Dr. Kevin Yip

Dr Kevin Yip
Orthopaedic Surgeon
MBBS(UK), FRCS(EDIN), FAM(SING), FHKCOS(ORTHO)

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Evaluation-Physical Examination

The physical examination findings of the athlete depend on the degree of nerve dysfunction and the chronicity of the injury. Athletes presenting early in the process often have an examination that is nonfocal and nonspecific. Patients with chronic problems will demonstrate wasting or atrophy of the involved muscles.

If the nerve is injured or entrapped at the suprascapular notch, atrophy of the supraspinatus and infraspinatus muscles occurs, while if the pathology occurs at the spinoglenoid notch, atrophy of the only infraspinatus muscle occurs. The atrophy of the infraspinatus is more obvious than wasting of the supraspinatus muscle, because the supraspinatus atrophy may be partly hidden by the overlying trapezius muscle.

With underlying pathology or if the injury to the nerve is localized, tenderness at the affected area often is noted on deep palpation, such as at the suprascapular notch or the spinoglenoid notch.

The rotator cuff should be tested carefully for weakness of involved muscles, which can suggest the level of nerve injury. If the nerve is injured at the suprascapular notch, weakness of external rotation typically is noted, especially in adduction but also in abduction, as is weakness of abduction in the scapular plane (particularly the empty can test) because of the involvement of innervation to the infraspinatus and the supraspinatus muscles.

If the nerve is injured at the spinoglenoid notch, these athletes are more likely to have painless wasting and weakness only with external rotation (especially in adduction). Cross-body adduction with the arm extended or internally rotated may exacerbate the posterior shoulder pain

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