Bone and Joint Specialists E-Newsletter Archive
Suprascapular Nerve Entrapment
Arthroscopic Treatment of Suprascapular Nerve Entrapment by Dr. Richard Bartholomew
The suprascapular nerve supplies function to the supra and infraspinatous muscles. The nerve has more recently gained a lot of attention as a source of pain and dysfunction in the shoulder. There are three main causes of this neuropathy: compression, traction, or direct trauma. Traction neuropathy commonly occurs at the scapular notch(fig 1a) and is becoming increasingly recognized with massive retracted tears of the rotator cuff. As the tendon is re-approximated to the greater tuberosity, there is increased traction on the nerve. This can be a source of continued pain and dysfunction. Neuropathy in this situation has been reported as much as 70% of the time. For this reason it is becoming more common to release the suprascapular ligament concomitantly with repair of these massive retracted tears of the rotator cuff.
Compression commonly occurs with paralabral cysts. These often occur with SLAP lesions and/or isolated labral tears. The tears allow fluid to 'leak' toward the spinoglenoid notch(fig 1a) and form ganglion like cysts which compress the nerve. Arthroscopic decompression, release of the spinoglenoid ligament, excision of the cysts, and repair of the SLAP and/or labral tear removes the compression and prevents recurrence of the cyst. Diagnoses of paralabral cysts are easily seen on MRI scan(fig 1b). EMG is also commonly helpful to diagnose suprascapular neuropathy. Weakness can often be appreciated by physical exam of the infraspinatous muscle. Sometimes, if the neuropathy is severe, atrophy of the supra and infraspinatous muscles can be seen.
Prior to the advent of modern arthroscopic techniques the only way to treat these lesions was through an extensive open surgical approach. This was reserved for only the most severe cases. Currently the nerve can be decompressed at the same time of the index arthroscopic procedure. This has led to much better outcomes of massive retracted rotator cuff repairs as well as paralabral cysts.
Dr. Bartholomew treats painful shoulder conditions such as bursitis, tendonitis, calcium deposition, advanced arthritis, rotator cuff tears and frozen shoulder.
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