Houston Methodist. Leading Medicine

Shoulder FAQ

Question:

I had a very painful shoulder, probably from too much weight lifting. I backed off on my weight program but the symptoms didn't go away. Eventually I went to see an orthopedic specialist. She says it's likely I have a torn labrum and maybe a cyst from fluid leaking out of the joint pressing on a nerve. We are waiting for the rest of the test results before finding out how to treat this problem. Can you give me some idea what to expect?

Answer:

Deciding what type of treatment is best requires an accurate diagnosis of the problem. It sounds like you are on the right track with that. Chronic pressure, traction, or kinking of the affected nerve can lead to denervation (destruction) of the nerve -- and that means permanent loss of muscle strength and function supplied by the nerve. In cases like that, surgery is needed to remove whatever is putting pressure on the nerve, a procedure called decompression. The most likely nerve involved is the suprascapular nerve along the back of the shoulder. When the nerve gets stretched or compressed enough to cause serious damage, the condition is called suprascapular neuropathy. The result can be shoulder pain and loss of function. For athletes who depend on the muscles supplied by that nerve, such a problem can be very disabling. Overhead lifting with rotator cuff tears seem to contribute to this problem most often in weight-lifters. Sometimes the surgeon must also go in and open up a notch (opening) in the scapula (shoulder blade) where the nerve passes through. This notch or opening is called the spinoglenoid notch. Everyone has one and the natural size, shape, and location in the bone can vary. If the ligament across the top of this notch is tight and pressing down on the nerve and/or if the notch is too shallow or too small, the surgeon must make corrections in order to take pressure off the nerve. The nerve can also get stuck to the bone by fibrous tissue so that it can't move as the arm is raised. This condition is called nerve entrapment. Other things that can cause suprascapular nerve entrapment include bone fracture, cysts, and enlarged veins. Cysts form most often when damage to the labrum (rim of fibrous cartilage around the shoulder joint) allows fluid from the joint to escape and pool inside the cyst. Unless there is imminent danger of permanent nerve damage, a conservative approach to treatment is usually tried first. Besides taking nonsteroidal antiinflammatory drugs (NSAIDs), tyou will likely be referred to a physical therapist for a course of stretching and strengthening exercises to address any rotator cuff problems. Special neural mobilization techniques can also be done to restore full, free mobility of the nerve along its course. Your surgeon will continue to follow your progress with therapy. If you do not improve, then surgery is considered. The risk of permanent nerve damage is greater when the symptoms have been present a long time (more than six months). Surgery is warranted if the surgeon is trying to prevent further nerve injury. Dana P. Piasecki, MD, et al. Suprascapular Neuropathy. In Journal of the American Academy of Orthopaedic Surgeons. November 2009. Vol. 17. No. 11. Pp. 665-676.

*Disclaimer:* The information contained herein is compiled from a variety of sources. It may not be complete or timely. It does not cover all diseases, physical conditions, ailments or treatments. The information should NOT be used in place of visit with your healthcare provider, nor should you disregard the advice of your health care provider because of any information you read in this topic.
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