultrasound. 2004;32:438–50.
Martinoli C, Gandolfo N, Perez MM, et al. Brachial plexus and nerves about the shoulder. Semin Musculoskelet Radiol. 2010;14:523.
Huang K, Tu Y, Huang T, Hsu RW. Suprascapular neuropathy complicating a Neer type I distal clavicular fracture: a case report. J Orthop Trauma. 2005;19:343–5.
Visser CP, Coene L, Brand R, Tavy DL. Nerve lesions in proximal humeral fractures. J Shoulder Elb Surg. 2001;10:421–7.
Wijdicks CA, Armitage BM, Anavian J, Schroder LK, Cole PA. Vulnerable neurovasculature with a posterior approach to the scapula. Clin Orthop Relat Res. 2009;467:2011–7.
Fritz RC, Helms CA, Steinbach LS, Genant HK. Suprascapular nerve entrapment: evaluation with MR imaging. Radiology. 1992;182:437–44.
Bredella M, Tirman P, Fritz R, Wischer T, Stork A, Genant H. Denervation syndromes of the shoulder girdle: MR imaging with electrophysiologic correlation. Skelet Radiol. 1999;28:567–72.
Cahill BR, Palmer RE. Quadrilateral space syndrome. J Hand Surg. 1983;8:65–9.
Sanders TG, Tirman PF. Paralabral cyst: an unusual cause of quadrilateral space syndrome. Arthroscopy. 1999;15:632–7.
Redler MR, Ruland LJ 3rd, FC MC 3rd. Quadrilateral space syndrome in a throwing athlete. Am J Sports Med. 1986;14:511–3.
Schulte KR, Warner JJ. Uncommon causes of shoulder pain in the athlete. Orthop Clin North Am. 1995;26:505–28.
Robinson P, White L, Lax M, Salonen D, Bell R. Quadrilateral space syndrome caused by glenoid labral cyst. Am J Roentgenol. 2000;175:1103–5.
Tirman PF, Bost FW, Steinbach LS, et al. MR arthrographic depiction of tears of the rotator cuff: benefit of abduction and external rotation of the arm. Radiology. 1994;192:851–6.
Sofka CM, Lin J, Feinberg J, Potter HG. Teres minor denervation on routine magnetic resonance imaging of the shoulder. Skelet Radiol. 2004;33:514–8.
Perlmutter GS. Axillary nerve injury. Clin Orthop. 1999;368:28–36.
Bryan WJ, Schauder K, Tullos HS. The axillary nerve and its relationship to common sports medicine shoulder procedures. Am J Sports Med. 1986;14:113–6.
Wilson L, Sundaram M, Piraino DW, Ilaslan H, Recht MP. Isolated teres minor atrophy: manifestation of quadrilateral space syndrome or traction injury to the axillary nerve? Orthopedics. 2006;29:447–50.
Yanny S, Toms AP. MR patterns of denervation around the shoulder. Am J Roentgenol. 2010;195:W157–63.
Cothran RL Jr, Helms C. Quadrilateral space syndrome: incidence of imaging findings in a population referred for MRI of the shoulder. Am J Roentgenol. 2005;184:989–92.
Tuckman GA, Devlin TC. Axillary nerve injury after anterior glenohumeral dislocation: MR findings in three patients. AJR Am J Roentgenol. 1996;167:695–7.
Price MR, Tillett ED, Acland RD, Nettleton GS. Determining the relationship of the axillary nerve to the shoulder joint capsule from an arthroscopic perspective. J Bone Joint Surg Am. 2004;86:2135–42.
Fleckenstein JL, Watumull D, Conner KE, et al. Denervated human skeletal muscle: MR imaging evaluation. Radiology. 1993;187:213–8.
Bencardino J, Petchprapa C, Rybak L, Hassankhani A, Palmer W. Teres minor atrophy: a sign of axillary denervation injury following shoulder trauma. Radiology. 2002;225:371.
Omar N, Alvi F, Srinivasan M. An unusual presentation of whiplash injury: long thoracic and spinal accessory nerve injury. Eur Spine J. 2007;16:275–7.
McFarland EG, Garzon-Muvdi J, Jia X, Desai P, Petersen SA. Clinical and diagnostic tests for shoulder disorders: a critical review. Br J Sports Med. 2010;44:328–32.
Wiater JM, Flatow EL. Long thoracic nerve injury. Clin Orthop. 1999;368:17–27.
Sahin F, Yilmaz F, Esit N, Aysal F, Kuran B. Compressive neuropathy of long thoracic nerve and accessory nerve secondary to heavy load bearing. Eura Medicophys. 2007;47:71–4.
O'Dell M, Stubblefield M, O'Dell M, Stubblefield M. Cancer rehabilitation: principles and practice. New York: Demos Medical Publishing; 2009.
Martin RM, Fish DE. Scapular winging: anatomical review, diagnosis, and treatments. Curr Rev Musculoskelet Med. 2008;1:1–11.
Toth C, McNeil S, Feasby T. Peripheral nervous system injuries in sport and recreation. Sports Med. 2005;35:717–38.
Tubbs RS, Tyler-Kabara EC, Aikens AC, et al. Surgical anatomy of the dorsal scapular nerve. J Neurosurg. 2005;102:910–1.
Chen D, Gu Y, Lao J, Chen L. Dorsal scapular nerve compression. Atypical thoracic outlet syndrome. Chin Med J. 1995;108:582–5.
Akgun K, Aktas I, Terzi Y. Winged scapula caused by a dorsal scapular nerve lesion: a case report. Arch Phys Med Rehabil. 2008;89:2017–20.
Kuhn JE, Plancher KD, Hawkins RJ. Scapular Winging. J Am Acad Orthop Surg. 1995;3:319–25.
Spillane J. Localised neuritis of the shoulder girdle: a report of 46 cases in the MEF. Lancet. 1943;242:532–5.
Parsonage M, Aldren Turner J. Neuralgic amyotrophy the shoulder-girdle syndrome. Lancet. 1948;251:973–8.
Tsairis P, Dyck PJ, Mulder DW. Natural history of brachial plexus neuropathy: report on 99 patients. Arch Neurol. 1972;27:109–17.
Turner JA. Acute brachial radiculitis. Br Med J. 1944;2:592–4.
Dixon GJ, Dick T. Acute brachial radiculitis course and prognosis. Lancet. 1945;246:707–8.
Magee KR, DeJong RN. Paralytic brachial neuritis: discussion of clinical features with review of 23 cases. JAMA. 1960;174:1258–62.
Weikers NJ, Mattson RH. Acute paralytic brachial neuritis. A clinical and electrodiagnostic study. Neurology. 1969;19:1153–8.
Scalf RE, Wenger DE, Frick MA, Mandrekar JN, Adkins MC. MRI findings of 26 patients with Parsonage-Turner syndrome. Am J Roentgenol. 2007;189:W39–44.
Pellas F, Olivares J, Zandotti C, Delarque A. Neuralgic amyotrophy after parvovirus B19 infection. Lancet. 1993;342:503–4.
Suarez GA, Giannini C, Bosch EP, et al. Immune brachial plexus neuropathy: suggestive evidence for an inflammatory-immune pathogenesis. Neurology. 1996;46:559–61.
Ryan M, Twair A, Nelson E, Brennan D, Eustace S. Whole body magnetic resonance imaging in the diagnosis of Parsonage Turner syndrome. Acta Radiol. 2004;45:534–9.
Beghi E, Kurland LT, Mulder DW, Nicolosi A. Brachial plexus neuropathy in the population of Rochester, Minnesota, 1970–1981. Ann Neurol. 1985;18:320–3.
Helms CA, Martinez S, Speer KP. Acute brachial neuritis (Parsonage-Turner syndrome): MR imaging appearance--report of three cases. Radiology. 1998;207:255–9.
Gaskin CM, Helms CA. Parsonage-Turner Syndrome: MR Imaging Findings and Clinical Information of 27 Patients 1. Radiology. 2006;240:501–7.
Sallomi D, Janzen DL, Munk PL, Connell DG, Tirman PF. Muscle denervation patterns in upper limb nerve injuries: MR imaging findings and anatomic basis. AJR Am J Roentgenol. 1998;171:779–84.
Uetani M, Hayashi K, Matsunaga N, Imamura K, Ito N. Denervated skeletal muscle: MR imaging. Work in progress. Radiology. 1993;189:511–5.
May DA, Disler DG, Jones EA, Balkissoon AA, Manaster B. Abnormal signal intensity in skeletal muscle at MR imaging: patterns, pearls, and pitfalls 1. Radiographics. 2000;20:S295–315.
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2019 Springer Nature Switzerland AG
About this chapter
Cite this chapter
Eajazi, A., Bredella, M.A., Torriani, M. (2019). Imaging Diagnosis of Nerve Entrapments in the Shoulder. In: Bencardino, J. (eds) The Shoulder. Springer, Cham. https://doi.org/10.1007/978-3-030-06240-8_14
Download citation
DOI: https://doi.org/10.1007/978-3-030-06240-8_14
Published:
Publisher Name: Springer, Cham
Print ISBN: 978-3-030-06239-2
Online ISBN: 978-3-030-06240-8
eBook Packages: MedicineMedicine (R0)