Neurological Problems around shoulder

Suprascapular Nerve (C5,6 ) Injury

Compression

     due to Ganglion , Labral tears


   Above spinoglenoid notch - Supra/infra-scapular muscles

   Below spinoglenoid notch with infracspinatus muscle

Clinical features

    Lateral shoulder pain

     Wasting of supraspinatus /infraspinatus muscles

      Loss of abduction and external rotation


Management

    EMGs

    NCS



Treatment

     Trapezius muscle splitting approach

       decompress notch

     arthroscopic debridement of notch







Long Thoracic Nerve (C5-7 )

           Neuorolysis

           Pectoralis Major transfer



Spinal Accessory Nerve Injury

    Mx

        Non-operative after more than 12 months with good compensation


        Options - Neurolysis ,direct repair with nerve grafting , muscle transfer ,scapulothoracic fusion





Thoracic Outlet Syndrome

   Causes


          Cervical rib, anomalous scalenius


Types

        Neurogenic - Upper Plexus Type

                               Lower Plexus Type

        Vascular

    sites of compression

       as plexus passes over first rib

       under clavicle by subclavian tendon

        underneath coracoid process


  Provocative

     Adson , Wright ,Roos


 Investigations

        Plain radiographs of Chest  and Spine

         CT- for suspected bony anomaly

        MRI - for cervical pathology , tumor or radiation plexitis

        Doppler arteriography /Venography

        EMG and NCS


Treatment

     Physiotherapy 

      Ist rib resection , release or excision of scalene anterior and middle muscles

      via transaxillary or supraclavicular approach

     Venous thrombolysis or arterial thrombectomy and vascular reconstruction