Musculoskeletal
Harrison Jordan, DO
Resident Physician
East Carolina University Department of Physical Medicine and Rehabilitation
Greenville, North Carolina, United States
Ryan A. Brady, MD
Resident Physician
ECU Health Medicine Center - Dept. of Physical Medicine & Rehabilitation
Winterville, North Carolina, United States
Bill Rieck, DO
Clinical Assistant Professor
ECU Health
Greenville, North Carolina, United States
Harrison Jordan, DO
East Carolina University Department of Physical Medicine and Rehabilitation
Greenville, North Carolina, United States
Fatty atrophy and injury to the suprascapular nerve branch to the supraspinatus.
A 61-year-old female with a past medical history of rotator cuff repair of the right shoulder within the previous year presented with right shoulder weakness. On evaluation, the patient had a limited right shoulder range of motion to 90 degrees of abduction and 90 degrees of flexion. Given the patient’s recent full-thickness rotator cuff tear and repair, injury to the suprascapular nerve was suspected. Electrodiagnostic studies (EDX) were performed and revealed active denervation of the right supraspinatus muscle with normal activation of the infraspinatus, suggesting injury to the suprascapular nerve branch to the supraspinatus. As these changes may also be present following rotator cuff repair, an MRI of the right shoulder was completed and revealed fatty atrophy of the supraspinatus, which confirmed compression of the suprascapular nerve, and the patient was advised to follow up with orthopedic surgery for possible suprascapular nerve release.
Suprascapular neuropathy (SSN) following repair of full-thickness rotator cuff tears has been shown in several studies; however, it is a rare complication following primary rotator cuff repair. When post-operative neuropathy occurs and persists, the differential diagnosis remains broad and includes: direct iatrogenic injury, cervical radiculopathy, brachial plexitis, and compression by a mass such as a hematoma or cyst. As demonstrated in this case, EDX remains the gold standard in the evaluation of suspected SSN and should be performed in patients with persistent weakness following rotator cuff tear and repair to help guide a tailored approach to treatment.
In conclusion, EDX is a useful diagnostic tool for evaluating suspected SSN, particularly in patients who have undergone rotator cuff tear and repair, where it can help identify isolated nerve compression and provide details for further management.
