Introduction
The suprascapular nerve originates from the upper trunk of the brachial plexus. Suprascapular neuropathy may be caused by repetitive use, direct trauma, transverse scapular ligament injury, tumors or massive retracted rotator cuff tears. However, it is a rare conditions that suprascapular nerve damage induced by shoulder subluxation. We report a patient with suprascapular nerve injury following a shoulder subluxation.
Case report
A 38-year-old man referred to the Department of the Rehabilitation Medicine to evaluate his right shoulder pain. In his past medical history, he underwent surgery for the right shoulder instability in 2000. The patient slipped down and hit his right shoulder. He felt right shoulder pain and felt discomfort when moving the glenohumeral joint. He performed a closed reduction immediately. After closed reduction, he felt discomfort when he raised up his right shoulder and he felt weakness on his right shoulder. On Manual muscle strength testing, abduction, flexion and external rotation of the right glenohumeral joint were moderately weak. On physical examination the apprehension test and sulcus test for shoulder joint instability were positive. MRI images showed Bankart fractures and Hill-Sachs lesions.
For further evaluation, we performed electromyography to evaluate weakness of the right shoulder. During needle electromyography, abnormal spontaneous activities were observed only in the supraspinatus, infraspinatus, deltoid and teres minor muscle. On the motor nerve conduction test, the right axillary nerve showed reduced compound muscle action potential (CMAP). The patient underwent open reduction and internal fixation in the Department of Orthopedic surgery. After surgery, the patient was discharged without complications.
Conclusion
Clinically, injury of the suprascapular nerve may be overlooked at the shoulder subluxation However, through accurate physical examination and interview with the patient, we performed additional EMG and confirmed suprascapular nerve injury. A function of the shoulder was significantly impaired in patients with injury of the suprascapular nerve. Therefore, it is important to confirm the lesion of the suprascapular nerve at the shoulder subluxation.
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