AANA Lab Course 915 - Foundations in Arthroscopy-NEUROLOGIC PROBLEMS IN THE ATHLETE’S SHOULDER-John Orwin, M.D.

NEUROLOGIC PROBLEMS IN THE ATHLETE’S SHOULDER-John Orwin, M.D.

Pdf Summary

This presentation by Dr. John F. Orwin addresses neurologic problems affecting the athlete’s shoulder, focusing primarily on cervical radiculopathy, plexopathy, entrapment neuropathies, and suprascapular ganglion cysts.<br /><br />Plexopathies include thoracic outlet syndrome, brachial plexitis (Parsonage-Turner syndrome), and burners. Parsonage-Turner syndrome is most common in young athletes, believed to be immunologically mediated, often following viral illness, surgery, or trauma, with acute onset of severe shoulder pain followed by weakness and atrophy in nerves such as the long thoracic, axillary, musculocutaneous, and suprascapular nerves. Diagnosis involves imaging (MRI, ultrasound, CT arthrogram) to exclude other lesions and EMG/NCS to confirm an extrinsic plexus process. Treatment centers on physical therapy for motion and strength restoration; recovery occurs in 85-90% of cases over weeks to months.<br /><br />Suprascapular nerve (SSN) entrapment, analogous to carpal tunnel syndrome, typically occurs at the suprascapular or spinoglenoid notch, compressing the nerve that innervates the supraspinatus and infraspinatus muscles. Symptoms are pain and weakness, often misdiagnosed as rotator cuff tears or impingement, leading to unsuccessful treatments. Diagnosis requires detailed EMG/NCS focusing on rotator cuff muscles. Surgical nerve decompression via a superior approach shows 85-90% good to excellent outcomes, with pain relief often preceding strength recovery.<br /><br />Suprascapular ganglion cysts arise from defects in the posterior superior glenohumeral joint capsule (often linked to SLAP or posterior labral tears), compressing the nerve branches—affecting only infraspinatus if at the spinoglenoid notch or both supraspinatus and infraspinatus if in the supraspinatus fossa. MRI with fluid-sensitive sequences is essential for detection. Small cysts (<1 cm) with normal nerve studies may be observed; larger cysts with positive EMG/NCS are treated surgically—arthroscopic or open removal—with 90% good to excellent outcomes and rare recurrence.<br /><br />In summary, awareness and correct diagnosis of neurologic shoulder conditions, supported by targeted imaging and specialized EMG/NCS, allow effective treatment and excellent recovery in athletes experiencing persistent shoulder dysfunction.

Keywords

neurologic shoulder problems

cervical radiculopathy

plexopathy

entrapment neuropathies

suprascapular ganglion cysts

Parsonage-Turner syndrome

suprascapular nerve entrapment

thoracic outlet syndrome

EMG/NCS diagnosis

shoulder nerve decompression surgery