A volleyball player presents with dull pain over the posterior shoulder and progressive weakness of overhead activities. There is wasting below the spine of the scapula with preservation of deltoid bulk and normal sensation. External rotation against resistance is weak. At which site is the responsible nerve most likely compressed?

• A Suprascapular notch, beneath the superior transverse scapular ligament ✓
• B Quadrangular space, bounded by teres major and minor
• C Spinoglenoid notch, beneath the inferior transverse scapular ligament
• D Triangle of auscultation, deep to latissimus dorsi

Explanation

The suprascapular nerve arises from the upper trunk (C5, C6), runs through the suprascapular notch under the superior transverse scapular ligament, and supplies supraspinatus and infraspinatus. Compression there weakens both abduction initiation and external rotation with infraspinatus wasting. The spinoglenoid notch is the tempting distractor, but compression distal to that point affects only infraspinatus, sparing supraspinatus, whereas this patient has combined weakness.

Reference: Moore's Clinically Oriented Anatomy, 8th ed.

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Written and medically reviewed by the StethoPrep medical team.