Joints and ligaments · Upper limb
Suprascapular ligament !
The suprascapular ligament bridges a notch on the top edge of the shoulder blade, forming a tunnel for the suprascapular nerve.
Official name: Superior transverse scapular ligament
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What it is
A band that closes the notch on the top edge of the shoulder blade.
What it does
Forms a tunnel for the suprascapular nerve; a tight tunnel can pinch the nerve.
Key facts
- Attaches
- Bridges the suprascapular notch
- Function
- Suprascapular nerve passes below, artery above ('army over the bridge, navy under')
- Tight in
- Not joint-dependent
Relations
- Below
- Suprascapular nerve, passing through the foramen beneath it into the supraspinous fossa
- Above
- Suprascapular artery and vein (scapular arteries), which usually cross above it
- Lateral
- Base of the coracoid process
- Medial
- Superior border of the scapula, near the attachment of the inferior belly of omohyoid
- Behind
- Supraspinatus, which the nerve supplies just beyond the notch
How to find it
Not palpable: it lies at the upper border of the scapula, deep to trapezius and supraspinatus, just medial to the base of the coracoid. Arthroscopic release reaches it by following the conoid ligament back to the coracoid base, where the notch begins.
Examination
- Inspection from behind: hollowing both above and below the spine of the scapula suggests a lesion at this notch, while hollowing only below the spine points to the spinoglenoid notch
- Resisted external rotation with the arm at the side: weakness, with wasting of infraspinatus, suggests suprascapular nerve involvement; nerve conduction studies and EMG confirm it
On imaging
MRI shows denervation oedema and later fatty atrophy of supraspinatus and infraspinatus, and any mass at the notch; electromyography confirms the lesion. CT or an AP X-ray with caudal tilt shows an ossified ligament.
Clinical notes
- Suprascapular neuropathy: deep, vague pain at the back of the shoulder with weak abduction and external rotation, seen in overhead athletes such as volleyball players, after traction injuries and with massive retracted cuff tears
- Arthroscopic or open release of the ligament decompresses the nerve
- The suprascapular nerve block, used for shoulder pain and after surgery, targets the nerve in the floor of the supraspinous fossa near the notch
Anatomical variants
- Partial or complete ossification of the ligament (reported rates vary widely between studies)
- The notch ranges from a shallow dip to a deep U or V; a narrow notch may favour entrapment
- The suprascapular artery or vein sometimes runs under the ligament together with the nerve
Test yourself
Think of the answer, then tap the question to see it.
Which nerve passes under the suprascapular ligament, and which vessels usually pass above?
The suprascapular nerve passes under it; the suprascapular artery and vein usually cross above.
Which muscles weaken with nerve entrapment under the suprascapular ligament?
Both supraspinatus and infraspinatus, which waste.
How can the suprascapular ligament form a rigid ring around the nerve?
It can be partly or completely ossified.
Educational information, not medical advice. For any symptom, see a health professional.
Its names
- Official Latin (TA2)
- ligamentum transversum superius scapulae TA2 1741
- Official Spanish (DeCS)
- Ligamento transverso superior de la escápula
- English (TA2)
- Superior transverse scapular ligament
Related
Sources: Terminologia Anatomica (TA2); Anatomy, Shoulder and Upper Limb, Suprascapular Nerve.
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Representative model, for educational purposes only.
