Disclosures: Anthony L. Lombardi-Gonzalez, MD: No financial relationships or conflicts of interest

Case Diagnosis: 17-year-old male volleyball player with right suprascapular neuropathy.

Case Description: 17-year-old right-handed male volleyball player reported a 2-year history of right shoulder pain with overhead activity. He was treated with physical therapy and a shoulder steroid injection when he was 15 years with temporary symptom relief. Physical examination revealed a depressed right shoulder, mild medial winging of the scapula, right infraspinatus muscle (IM) atrophy and shoulder external rotation weakness at 0 degrees abduction. Right shoulder MRI was remarkable for a tortuous vein at the right spinoglenoid notch and edema of the IM suggestive of denervation. Diagnostic ultrasound revealed a hyperechogenic IM suggestive of muscle atrophy. Electrodiagnostic study revealed right suprascapular nerve injury at the spinoglenoid notch with axonal loss affecting the IM.

Setting: Outpatient Rehabilitation/Sports Medicine ClinicAssessment/

Results: This patient has a college scholarship to play volleyball, which was considered in the decision-making process. He continued conservative rehabilitation with little relief. After discussing different treatment options with athlete and his parents, it was decided that an orthopedic consult was warranted. Patient underwent right suprascapular nerve release and started rehabilitation.

Discussion: Suprascapular neuropathy affecting the IM only is an uncommon form of shoulder pain associated with overhead sports, such as volleyball and tennis. Most common etiologic causes include space-occupying lesions and traction injuries. In this patient, a vascular anomaly, in the form of a tortuous vein, was the likely cause. To our knowledge, suprascapular nerve compression in an overhead athlete is rarely reported. When conservative measures fail, evaluation for surgical management should be considered.

Conclusion: Tortuous vein can be a cause of right suprascapular neuropathy at the spinoglenoid notch resulting in isolated IM atrophy and weakness in young volleyball players. Surgical decompression of the suprascapular nerve is an alternative treatment if conservative measures fail.

Level of Evidence: Level V

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/suprascapular-neuropathy-in-a-volleyball-player-caused-by-atypical-vascular-etiology-a-case-report/