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Management-Nonoperative Management

The initial management of suprascapular nerve injuries usually is nonoperative. Most authors have found that resolution of symptoms occurs within 6 to 12 months after diagnosis. This is particularly true if the patient has no evidence of a space-occupying lesion (cyst). Because most of these injuries in athletes are thought to be related to traction or repetitive microtrauma, activity modification often is necessary.

Specific activities, such as overhead motions and weight lifting, should be avoided if they cause symptoms. Nonsteroidal anti-inflammatory medications may help to relieve nerve inflammation associated with irritation as well as pain. An appropriate therapy program consists of maintaining full shoulder motion and strengthening of the shoulder using proper posture and proprioceptive exercises.

Particular attention should be directed toward stretching the posterior capsule of the shoulder and adequate strength of the serratus anterior, trapezius, and rhomboids. Theoretically, stretching the posterior capsule, especially in abduction, because this is the insertion of the spinoglenoid ligament, will reduce tension on the ligament during overhead sports activities.

The goal of a strengthening program is to enhance the compensatory muscles and to regain muscular balance about the shoulder. Several authors recommend at least 4 to 6 months of nonoperative management, with follow-up electrodiagnostic testing to determine whether recovery is progressing if deficits or symptoms continue (132).

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