Suprascapular Nerve Entrapment: Image-Guided Minimally-Invasive Treatment Interventions

Nerve Entrapment Syndromes - Suprascapular Nerve [Part 2]
*Image-Guided Minimally-Invasive Treatment of Suprascapular Nerve Compression, Entrapment, or Impingement*
Even more interesting, further ultrasound imaging of the previously mentioned patient did not reveal any neuromas, stenoses, or aneurysms, but did seem to suggest somewhat diminished vascular flow with globally thinner diameter lumen on left arm vs right, and reduced left scapular circumflex anastomotic flow vs right, perhaps creating a watershed effect along with the serial constraints of axoplasmic flow. The patient was also found to have severe shoulder pain and numbness, worsened by pressing on the site of where the guitar strap sits on the shoulder. I found several major sensitive trigger points around the trapezius, axilla, and scapula, and ultrasound revealed a fibrotic and swollen suprascapular nerve at the suprascapular notch. The nerve can sometimes be entrapped with a rotator cuff tear putting strain on the nerve at the suprascapular notch or spinoglenoid notch, but this was not seen in this case, likely just entrapment from the guitar strap pressure. I again treated this with an image-guided corticosteroid injection plus local anesthetic to calm the nerve (this unique approach targets the specific cause and can provide significant numbing without the temporary paralysis of most other shoulder nerve blocks), giving immediate relief to the patient which lasted even after the anesthetic agent wore off. In addition, I also treated the trigger points with shockwave (which has been shown in several studies to increase blood flow as well as release or calm down entrapped nerves), and repeat ultrasound imaging after shockwave therapy showed improved flow and vessel diameter which will help nerve healing begin. Patient was also counseled on best myelin repair strategies. There are few places on earth that can do these kinds of minimally-invasive in-office same-day diagnostics and treatments, and this is the future of medicine.

Copyright © 2021 Richard J. McMurtrey, MD, MSc
Alpine Spine & Orthopedics Institute

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