Decompression ng suprascapular nerve Impormasyon Pahintulot

Bakit iminungkahi ang operasyong ito

Si Dr Kieran Hirpara, isang upper-limb surgeon sa Mater Private Hospital Rockhampton, ay nagsisimula sa mga opsyon na hindi gaanong invasive na angkop sa iyong kondisyon. Ang mga pasyente ay karaniwang nirerefer sa aming klinika ng kanilang GP; kung iminungkahi ng isang physiotherapist na magpatingin sa amin, kakailanganin mo pa rin ng referral mula sa iyong GP upang maging eligible para sa Medicare rebate. Sa iyong appointment, kumukuha kami ng history, sinusuri ang iyong balikat, at nag-aayos ng imaging o nerve tests kung kinakailangan. Ang suprascapular nerve ay isang nerve na tumatakbo sa likod ng balikat at nagbibigay-suplay sa ilang mga kalamnan doon. Kapag may pumipitpit dito, maaari kang makaranas ng mapurol at kumikirot na sakit sa likod o gilid ng balikat, kasama ang panghihina o pagliit (wasting) ng mga kalamnang iyon. Karaniwan itong ginagamot muna nang walang operasyon, gamit ang physiotherapy, anti-inflammatory medicine, at mga pagbabago sa iyong mga aktibidad. Isinasaalang-alang namin ang operasyon kapag ang mga hakbang na iyon ay hindi nagbigay sa iyo ng sapat na pagbuti, o kapag mayroong malinaw na pumipitpit sa nerve. Pinapalaya ng operasyon ang nerve mula sa pressure na iyon. Layunin nito na bawasan ang iyong sakit at pagbutihin ang lakas at function ng iyong balikat. Pag-uusapan namin kung ito ay angkop para sa iyo, at magdedesisyon tayo nang magkasama.

Bago ang operasyon

Karamihan sa iyong paghahanda ay nagaganap bago ka dumating sa ospital. Kakailanganin mong itigil ang pagkain at pag-inom pitong oras bago ang operasyon. Humihingi kami ng pitong oras sa halip na anim upang mauna ka kung sakaling maaga ang takbo ng listahan sa theatre. Sasabihin sa iyo ng iyong surgeon kung alin sa iyong mga regular na gamot ang dapat itigil at kailan, kaya magdala ng nakasulat na listahan ng lahat ng iyong iniinom. Mag-ayos ng taong maghahatid sa iyo pauwi pagkatapos, dahil hindi mo magagawang magmaneho nang mag-isa. Magsuot ng maluwag at komportableng damit na madaling hubarin. Maaaring kailanganin ang imaging tulad ng X-ray, MRI scan, o ultrasound upang planuhin ang operasyon at suriin nang eksakto kung saan naiipit ang nerve. Kung mayroon kang iba pang kondisyong medikal, maaaring kailanganin mo ng blood tests o review kasama ang anaesthetist.

Sa araw ng operasyon

Darating ka sa surgical admissions unit ng ospital, kung saan ka ire-rehistro at ihahanda para sa theatre. Makikipagkita ka sa anaesthetist bago ang iyong operasyon. Ang operasyong ito ay ginagawa sa ilalim ng general anaesthetic na pinagsama sa isang regional nerve block. Makikipagkita sa iyo ang anaesthetist bago ang operasyon at ipapaliwanag sa iyo ang dalawang bahaging ito.

Pagkatapos ay dadalhin ka sa operating theatre, kung saan isasagawa ang operasyon. Kapag natapos na ito, magigising ka sa recovery area. Babantayan ka ng mga nurse doon habang nawawala ang bisa ng anaesthetic. Kapag stable ka na, ililipat ka sa isang ward o uuwi sa parehong araw, depende sa procedure at kung paano ang iyong paggaling.

Ano ang kinapapalooban ng operasyon

Ito ay isang keyhole operation. Ang iyong surgeon ay gagawa ng ilang maliliit na hiwa sa paligid ng iyong balikat, kabilang ang isa sa likuran, at magtatrabaho sa pamamagitan ng mga ito gamit ang isang maliit na camera. Ipinapakita ng camera ang loob ng iyong balikat sa isang screen, kaya hindi kinakailangan ng malaking insisyon.

Ang suprascapular nerve ay dumadaan sa mga makitid na daanan sa buto sa likuran ng iyong balikat. Sa ilang tao, isang mahigpit na banda ng tissue o isang supot na puno ng likido ang umiipit sa nerve doon. Gagamitin ng iyong surgeon ang camera upang hanapin ang bahagi kung saan naiipit ang nerve. Pagkatapos ay luluwagan nila ang mahigpit na banda ng tissue, o tatanggalin ang supot, upang hindi na maipit ang nerve. Ang nerve mismo ay hindi gagalawin. Kung mayroon kang iba pang problema sa balikat sa parehong pagkakataon, gaya ng napunit na tendon, madalas ay kayang gamutin ng iyong surgeon ang mga ito sa pamamagitan ng parehong maliliit na hiwa.

Ang mga hiwa ay sasara gamit ang mga tahi. Magkakaroon ka ng dressing sa ibabaw ng mga sugat, na mananatili nang humigit-kumulang 10 araw.

Pagkatapos ng operasyon

Karamihan sa mga pasyente ay nananatili ng isang gabi sa ospital pagkatapos ng operasyong ito, bagaman ang ilan ay nakakauwi sa mismong araw. Magigising ka sa recovery area, kung saan babantayan ka ng mga nars habang nawawala ang bisa ng anaesthetic. Maaaring makaramdam ng hapdi o bigat sa iyong balikat, at maaaring bigyan ka ng mga nars ng gamot upang mapanatili kang komportable. Ang iyong braso ay ilalagay sa isang simpleng sling para sa iyong kaginhawaan. Tinatanggal ito para sa paghuhugas at para sa iyong mga ehersisyo. Dapat may kasama ka sa unang 24 oras pagkauwi mo sa bahay. Panatilihing malinis at tuyo ang mga sugat. Iniiwan namin ang dressing sa loob ng humigit-kumulang 10 araw; pakiusap na huwag itong tanggalin bago ang panahong iyon maliban kung sinabi namin sa iyo. Papalitan o tatanggalin namin ito kapag nakita ka namin. Maaari ka nang gumalaw-galaw sa loob ng bahay mula sa araw ng operasyon, at ang banayad na paggalaw ng kamay at siko ay nakatutulong sa iyong sirkulasyon. Hindi ka maaaring magmaneho sa loob ng hindi bababa sa anim na linggo; kapag binigyan ka na ng clearance ng iyong surgeon, karaniwan sa six-week review, tingnan ang Driving after upper-limb surgery.

Paggaling

Ang iyong balikat ay magiging masakit at medyo mamamaga sa unang ilang araw. Unti-unti itong huhupa habang gumagaling ang nerve. Ang pahinga, pagpapanatili ng iyong braso sa sling, at ang gamot sa sakit na ibinigay sa iyo ay makakatulong upang maibsan ang discomfort. Ang maliliit na hiwa sa paligid ng iyong balikat ay gagaling sa panahon ng pag-dressing, at susuriin namin ang mga ito kapag nakita ka namin.

Ang iyong braso ay nakapahinga sa isang simpleng sling para sa comfort sa simula. Tinatanggal ito para sa paghuhugas at para sa iyong mga ehersisyo. Gagabayan ka ng iyong physiotherapist sa mga banayad na paggalaw, pagkatapos ay palalakasin ang iyong strength ayon sa kakayahan ng iyong balikat. Maaari ka nang gumalaw sa loob ng bahay mula sa araw ng operasyon, at ang banayad na paggalaw ng kamay at siko ay nakakatulong sa iyong sirkulasyon. Hindi ka magmamaneho sa loob ng hindi bababa sa anim na linggo; kapag binigyan ka na ng clearance ng iyong surgeon, karaniwan sa six-week review, tingnan ang Driving after upper-limb surgery.

Habang humuhupa ang pamamaga at bumabalik ang paggalaw, nagiging mas madali ang mga pang-araw-araw na gawain. Mapapansin mong bumubuti ang iyong grip at pagbuhat habang nababawi ng mga kalamnan sa paligid ng iyong balikat ang kanilang lakas. Karamihan sa mga tao ay nakikita na nababawasan ang kanilang sakit at nararamdamang mas lumalakas ang kanilang balikat sa paglipas ng panahon. Kapag magagamit mo na ang iyong braso para sa mga pang-araw-araw na aktibidad nang walang sakit, maaari ka nang unti-unting bumalik sa trabaho at sa mga aktibidad na iyong kinagigiliwan, base sa nararamdaman ng iyong balikat.

Ang paggaling ay nag-iiba sa bawat tao. Maaaring magkaiba ang iyong timeline, at gagabayan ka ng iyong surgeon at physiotherapist sa bawat hakbang.

Ano ang maaaring maging problema

Karamihan sa mga pasyente ay gumagaling nang maayos, ngunit paminsan-minsan ay maaaring magkaroon ng mga problema. Binabantayan kayo nang maigi ng inyong surgeon at ng team upang maagapan ang anumang isyu.

Ang nerve na ginagamot ay maaaring mairita paminsan-minsan habang isinasagawa ang operasyon. Kung mangyari ito, maaari kayong makapansin ng bagong panghihina sa mga kalamnan ng balikat o braso, o isang bahagi ng pamamanhid o pangingilig na wala noon. Sabihin sa inyong surgeon sa susunod na review kung mapapansin ninyo ang mga pagbabagong ito.

Ang keyhole shoulder surgery ay may maliit na pagkakataon ng impeksyon. Bantayan ang mga maliliit na hiwa sa inyong balikat. Ang mga palatandaan ay kinabibilangan ng tumitinding sakit sa paligid ng sugat, pamumula na kumakalat mula rito, init, o pagtagas ng likido mula rito. Maaari rin kayong makaramdam ng lagnat. Makipag-ugnayan sa klinika kung makakita ng alinman sa mga palatandaang ito, o pumunta sa emergency department kung masama ang inyong pakiramdam.

Ang likido ay maaaring makaipon paminsan-minsan sa ilalim o malapit sa sugat pagkatapos ng operasyon. Lumalabas ito bilang pamamaga na malambot o maselan, at maaaring maramdamang matigas kapag hinawakan. Ang maliit na halaga ng pamamaga ay normal sa unang ilang araw. Kung ang pamamaga ay lumalaki, nagiging masakit, o ang balat sa ibabaw nito ay mukhang banat at makintab, ipaalam ito sa klinika.

Ang operasyon sa balikat ay maaaring makaapekto paminsan-minsan sa mga nerve na mas ibaba sa braso. Maaari kayong makapansin ng pangingilig, pamamanhid, o panghihina sa inyong siko, forearm, kamay, o mga daliri. Madalas itong nawawala nang kusa sa pamamagitan ng mga simpleng hakbang tulad ng pahinga at banayad na paggalaw. Kung hindi ito nawawala, o kung lumalala, banggitin ito sa inyong review. Ang operasyon upang palayain ang nerve sa mas ibaba ng braso ay isang opsyon kung ang problema ay hindi mawawala nang kusa.

Ang table ng mga komplikasyon sa pahinang ito ay naglilista ng mga tipikal na rate kung nais ninyo ang mga detalye.

Kailan dapat tumawag sa amin

Karamihan sa mga problema pagkatapos ng operasyong ito ay lumalabas nang maaga, at mas gusto naming malaman ang mga ito nang mas maaga kaysa huli na. Tumawag sa amin kung mapansin ang lagnat, pamumula o pagtagas ng likido mula sa sugat na lumalala, o pamamaga na patuloy na lumalaki at nagiging masakit. Pumunta sa emergency kung may biglaang matinding sakit, pamamaga o sakit sa binti (calf), kahirapan sa paghinga, bagong bahagi ng pamamanhid, o kung hindi mo maigalaw ang iyong braso. Kung mapansin ang bagong panghihina o pangingilig sa balikat, braso, o kamay, tumawag sa klinika upang masuri namin ito nang maaga.

Saan maaaring magbasa nang higit pa tungkol sa kondisyon

Ang pahinang ito ay tungkol sa operasyon mismo. Ang kondisyong ginagamot nito, kabilang ang kung ano ang ipinapakita ng ebidensya tungkol sa kung kailan nakatutulong ang operasyon at kung kailan hindi, ay tinalakay nang mas detalyado sa pahinang Suprascapular neuropathy.

Evidence & references

This is the clinical evidence summary written for health professionals. It is technical, and it lists the research this page was built from. You do not need to read it to understand your treatment or to make a decision about it.

Overview

Arthroscopic decompression of the suprascapular nerve provides excellent visualization and the ability to address concomitant shoulder pathology [1].
Surgical decompression in the setting of suprascapular neuropathy leads to satisfactory outcomes as evidenced by patient-reported outcomes and return to sport rate [2].
Suprascapular neuropathy treated with suprascapular nerve decompression significantly improves patient-reported outcomes and is noninferior to similar procedures without suprascapular nerve decompression [3].
Arthroscopic suprascapular nerve decompression for suprascapular neuropathy at the suprascapular and/or spinoglenoid notch in the absence of major concomitant glenohumeral pathology results in good functional outcomes with significant improvements from before to after surgery [4].
Release of the spinoglenoid ligament with resultant suprascapular nerve decompression may result in relief of pain and a return of normal shoulder function [5].
No recommendations regarding suprascapular nerve release in conjunction with rotator cuff repair can be made at this time, and further research is necessary to better delineate the indications in the future [6].
Decompression of the suprascapular nerve at the spinoglenoid notch did not lead to a better functional outcome compared to repair alone in patients with posterosuperior massive rotator cuff tears and suprascapular neuropathy [7].
A novel arthroscopic technique for suprascapular nerve decompression uses the superior border of the scapula as a guide, potentially reducing operative time and tissue removal compared to previous methods [8].
The suprascapular artery must be identified and protected along with the nerve during decompression to ensure safety [9].
Outcomes after arthroscopic suprascapular nerve release at the suprascapular notch predictably led to successful pain relief and strength improvement in patients presenting with pain and weakness respectively [10].
Arthroscopic release of the suprascapular nerve can be performed safely and effectively, with all patients showing improvement in postoperative electromyographic findings and marked improvement in pain relief and function [12].
Suprascapular nerve release does not seem to be justified as an adjunct to rotator cuff repair if preoperative EMG findings document normal suprascapular nerve function [19].

Anatomy & Pathophysiology

Nerve Course and Entrapment Sites

The suprascapular nerve courses from the upper trunk of the brachial plexus to its motor insertion on the supraspinatus and, more distally, the infraspinatus [17].
The superior transverse scapular ligament arises from the medial base of the coracoid overlying the suprascapular notch [35].
The suprascapular artery runs superior to the superior transverse scapular ligament, while the nerve runs deep to it [35].
Entrapment of the suprascapular nerve at the superior transverse scapular ligament causes denervation of both the supraspinatus and the infraspinatus [35].
The spinoglenoid ligament overlies the suprascapular nerve at the spinoglenoid notch [35].
Entrapment, traction, or compression at the spinoglenoid notch causes denervation of the infraspinatus [35].
At the suprascapular notch, the nerve has little translational freedom as it angles around a confined space [49].
The angled pathway and limited mobility at the suprascapular notch predispose the nerve to mechanical stretching [49].
Mechanical stretching at the suprascapular notch may be exacerbated by extreme positions of scapular depression, retraction, or abduction [49].

Anatomical Variations and Predisposing Factors

Anatomical variations at the suprascapular notch include abnormally oriented subscapularis muscle fibers [22].
Anatomical variations at the suprascapular notch include an anterior coracoscapular ligament [22].
Anatomical variations at the suprascapular notch include a calcified superior transverse scapular ligament [22].
These anatomical variations are predisposing factors for suprascapular nerve entrapment [22].

Mechanisms of Injury

Suprascapular neuropathy can occur as a result of traction, direct trauma, or extrinsic compression [49].
Suprascapular neuropathy can occur as part of a more generalized brachial plexus disorder [49].
Traction of the suprascapular nerve can occur at the suprascapular or spinoglenoid notch secondary to repetitive microtrauma [49].
Repetitive microtrauma primarily arises from overhead activities such as tennis, volleyball, and weight lifting [49].
Repetitive microtrauma may lead to direct injury to the nerve [49].
Repetitive microtrauma may lead to indirect injury by affecting the vascular supply to the nerve [49].
Intimal damage to the axillary or suprascapular artery may lead to microemboli that become trapped in the vasa nervorum [49].
Microemboli trapped in the vasa nervorum lead to ischemic injury to the suprascapular nerve [49].
Direct trauma or indirect trauma during glenohumeral dislocation may result in suprascapular neuropathy [49].
Direct trauma or indirect trauma during proximal humerus fracture may result in suprascapular neuropathy [49].
Direct trauma or indirect trauma during scapular fracture may result in suprascapular neuropathy [49].
Iatrogenic injury to the suprascapular nerve has been reported as a consequence of distal clavicle resection [49].
Iatrogenic injury to the suprascapular nerve has been reported as a consequence of positioning during spine surgery [49].
Iatrogenic injury to the suprascapular nerve has been reported as a consequence of transglenoid arthroscopic anterior shoulder stabilization [49].
Iatrogenic injury to the suprascapular nerve has been reported as a consequence of shoulder arthrodesis [49].
Iatrogenic injury to the suprascapular nerve has been reported as a consequence of procedures utilizing the posterior approach to the shoulder, such as posterior shoulder stabilization [49].
Repetitive microtrauma or a single traumatic event is more likely to cause suprascapular neuropathy at the level of the suprascapular notch [49].
Compression by a ganglion cyst or tumor is a cause of suprascapular neuropathy, particularly at the level of the spinoglenoid notch [49].
Cystic lesions arising from a labral or capsular tear can compress the nerve along its course over the scapula [17].
Nerve traction is theorized to arise from chronic overhead athletics [17].
Nerve traction is theorized to arise from a retracted rotator cuff tear [17].

Pathological Associations and Outcomes

The exact association and etiology of suprascapular neuropathy in patients with rotator cuff pathology remain unclear [16].
Complete fatty infiltration of intact rotator cuffs can be caused by suprascapular neuropathy [11].
Fatty infiltration resulting from suprascapular neuropathy is not reversible [11].

Classification

Suprascapular neuropathy can present secondary to various etiologies including entrapment or compression [17].
Nerve traction is theorized to arise from chronic overhead athletics or due to a retracted rotator cuff tear [17].
Suprascapular nerve neuropathy occurs when the suprascapular nerve is injured along its course from the upper trunk of the brachial plexus to its motor insertion on the supraspinatus and, more distally, the infraspinatus [17].
Nerve injury can occur from either compression or traction [17].

Clinical Presentation

Symptoms and Signs

Patients with suprascapular nerve neuropathy usually complain of a dull, aching pain in the posterior and lateral aspects of the shoulder [18].
Suprascapular neuropathy is a potential source of shoulder pain and functional limitation [17].
Entrapment of the suprascapular nerve at the suprascapular notch is a cause of shoulder pathology that should be considered in people presenting with wasting of the supraspinatus or infraspinatus muscles, or both [29].
When the nerve is entrapped at the suprascapular notch, patients present with weakness and atrophy of both the supraspinatus and infraspinatus [18].
With entrapment at the spinoglenoid notch, symptoms of weakness and atrophy are isolated to the infraspinatus [18].
Compression of the nerve at the level of the spinoglenoid notch leads to weakness and atrophy of the infraspinatus [18].

Etiology and Risk Factors

A variety of potential causes of compression have been described, including anomalous transverse scapular ligaments, ganglion cysts, abnormal bony morphology, direct trauma, and traction injury [18].
The incidence of compressive neuropathy is quite high in the overhead athletic cohort [17].
Most patients in the overhead athletic cohort do not show clinically relevant deficiencies in function [17].

Diagnosis

The diagnosis of suprascapular neuropathy is based on a combination of a detailed history, a comprehensive physical examination, imaging, and electrodiagnostic studies [17].
A detailed history and physical examination along with appropriate workup are paramount to arrive at a diagnosis of suprascapular nerve entrapment [18].
Shoulder surgeons should consider electrophysiologic evaluation of patients with clinical or radiographic signs of suprascapular neuropathy [20].
Shoulder surgeons should be cognizant of the parameters that constitute an abnormal electrodiagnostic study [20].

Investigations

Shoulder surgeons should consider electrophysiologic evaluation of patients with clinical or radiographic signs of suprascapular neuropathy and be cognizant of the parameters that constitute an abnormal study [20].
In the absence of a well-defined lesion producing mechanical compression of the suprascapular nerve, suprascapular neuropathy should be treated non-operatively [15].
Anatomical variations at the suprascapular notch, including abnormally oriented subscapularis muscle fibers, anterior coracoscapular ligament, and calcified superior transverse scapular ligament, are predisposing factors for suprascapular nerve entrapment [22].
The purpose of imaging of the shoulder is to help establish the diagnosis, determine the severity of the pathoanatomy, assist in surgical planning, and enable the surgeon to illustrate the condition of the shoulder to the patient [24].
Unless a specific research protocol is in place, the temptation to “overimage” should be resisted, obtaining only the scans or reconstructions that are necessary for the care of the patient [24].
Standardized plain films are almost always sufficient to garner the information needed for shoulder evaluation [24].
The first key radiographic view is the anteroposterior (AP) in the plane of the scapula taken so that the x-ray beam passes through the glenohumeral joint [24].
The second key radiographic view is the axillary view taken with the arm in the functional position of elevation in the plane of the scapula and oriented so that both the spinoglenoid notch and the scapular neck are visible [24].
At least two X-ray views should be obtained for shoulder imaging: an anteroposterior in the plane of the glenoid and an axillary projection with the arm in abduction to show the relationship of the humeral head to the glenoid [40].
Magnetic resonance imaging (MRI) is useful to identify osteonecrosis of the humeral head, or a bone tumour [40].
MRI can also identify labral tears and rotator cuff tears, although the accuracy for these latter two is enhanced by combining the scan with arthrography [40].
Computed tomography (CT) is helpful for planning fracture surgery and shoulder joint replacement [40].
Ultrasound is a simple and accurate test for identifying rotator cuff tears and calcific tendinitis [40].
Ultrasound can also be useful in guiding injections or barbotage (aspirating calcific deposits in the rotator cuff) [40].
Arthroscopy is useful for diagnosing and treating subacromial impingement, intra-articular lesions, detachment of the glenoid labrum and rotator cuff tears [40].

Treatment

Non-Operative Management

Initial treatment of isolated suprascapular neuropathy typically consists of physical therapy, nonsteroidal anti-inflammatory drugs, and activity modification [14].

Operative Indications

Open or arthroscopic operative intervention is warranted when there is extrinsic nerve compression or progressive pain and/or weakness [14].
Surgical decompression is indicated in cases refractory to conservative management [18].

Surgical Techniques

The anterior release of the suprascapular nerve is a feasible alternative to the lateral approach [26].
Open decompression at the spinoglenoid notch permits direct visualization of the suprascapular nerve and allows for a safe, reliable, and thorough decompression [18].
For open spinoglenoid notch decompression, the patient is placed in the lateral decubitus position with the head elevated 30° and the body over-rotated 10° to 20° past parallel anteriorly [50].
During open spinoglenoid notch decompression, the deltoid is split in line with its fibers beginning approximately 4 to 5 cm from the posterolateral corner of the acromion [50].
The spinoglenoid ligament is released sharply from the edge of the scapular spine during open decompression [50].

Safety Considerations

Clinical Outcomes

Suprascapular neuropathy treated with suprascapular nerve decompression significantly improves patient-reported outcomes and is noninferior to similar procedures without decompression [3].
Arthroscopic management of suprascapular neuropathy provides patients with significant improvements in pain, strength, and subjective function of the shoulder, and has a low incidence of complications [13].

Concomitant Pathology

Complications

Arthroscopic management of suprascapular neuropathy has a low incidence of complications [13].
Ultrasound-assisted intralesional methylene blue injection may facilitate uneventful decompression of symptomatic spinoglenoid notch cysts while preventing iatrogenic suprascapular nerve injury [51].
A malpositioned superior screw from reverse shoulder arthroplasty can cause suprascapular nerve entrapment [30].
Baseplate screw penetration in reverse total shoulder arthroplasty poses a risk of iatrogenic suprascapular neuropathy by screw violation [31].
Failure to treat multiple diagnoses in the same shoulder can lead to missed pathologic features and the necessity for revision operations [21].

Recovery

Surgical decompression for suprascapular neuropathy leads to satisfactory outcomes as evidenced by patient-reported outcomes and return to sport rate [2].
Suprascapular neuropathy treated with suprascapular nerve decompression significantly improves patient-reported outcomes [3].
Suprascapular nerve decompression is noninferior to similar procedures without suprascapular nerve decompression [3].
Arthroscopic suprascapular nerve decompression at the suprascapular and/or spinoglenoid notch in the absence of major concomitant glenohumeral pathology results in good functional outcomes [4].
Arthroscopic suprascapular nerve decompression at the suprascapular and/or spinoglenoid notch in the absence of major concomitant glenohumeral pathology results in significant improvements from before to after surgery [4].
Release of the spinoglenoid ligament with resultant suprascapular nerve decompression may result in relief of pain [5].
Release of the spinoglenoid ligament with resultant suprascapular nerve decompression may result in a return of normal shoulder function [5].
Outcomes after arthroscopic suprascapular nerve release at the suprascapular notch predictably led to successful pain relief in patients presenting with pain [10].
Outcomes after arthroscopic suprascapular nerve release at the suprascapular notch predictably led to strength improvement in patients presenting with weakness [10].
Patients experienced immediate improvement in pain following treatment for suprascapular neuropathy [11].
Patients experienced immediate improvement in subjective shoulder value following treatment for suprascapular neuropathy [11].
Fatty infiltration was not reversible following treatment for suprascapular neuropathy [11].
All patients showed improvement in postoperative electromyographic findings after arthroscopic release of the suprascapular nerve [12].
All patients showed marked improvement in pain relief after arthroscopic release of the suprascapular nerve [12].
All patients showed marked improvement in function after arthroscopic release of the suprascapular nerve [12].
Full recovery of shoulder function was achieved in a case of suprascapular nerve entrapment caused by a large hematoma of the scapula [25].

Key Evidence

[L5] Arthroscopic decompression of the suprascapular nerve provides excellent visualization and the ability to address concomitant shoulder pathology. [1] (10.1016/j.jse.2010.01.006)
[L4] Surgical decompression in the setting of suprascapular neuropathy leads to satisfactory outcomes as evidenced by the patient-reported outcomes and return to sport rate. [2] (10.1016/j.jse.2017.09.025)
[L4] Suprascapular neuropathy treated with SSND significantly improves patient-reported outcomes and is noninferior to similar procedures without SSND. [3] (10.1016/j.xrrt.2024.05.007)
[L4] Arthroscopic SSN decompression for suprascapular neuropathy at the suprascapular and/or spinoglenoid notch in the absence of major concomitant glenohumeral pathology results in good functional outcomes with significant improvements from before to after surgery. [4] (10.1016/j.arthro.2020.10.020)
[L4] Release of the spinoglenoid ligament with resultant suprascapular nerve decompression may result in relief of pain and a return of normal shoulder function. [5] (10.1177/03635465990270062101)
[L4] No recommendations regarding suprascapular nerve release in conjunction with rotator cuff repair can be made at this time, and further research is necessary to better delineate the indications in the future. [6] (10.1016/j.jse.2011.11.033)
[L3] Decompression of the suprascapular nerve at the spinoglenoid notch did not lead to a better functional outcome compared to repair alone in patients with posterosuperior massive rotator cuff tears and suprascapular neuropathy. [7] (10.1186/s12891-021-04075-1)
[L4] The study describes a novel arthroscopic technique for suprascapular nerve decompression that uses the superior border of the scapula as a guide, potentially reducing operative time and tissue removal compared to previous methods. [8] (10.1007/s00167-009-0858-1)
[L4] The authors emphasize that the suprascapular artery must be identified and protected along with the nerve during decompression to ensure safety. [9] (10.1016/j.jse.2008.08.007)
[L4] Outcomes after arthroscopic suprascapular nerve release at the suprascapular notch predictably led to successful pain relief and strength improvement in patients presenting with pain and weakness respectively. [10] (10.1177/2325967123s00003)
[L4] Patients experienced immediate improvement in pain and subjective shoulder value, though fatty infiltration was not reversible. [11] (10.1016/j.arthro.2014.01.010)
[L4] Arthroscopic release of the suprascapular nerve can be performed safely and effectively, with all patients showing improvement in postoperative electromyographic findings and marked improvement in pain relief and function. [12] (10.1016/j.arthro.2006.10.003)
[L4] Results indicate that arthroscopic management provides patients with significant improvements in pain, strength, and subjective function of the shoulder, and has a low incidence of complications. [13] (10.1007/s00167-017-4694-4)
[L5] Initial treatment of isolated suprascapular neuropathy is typically nonoperative, consisting of physical therapy, nonsteroidal anti-inflammatory drugs, and activity modification; however, open or arthroscopic operative intervention is warranted when there is extrinsic nerve compression or progressive pain and/or weakness. [14] (10.2106/jbjs.i.01743)
[L4] In the absence of a well-defined lesion producing mechanical compression of the suprascapular nerve, suprascapular neuropathy should be treated non-operatively. [15] (10.2106/00004623-199708000-00007)
[L3] The exact association and etiology of suprascapular neuropathy in patients with rotator cuff pathology remain unclear. [16] (10.1016/j.jse.2013.06.011)
[L5] [17] (10.5435/jaaos-d-19-00526)
[L5] [18] (10.1016/j.eats.2024.103051)
[L2] Suprascapular nerve release does not therefore seem to be justified as an adjunct to RC repair if preoperative EMG findings document normal suprascapular nerve function. [19] (10.1016/j.jse.2020.03.051)
[L4] Shoulder surgeons should consider electrophysiologic evaluation of patients with clinical or radiographic signs of suprascapular neuropathy and be cognizant of the parameters that constitute an abnormal study. [20] (10.1016/j.jse.2010.10.039)
[L4] A complete history and physical, careful attention to auxiliary tests, and treatment of multiple diagnoses in the same shoulder avoids missed pathologic features and necessity for revision operations. [21] (10.1097/01.blo.0000063791.32430.59)
[L4] Anatomical variations at the suprascapular notch, including abnormally oriented subscapularis muscle fibers, anterior coracoscapular ligament, and calcified superior transverse scapular ligament, are predisposing factors for suprascapular nerve entrapment. [22] (10.1007/s00167-003-0378-3)
[Case_report] Full recovery of shoulder function was achieved. [25] (10.1186/s12891-023-06723-0)
[L5] The anterior release of the suprascapular nerve is a feasible alternative to the lateral approach. [26] (10.1016/j.eats.2024.103237)
[L5] Entrapment of the SSN at the suprascapular notch is a cause of shoulder pathology that should be considered in people presenting with wasting of the supraspinatus or infraspinatus muscles, or both. [29] (10.1016/j.jse.2010.12.003)
[Case_report] This case is the first report of malpositioned superior screw from reverse shoulder arthroplasty causing suprascapular nerve entrapment. [30] (10.1016/j.jse.2009.10.004)
[L3] [31] (10.1016/j.jse.2021.10.024)
[L5] [49] (10.5435/00124635-199911000-00002)
[L4] [50] (10.1016/j.jse.2013.03.009)
[L4] We believe that this technique may facilitate uneventful decompression of symptomatic spinoglenoid notch cysts while preventing iatrogenic suprascapular nerve injury. [51] (10.1016/j.jse.2021.03.076)

References

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[31] Three-dimensional analysis of baseplate screw penetration in reverse total shoulder arthroplasty: risk of iatrogenic suprascapular neuropathy by screw violation. Journal of Shoulder and Elbow Surgery. 2022. DOI: 10.1016/j.jse.2021.10.024

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