Suprascapular neuropathy complicating a Neer type I distal clavicular fracture: A case report

We report the case of a 43-year-old male patient who sustained a Neer type I distal clavicular fracture after a fall onto his lateral shoulder. He was initially treated nonoperatively, and the associated suprascapular nerve injury was not diagnosed until 3 months after the accident, when the obvious hypotrophic changes in the scapular muscles were noticed. After an additional 6 weeks of observation, surgery was performed due to the absence of any clinical and electrodiagnostic evidence of recovery. At the time of exploration, through a posterior approach, the suprascapular nerve was found to be entrapped in scar tissue located proximally to the suprascapular notch. A surgical release of the transverse scapular ligament and external neurolysis of the embedded scar tissue was done. One month after the procedure, the patient could effectively elevate his arm to 180° and externally rotate his shoulder to 75°. The last muscle examination (1 year postsurgery) demonstrated grade 5 abductors and grade 4 external rotators, but the muscle bulk had not returned to normal size at 1.5 years after operation. Our experience with this case emphasizes the importance of serial examinations of the shoulder following trauma to that joint.