Working Diagnosis:
Volleyball-related suprascapular neuropathy with isolated denervation and hypotrophy of the infraspinatus muscle

Treatment:
Advised to stop playing volleyball.
The patient completed a course of Physical Therapy (PT) focused on rotator cuff strengthening, and scapular stabilization with goal of optimizing shoulder biomechanics and remaining infraspinatus function.
The case was reviewed with a consulting shoulder surgeon and neurologist, after course of non-operative treatment.

Outcome:
Despite aggressive PT, there was no improvement in symptoms.
Given MRI and EMG findings, it was felt he had no further potential to restore function of the superior portion of his infraspinatus.

Author's Comments:
The suprascapular nerve can be compressed at suprascapular or spinoglenoid notch. Nerve release has better success with more proximal lesions. As many as 30% of professional volleyball players have an asymptomatic deficit. Posterior deltoid and teres minor tend to compensate isolated infraspinatus weakness. Repetitive dynamic compression injury of nerve by superior aspect of the infraspinatus during shoulder abduction and external rotation has been proposed as a possible mechanism of injury. Additionally, the unique braking action at the end of a volleyball serve likely contributes, as it causes the infraspinatus to maximally, eccentrically contract.

Editor's Comments:
This case highlights the important physical examination component of observation in order to discover the isolated muscle atrophy.

References:
Ferretti, A et al. Suprascapular Neuropathy in Volleyball Players. J Bone and Joint Surgery. 1987; 69: 260-263.
Moen, Todd C. Suprascapular neuropathy: what does the literature show? Journal of Shoulder and Elbow Surgery. 2012, 21; 835-846.
Witvrouw, E et al. Suprascapular neuropathy in volleyball players. Br J Sports Med 2000; 34: 174-180.

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