Issue link: https://www.massageandbodyworkdigital.com/i/812910
88 m a s s a g e & b o d y w o r k m a y / j u n e 2 0 1 7 Impaired motor signals to the affected muscles from suprascapular nerve compression can also be evaluated with manual resistive tests. Perform the test on the healthy side first to establish a normal baseline. Resisted abduction will test function of the supraspinatus, while resisted lateral rotation will test the integrity of the infraspinatus. If the resisted motion is weak, there may be impairment of the suprascapular nerve. There are other muscles that assist these two rotator cuff muscles in each of their actions, so suprascapular nerve compression will not completely stop active motion; it will simply appear to be weaker than the healthy side. While the report of pain from suprascapular nerve compression is usually in the posterior and lateral shoulder region, it can also sometimes be felt down the upper extremity, especially along the area innervated by the radial nerve or its branches. Pain follows patterns of the radial nerve because the suprascapular and radial nerves share a similar pathway of origin at the C5 and C6 nerve roots and the superior trunk of the brachial plexus. Nerve compression or tension problems can also be further identified by increased sensitivity to palpation along the nerve's path. If pressing into the distal region of the supraspinatus muscle (or the most lateral aspect of the infraspinatus near its musculotendinous junction) reproduces this pain, there is a likelihood of suprascapular nerve involvement. Interestingly, common trigger-point maps show irritable trigger points just below the spine of the scapula that tend to refer pain or other sensations down the upper arm along the same path of the radial nerve (Image 4). Palpating the posterior shoulder area where these active trigger points exist could likely compress the suprascapular nerve, and that could be a partial explanation for this pain pattern that appears down the upper arm. TREATMENT Suprascapular neuropathy can be challenging to address because there are few things that can be done for it. The most important factor is to identify any biomechanical patterns, such as keeping the arms in abduction for long periods or excessive and repetitive motion that may be aggravating the nerve compression. Limiting those aggravating factors is the first strategy for addressing any nerve compression problem. As noted earlier, branches of the suprascapular nerve may course directly through the supraspinatus muscle and may be bound or restricted by the other tissues that interface with the nerve. Consequently, it is helpful to reduce any hypertonicity in the supraspinatus or infraspinatus muscles to encourage full freedom and mobility of the nerve so it can easily glide in relation to adjacent structures. One of the most effective ways to help reduce hypertonicity in the supraspinatus muscle is through deep stripping techniques applied directly to the supraspinatus in a longitudinal direction along its length. It is difficult to access the most distal portion of the supraspinatus near its musculotendinous junction, as the muscle goes under the acromion process at the acromioclavicular joint. However, the area of potential suprascapular nerve restriction is more proximal to the region and is accessible through massage treatment. When performing this stripping technique, make sure the contact (finger, thumb, pressure tool) remains anterior to the large bundle of the upper trapezius. If you simply perform the stripping technique across the top of the shoulder without getting anterior to the trapezius, you will simply be working on the trapezius and will give very little pressure down into the supraspinatus. Once the contact point is established anterior to the trapezius, perform a slow longitudinal stripping technique along the length of the supraspinatus (Image 5). This 4 5 Common trigger points in the infraspinatus. Mediclip image copyright (1998) Williams & Wilkins. All rights reserved. Deep stripping to the supraspinatus.