The upper subscapular nerve arises from the posterior cord of the brachial plexus (C5-C6) and innervates the upper portion of the subscapularis muscle. It is the smaller of the two subscapular nerves and does not supply teres major.
The upper subscapular nerve is injured in posterior cord brachial plexus lesions, resulting in weakness of internal rotation and subscapularis atrophy. Electromyography differentiates upper from lower subscapular nerve involvement. Denervation changes in subscapularis are visible on MRI as fatty infiltration of the upper muscle belly.
Internal rotation weakness from subscapularis denervation following posterior cord brachial plexus injury or direct axillary trauma, confirmed by EMG showing subscapularis denervation potentials.
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