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Images in Neurology |

Suprascapular Nerve Entrapment in a Canoeist

Frauke Knossalla, MD; Volkmar Nicolas, MD; Martin Tegenthoff, MD
Arch Neurol. 2006;63(5):781. doi:10.1001/archneur.63.5.781.
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A 15-year-old girl described pain, reduced abduction, and external rotation of the left shoulder as well as intermittent paresthesia over the left scapula. She recalled no trauma, and the symptoms were exacerbated by exercise and abated with rest. On physical examination of the patient, we found a moderate lesion of the suprascapular nerve and moderate atrophy of the left infraspinatus muscle. Electromyographic examination revealed signs of a lesion that caused the neuropraxic state of the left suprascapular nerve, moderate axonal loss, and denervation of the left infraspinatus muscle. T2-weighted magnetic resonance imaging provided anatomical demonstration of nerve entrapment caused by a well-distinguished round structure next to the left incisura scapularis (Figure).1 After surgical decompression and extirpation of the structure, histological analysis identified it as a ganglion cyst. Surgical decompression gave complete pain relief and full recovery of the shoulder function. It is known that sports involving overhead motions, such as tennis, weight lifting, and volleyball, may result in traction injury to the suprascapular nerve.2,3

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Figure.

T2-weighted axial magnetic resonance image of the left shoulder before the surgical procedure, demonstrating a structure (1) of abnormally high signal intensity between the glenoid and the infraspinatus that is recognized as a ganglion cyst. 1 indicates ganglion cyst; 2, glenoid; 3, infraspinatus; 4, caput humeri; and 5, deltoideus.

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