Suprascapular neuropathy during progressive resistive exercises in a cardiac rehabilitation program

A 56-year-old man developed left shoulder pain three weeks after starting a cardiac rehabilitation program, which consisted of submaximal aerobic and progressive resistive exercises. Pain in the left shoulder intensified and weakness developed one week later. He sought medical attention ten weeks after the onset. Physical examination showed only weakness of left shoulder abduction and external rotation with mild atrophy of the left supraspinatus and infraspinatus muscles. Electrodiagnostic study showed fibrillation potentials and positive sharp waves in the left supraspinatus and infraspinatus muscles with delayed conduction to the supraspinatus. The left suprascapular notch was injected with local steroid. Within one week, improvement occurred, and one month later the patient was pain free and stronger. The motor latency returned to normal, and no fibrillations nor positive waves were seen. The patient returned to his previous functional level. Suprascapular neuropathy should be considered as a cause of shoulder pain and weakness in a person involved in any strengthening exercise program. A steroid injection of the suprascapular notch performed early may avoid the need for surgery.