Suprascapular nerve !
The suprascapular nerve runs over the top of the shoulder blade; it moves the supraspinatus and infraspinatus and carries shoulder joint sensation.
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What it is
A nerve from the upper trunk that runs through the notch of the shoulder blade.
What it does
Powers the supraspinatus and infraspinatus; also used for shoulder pain blocks.
Key facts
- Roots
- C5–C6, superior trunk
- Moves
- Supraspinatus, infraspinatus
- Feeling from
- Glenohumeral and AC joints (no skin)
Relations
- Course
- From the upper trunk it runs laterally across the posterior triangle of the neck, deep to trapezius and omohyoid, to the suprascapular notch; it supplies supraspinatus, then winds round the lateral border of the scapular spine through the spinoglenoid notch into the infraspinous fossa
- Above
- The superior transverse scapular ligament bridging the notch, with the suprascapular artery and vein usually above it
- Superficial
- Trapezius, then supraspinatus in the supraspinous fossa
- Deep
- The bone of the supraspinous fossa and the spinoglenoid notch, which an inconstant spinoglenoid ligament may roof over
How to find it
Not palpable. The suprascapular notch lies on the upper border of the scapula, just medial to the base of the coracoid process; for a suprascapular nerve block the nerve is reached in the supraspinous fossa above the scapular spine, usually under ultrasound.
Examination
- Resisted external rotation with the arm at the side (infraspinatus) and the empty-can (Jobe) test (supraspinatus): weakness with intact cuff tendons on imaging suggests the nerve
- Inspection from behind: wasting of the infraspinous fossa (and the supraspinous fossa in a notch lesion) makes the scapular spine stand out
- Cross-body adduction stretches the nerve at the notch and may reproduce deep, poorly localised posterior shoulder pain
On imaging
MRI shows denervation oedema or fatty atrophy in supraspinatus and infraspinatus (notch lesion) or infraspinatus alone (spinoglenoid lesion), and any cyst pressing on the nerve; EMG confirms the level.
Clinical notes
- Overhead athletes (volleyball, pitching): repeated traction at the spinoglenoid notch can cause painless infraspinatus wasting
- Suprascapular nerve block is used for pain after shoulder surgery and in chronic shoulder pain, often combined with an axillary nerve block
- At risk in scapular and distal clavicle fractures and with large retracted rotator cuff tears that pull the nerve tight
- Entrapment vs rotator cuff tear: both weaken abduction and external rotation; normal tendons with muscle wasting on imaging point to the nerve
Anatomical variants
- The suprascapular vessels usually run above the ligament and the nerve below it, but the vessels sometimes pass under it with the nerve
- The superior transverse scapular ligament may be partly or completely ossified, turning the notch into a narrow foramen
Development
Its C5–C6 fibres are among the first lost in Erb (upper trunk) birth palsy. With supraspinatus and infraspinatus weak, nothing balances internal rotation; a lasting contracture in a growing child can deform the glenoid and sublux the humeral head backward.
Memory aid
'The Army goes over the bridge, the Navy goes under': suprascapular Artery over the ligament, Nerve under it.
Related conditions
Test yourself
Think of the answer, then tap the question to see it.
How do the suprascapular nerve and artery pass the superior transverse scapular ligament?
The nerve passes under the ligament through the suprascapular notch; the artery usually passes over it.
Which muscles are weak with suprascapular nerve entrapment at the suprascapular notch versus the spinoglenoid notch?
At the suprascapular notch, supraspinatus and infraspinatus; at the spinoglenoid notch, infraspinatus only.
What is a classic cause of suprascapular nerve compression at the spinoglenoid notch?
A paralabral cyst from a superior labral (SLAP) tear.
How is suprascapular nerve entrapment told apart from a rotator cuff tear?
Both weaken abduction and external rotation; normal tendons with muscle wasting on imaging point to the nerve.
Educational information, not medical advice. For any symptom, see a health professional.
Its names
- Official Latin (TA2)
- nervus suprascapularis TA2 6411
- Official Spanish (DeCS)
- Nervio supraescapular
- English (TA2)
- Suprascapular nerve
Related
Sources: Terminologia Anatomica (TA2); Anatomy, Shoulder and Upper Limb, Suprascapular Nerve.
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Representative model, for educational purposes only.
