Suprascapular Neuropathy and Point-Of-Care Ultrasound Diagnostic Criteria: A Case Report

Case Diagnosis: A 57-year-old female with carpal tunnel syndrome and suprascapular neuropathy.

Case Description or Program Description: A 57-year-old right-hand dominant female with a past medical history of a cerebrovascular accident presented with a complaint of “dropping things” and shoulder pain. She reported three months of left hand pain with worsening numbness, tingling, and weakness in the first, second, and third digits, that is worse in the morning. She has had baseline numbness and tingling in the left upper extremity secondary to a cerebrovascular accident. On examination of the left shoulder, there was slight atrophy of the supraspinatus, tenderness to palpation at the acromion and distal clavicle, decreased range of motion of the shoulder, and crepitus noted with internal and external rotation. Examination of the left hand revealed positive carpal compression test; electrodiagnostic testing revealed left median nerve sensory neuropathy, consistent with mild to moderate carpal tunnel syndrome. This was supported by visualization of the median nerve with point-of-care ultrasound. The suprascapular nerve was visualized at the suprascapular and spinoglenoid notches and cross sectional area was noted to be 0.58 cm2 and 0.36 cm2, respectively.

Setting: Outpatient Clinic

Assessment/Results: The diagnosis of carpal tunnel syndrome was supported using physical examination, electrodiagnostic studies, and point-of-care ultrasound. Recommendations discussed were consistent use of a carpal tunnel brace, activity modification, and a formal home exercise program. She was recommended to follow up with her referring provider, consider occupational therapy, and diagnostic studies for suprascapular neuropathy if symptoms do not improve.

Discussion (relevance): We provide justification for the need of ultrasound reference ranges for evaluation of diagnosis of suprascapular neuropathy while highlighting existing literature on the topic.

Conclusions: While the current gold standard for diagnostic testing of suprascapular neuropathy consists of electrodiagnostic studies, the creation of diagnostic criteria for point-of-care ultrasound offers an additional clinical tool that increases both accessibility and affordability for patients.