Skip to main content
Journal of Athletic Training logoLink to Journal of Athletic Training
. 2000 Jul-Sep;35(3):316–328.

Neurologic Injuries in the Athlete's Shoulder

Xavier A Duralde 1
PMCID: PMC1323394  PMID: 16558645

Abstract

Objective:

To review the presentation, evaluation, treatment, and prognosis of various nerve injuries about the shoulder in the athletic population. Included are injuries to the axillary, suprascapular, musculocutaneous, long thoracic, and spinal accessory nerves.

Data Sources:

This article represents a review of the literature regarding incidence, presentation, and results of treatment of these various nerve injuries. The clinically pertinent anatomy is also presented to better relate mechanism of injury to the occurrence of nerve injury. I searched MEDLINE from 1966 through 1999 and the Journal of Shoulder and Elbow Surgery from 1992 through 1999 for the key words “nerve” and “shoulder.”

Data Synthesis:

A historical review of treatment results is presented as well as a review of treatment options and the results of studies using modern techniques in the management of nerve injuries.

Conclusions/Recommendations:

Nerve injuries about the shoulder present as distinct clinical syndromes, although signs and symptoms can be subtle. The athletic trainer and team physician must be able to recognize the presentation of these injuries so that adequate evaluation and prompt treatment can be instituted to maximize the athlete's chance for early return to sport.

Keywords: axillary nerve, suprascapular nerve, musculocutaneous nerve, long thoracic nerve, spinal accessory nerve, athletic nerve injury

Full text

PDF
316

Images in this article

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Agre J. C., Ash N., Cameron M. C., House J. Suprascapular neuropathy after intensive progressive resistive exercise: case report. Arch Phys Med Rehabil. 1987 Apr;68(4):236–238. [PubMed] [Google Scholar]
  2. Alnot J. Y., Jolly A. Les lésions du nerf circonflexe. A propos de 19 cas. Rev Chir Orthop Reparatrice Appar Mot. 1983;69(7):539–546. [PubMed] [Google Scholar]
  3. Alnot J. Y. Traumatic brachial plexus palsy in the adult. Retro- and infraclavicular lesions. Clin Orthop Relat Res. 1988 Dec;(237):9–16. [PubMed] [Google Scholar]
  4. Alon M., Weiss S., Fishel B., Dekel S. Bilateral suprascapular nerve entrapment syndrome due to an anomalous transverse scapular ligament. Clin Orthop Relat Res. 1988 Sep;(234):31–33. [PubMed] [Google Scholar]
  5. Bateman J. E. Nerve injuries about the shoulder in sports. J Bone Joint Surg Am. 1967 Jun;49(4):785–792. [PubMed] [Google Scholar]
  6. Berry H., Bril V. Axillary nerve palsy following blunt trauma to the shoulder region: a clinical and electrophysiological review. J Neurol Neurosurg Psychiatry. 1982 Nov;45(11):1027–1032. doi: 10.1136/jnnp.45.11.1027. [DOI] [PMC free article] [PubMed] [Google Scholar]
  7. Bigliani L. U., Compito C. A., Duralde X. A., Wolfe I. N. Transfer of the levator scapulae, rhomboid major, and rhomboid minor for paralysis of the trapezius. J Bone Joint Surg Am. 1996 Oct;78(10):1534–1540. doi: 10.2106/00004623-199610000-00011. [DOI] [PubMed] [Google Scholar]
  8. Bigliani L. U., Dalsey R. M., McCann P. D., April E. W. An anatomical study of the suprascapular nerve. Arthroscopy. 1990;6(4):301–305. doi: 10.1016/0749-8063(90)90060-q. [DOI] [PubMed] [Google Scholar]
  9. Blom S., Dahlbäck L. O. Nerve injuries in dislocations of the shoulder joint and fractures of the neck of the humerus. A clinical and electromyographical study. Acta Chir Scand. 1970;136(6):461–466. [PubMed] [Google Scholar]
  10. Bonnard C., Anastakis D. J., van Melle G., Narakas A. O. Isolated and combined lesions of the axillary nerve. A review of 146 cases. J Bone Joint Surg Br. 1999 Mar;81(2):212–217. doi: 10.1302/0301-620x.81b2.8301. [DOI] [PubMed] [Google Scholar]
  11. Brumback R. A., Bobele G. B., Rayan G. M. Electrodiagnosis of compressive nerve lesions. Hand Clin. 1992 May;8(2):241–254. [PubMed] [Google Scholar]
  12. Bryan W. J., Schauder K., Tullos H. S. The axillary nerve and its relationship to common sports medicine shoulder procedures. Am J Sports Med. 1986 Mar-Apr;14(2):113–116. doi: 10.1177/036354658601400203. [DOI] [PubMed] [Google Scholar]
  13. Bryan W. J., Wild J. J., Jr Isolated infraspinatus atrophy. A common cause of posterior shoulder pain and weakness in throwing athletes? Am J Sports Med. 1989 Jan-Feb;17(1):130–131. doi: 10.1177/036354658901700123. [DOI] [PubMed] [Google Scholar]
  14. Burge P., Rushworth G., Watson N. Patterns of injury to the terminal branches of the brachial plexus. The place for early exploration. J Bone Joint Surg Br. 1985 Aug;67(4):630–634. doi: 10.1302/0301-620X.67B4.4030864. [DOI] [PubMed] [Google Scholar]
  15. Cahill B. R., Palmer R. E. Quadrilateral space syndrome. J Hand Surg Am. 1983 Jan;8(1):65–69. doi: 10.1016/s0363-5023(83)80056-2. [DOI] [PubMed] [Google Scholar]
  16. Cohn B. T., Brahms M. A., Cohn M. Injury to the eleventh cranial nerve in a high school wrestler. Orthop Rev. 1986 Sep;15(9):590–595. [PubMed] [Google Scholar]
  17. Colachis S. C., Jr, Strohm B. R. Effect of suprascauular and axillary nerve blocks on muscle force in upper extremity. Arch Phys Med Rehabil. 1971 Jan;52(1):22–29. [PubMed] [Google Scholar]
  18. Connor P. M., Yamaguchi K., Manifold S. G., Pollock R. G., Flatow E. L., Bigliani L. U. Split pectoralis major transfer for serratus anterior palsy. Clin Orthop Relat Res. 1997 Aug;(341):134–142. [PubMed] [Google Scholar]
  19. Cormier P. J., Matalon T. A., Wolin P. M. Quadrilateral space syndrome: a rare cause of shoulder pain. Radiology. 1988 Jun;167(3):797–798. doi: 10.1148/radiology.167.3.3363143. [DOI] [PubMed] [Google Scholar]
  20. DEWAR F. P., HARRIS R. I. Restoration of function of the shoulder following paralysis of the trapezius by fascial sling fixation and transplantation of the levator scapulae. Ann Surg. 1950 Dec;132(6):1111–1115. doi: 10.1097/00000658-195012000-00010. [DOI] [PMC free article] [PubMed] [Google Scholar]
  21. Donovan W. H., Kraft G. H. Rotator cuff tear versus suprascapular nerve injury: a problem in differential diagnosis. Arch Phys Med Rehabil. 1974 Sep;55(9):424–428. [PubMed] [Google Scholar]
  22. Drez D., Jr Suprascapular neuropathy in the differential diagnosis of rotator cuff injuries. Am J Sports Med. 1976 Mar-Apr;4(2):43–45. doi: 10.1177/036354657600400201. [DOI] [PubMed] [Google Scholar]
  23. Dunn A. W. Trapezius paralysis after minor surgical procedures in the posterior cervical triangle. South Med J. 1974 Mar;67(3):312–315. doi: 10.1097/00007611-197403000-00016. [DOI] [PubMed] [Google Scholar]
  24. Duralde X. A. Evaluation and treatment of the winged scapula. J South Orthop Assoc. 1995 Spring;4(1):38–52. [PubMed] [Google Scholar]
  25. Edeland H. G., Zachrisson B. E. Fracture of the scapular notch associated with lesion of the suprascapular nerve. Acta Orthop Scand. 1975 Nov;46(5):758–763. doi: 10.3109/17453677508989262. [DOI] [PubMed] [Google Scholar]
  26. Ferretti A., Cerullo G., Russo G. Suprascapular neuropathy in volleyball players. J Bone Joint Surg Am. 1987 Feb;69(2):260–263. [PubMed] [Google Scholar]
  27. Flatow E. L., Bigliani L. U., April E. W. An anatomic study of the musculocutaneous nerve and its relationship to the coracoid process. Clin Orthop Relat Res. 1989 Jul;(244):166–171. [PubMed] [Google Scholar]
  28. Garcia G., McQueen D. Bilateral suprascapular-nerve entrapment syndrome. Case report and review of the literature. J Bone Joint Surg Am. 1981 Mar;63(3):491–492. [PubMed] [Google Scholar]
  29. Goodman C. E., Kenrick M. M., Blum M. V. Long thoracic nerve palsy: a follow-up study. Arch Phys Med Rehabil. 1975 Aug;56(8):352–358. [PubMed] [Google Scholar]
  30. Goodman C. E. Unusual nerve injuries in recreational activities. Am J Sports Med. 1983 Jul-Aug;11(4):224–227. doi: 10.1177/036354658301100408. [DOI] [PubMed] [Google Scholar]
  31. Gregg J. R., Labosky D., Harty M., Lotke P., Ecker M., DiStefano V., Das M. Serratus anterior paralysis in the young athlete. J Bone Joint Surg Am. 1979 Sep;61(6A):825–832. [PubMed] [Google Scholar]
  32. Harris H. H., Dickey J. R. Nerve grafting to restore function of the trapezius muscle after radical neck dissection. (A preliminary report). Ann Otol Rhinol Laryngol. 1965 Sep;74(3):880–886. doi: 10.1177/000348946507400326. [DOI] [PubMed] [Google Scholar]
  33. Hayes J. M., Zehr D. J. Traumatic muscle avulsion causing winging of the scapula. A case report. J Bone Joint Surg Am. 1981 Mar;63(3):495–497. [PubMed] [Google Scholar]
  34. Hershman E. B. Brachial plexus injuries. Clin Sports Med. 1990 Apr;9(2):311–329. [PubMed] [Google Scholar]
  35. Jerosch J., Castro W. H., Colemont J. A lesion of the musculocutaneous nerve. A rare complication of anterior shoulder dislocation. Acta Orthop Belg. 1989;55(2):230–232. [PubMed] [Google Scholar]
  36. Karas S. E. Thoracic outlet syndrome. Clin Sports Med. 1990 Apr;9(2):297–310. [PubMed] [Google Scholar]
  37. Katzman B. M., Bozentka D. J. Peripheral nerve injuries secondary to missiles. Hand Clin. 1999 May;15(2):233-44, viii. [PubMed] [Google Scholar]
  38. Kim S. M., Goodrich J. A. Isolated proximal musculocutaneous nerve palsy: case report. Arch Phys Med Rehabil. 1984 Nov;65(11):735–736. [PubMed] [Google Scholar]
  39. Kulund D. N., McCue F. C., 3rd, Rockwell D. A., Gieck J. H. Tennis injuries: prevention and treatment. A review. Am J Sports Med. 1979 Jul-Aug;7(4):249–253. doi: 10.1177/036354657900700409. [DOI] [PubMed] [Google Scholar]
  40. LEFFERT R. D., SEDDON H. INFRACLAVICULAR BRACHIAL PLEXUS INJURIES. J Bone Joint Surg Br. 1965 Feb;47:9–22. [PubMed] [Google Scholar]
  41. Langenskiöld A., Ryöppy S. Treatment of paralysis of the trapezius muscle by the Eden-Lange operation. Acta Orthop Scand. 1973;44(4):383–388. doi: 10.3109/17453677308989074. [DOI] [PubMed] [Google Scholar]
  42. Logigian E. L., McInnes J. M., Berger A. R., Busis N. A., Lehrich J. R., Shahani B. T. Stretch-induced spinal accessory nerve palsy. Muscle Nerve. 1988 Feb;11(2):146–150. doi: 10.1002/mus.880110210. [DOI] [PubMed] [Google Scholar]
  43. Loomer R., Graham B. Anatomy of the axillary nerve and its relation to inferior capsular shift. Clin Orthop Relat Res. 1989 Jun;(243):100–105. [PubMed] [Google Scholar]
  44. Mallon W. J., Bassett F. H., 3rd, Goldner R. D. Luxatio erecta: the inferior glenohumeral dislocation. J Orthop Trauma. 1990;4(1):19–24. [PubMed] [Google Scholar]
  45. Matz S. O., Welliver P. S., Welliver D. I. Brachial plexus neuropraxia complicating a comminuted clavicle fracture in a college football player. Case report and review of the literature. Am J Sports Med. 1989 Jul-Aug;17(4):581–583. doi: 10.1177/036354658901700423. [DOI] [PubMed] [Google Scholar]
  46. McIlveen S. J., Duralde X. A., D'Alessandro D. F., Bigliani L. U. Isolated nerve injuries about the shoulder. Clin Orthop Relat Res. 1994 Sep;(306):54–63. [PubMed] [Google Scholar]
  47. McKowen H. C., Voorhies R. M. Axillary nerve entrapment in the quadrilateral space. Case report. J Neurosurg. 1987 Jun;66(6):932–934. doi: 10.3171/jns.1987.66.6.0932. [DOI] [PubMed] [Google Scholar]
  48. Mendoza F. X., Main W. K., Main K. Peripheral nerve injuries of the shoulder in the athlete. Clin Sports Med. 1990 Apr;9(2):331–342. [PubMed] [Google Scholar]
  49. Mitsunaga M. M., Nakano K. High radial nerve palsy following strenuous muscular activity. A case report. Clin Orthop Relat Res. 1988 Sep;(234):39–42. [PubMed] [Google Scholar]
  50. Moore T. P., Fritts H. M., Quick D. C., Buss D. D. Suprascapular nerve entrapment caused by supraglenoid cyst compression. J Shoulder Elbow Surg. 1997 Sep-Oct;6(5):455–462. doi: 10.1016/s1058-2746(97)70053-3. [DOI] [PubMed] [Google Scholar]
  51. Neer C. S., 2nd, Foster C. R. Inferior capsular shift for involuntary inferior and multidirectional instability of the shoulder. A preliminary report. J Bone Joint Surg Am. 1980 Sep;62(6):897–908. [PubMed] [Google Scholar]
  52. Neviaser R. J., Neviaser T. J., Neviaser J. S. Concurrent rupture of the rotator cuff and anterior dislocation of the shoulder in the older patient. J Bone Joint Surg Am. 1988 Oct;70(9):1308–1311. [PubMed] [Google Scholar]
  53. Neviaser T. J., Ain B. R., Neviaser R. J. Suprascapular nerve denervation secondary to attenuation by a ganglionic cyst. J Bone Joint Surg Am. 1986 Apr;68(4):627–628. [PubMed] [Google Scholar]
  54. O'Neill D. B., Micheli L. J. Overuse injuries in the young athlete. Clin Sports Med. 1988 Jul;7(3):591–610. [PubMed] [Google Scholar]
  55. Pasila M., Jaroma H., Kiviluoto O., Sundholm A. Early complications of primary shoulder dislocations. Acta Orthop Scand. 1978 Jun;49(3):260–263. doi: 10.3109/17453677809005762. [DOI] [PubMed] [Google Scholar]
  56. Petrera J. E., Trojaborg W. Conduction studies of the long thoracic nerve in serratus anterior palsy of different etiology. Neurology. 1984 Aug;34(8):1033–1037. doi: 10.1212/wnl.34.8.1033. [DOI] [PubMed] [Google Scholar]
  57. Petrucci F. S., Morelli A., Raimondi P. L. Axillary nerve injuries--21 cases treated by nerve graft and neurolysis. J Hand Surg Am. 1982 May;7(3):271–278. doi: 10.1016/s0363-5023(82)80178-0. [DOI] [PubMed] [Google Scholar]
  58. Post M., Mayer J. Suprascapular nerve entrapment. Diagnosis and treatment. Clin Orthop Relat Res. 1987 Oct;(223):126–136. [PubMed] [Google Scholar]
  59. Priest J. D. The shoulder of the tennis player. Clin Sports Med. 1988 Apr;7(2):387–402. [PubMed] [Google Scholar]
  60. Rayan G. M. Lower trunk brachial plexus compression neuropathy due to cervical rib in young athletes. Am J Sports Med. 1988 Jan-Feb;16(1):77–79. doi: 10.1177/036354658801600114. [DOI] [PubMed] [Google Scholar]
  61. Redler M. R., Ruland L. J., 3rd, McCue F. C., 3rd Quadrilateral space syndrome in a throwing athlete. Am J Sports Med. 1986 Nov-Dec;14(6):511–513. doi: 10.1177/036354658601400615. [DOI] [PubMed] [Google Scholar]
  62. Rengachary S. S., Burr D., Lucas S., Hassanein K. M., Mohn M. P., Matzke H. Suprascapular entrapment neuropathy: a clinical, anatomical, and comparative study. Part 2: anatomical study. Neurosurgery. 1979 Oct;5(4):447–451. doi: 10.1227/00006123-197910000-00007. [DOI] [PubMed] [Google Scholar]
  63. Rose D. L., Kelly C. R. Shoulder pain. Suprascapular nerve block in shoulder pain. J Kans Med Soc. 1969 Mar;70(3):135–136. [PubMed] [Google Scholar]
  64. STROHM B. R., COLACHIS S. C., Jr SHOULDER JOINT DYSFUNCTION FOLLOWING INJURY TO THE SUPRASCAPULAR NERVE. Phys Ther. 1965 Feb;45:106–111. doi: 10.1093/ptj/45.2.106. [DOI] [PubMed] [Google Scholar]
  65. Sarno J. B. Suprascapular nerve entrapment. Surg Neurol. 1983 Dec;20(6):493–497. doi: 10.1016/0090-3019(83)90033-2. [DOI] [PubMed] [Google Scholar]
  66. Sicuranza M. J., McCue F. C., 3rd Compressive neuropathies in the upper extremity of athletes. Hand Clin. 1992 May;8(2):263–273. [PubMed] [Google Scholar]
  67. TURNER J. W. A., PARSONAGE M. J. Neuralgic amyotrophy (paralytic brachial neuritis); with special reference to prognosis. Lancet. 1957 Aug 3;273(6988):209–212. [PubMed] [Google Scholar]
  68. Thompson R. C., Jr, Schneider W., Kennedy T. Entrapment neuropathy of the inferior branch of the suprascapular nerve by ganglia. Clin Orthop Relat Res. 1982 Jun;(166):185–187. [PubMed] [Google Scholar]
  69. VAN LINGE, MULDER J. D. FUNCTION OF THE SUPRASPINATUS MUSCLE AND ITS RELATION TO THE SUPRASPINATUS SYNDROME. AN EXPERIMENTAL STUDY IN MAN. J Bone Joint Surg Br. 1963 Nov;45(4):750–754. [PubMed] [Google Scholar]
  70. Weaver H. L. Isolated suprascapular nerve lesions. Injury. 1983 Sep;15(2):117–126. doi: 10.1016/0020-1383(83)90039-6. [DOI] [PubMed] [Google Scholar]
  71. Wilbourn A. J. Electrodiagnostic testing of neurologic injuries in athletes. Clin Sports Med. 1990 Apr;9(2):229–245. [PubMed] [Google Scholar]
  72. Woodhead A. B., 3rd Paralysis of the serratus anterior in a world class marksman. A case study. Am J Sports Med. 1985 Sep-Oct;13(5):359–362. doi: 10.1177/036354658501300511. [DOI] [PubMed] [Google Scholar]
  73. Wroble R. R., Albright J. P. Neck and low back injuries in wrestling. Clin Sports Med. 1986 Apr;5(2):295–325. [PubMed] [Google Scholar]
  74. Yoon T. N., Grabois M., Guillen M. Suprascapular nerve injury following trauma to the shoulder. J Trauma. 1981 Aug;21(8):652–655. doi: 10.1097/00005373-198108000-00010. [DOI] [PubMed] [Google Scholar]
  75. Zoltan J. D. Injury to the suprascapular nerve associated with anterior dislocation of the shoulder: case report and review of the literature. J Trauma. 1979 Mar;19(3):203–206. doi: 10.1097/00005373-197903000-00015. [DOI] [PubMed] [Google Scholar]

Articles from Journal of Athletic Training are provided here courtesy of National Athletic Trainers Association

RESOURCES