Arthroscopic Treatment of Suprascapular Nerve Entrapment
by Dr. Richard Bartholomew
Pinched Nerve in Shoulder
The suprascapular nerve supplies function to the supra and infraspinatous muscles. Nerve entrapment has recently gained a lot of attention as a source of pain and dysfunction in the shoulder feeling like a pinched nerve in shoulder. There are three leading causes of this neuropathy: compression, traction, or direct trauma. Traction neuropathy commonly occurs at the suprascapular notch (fig 1a) and is frequently 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 and can be a source of continued pain and dysfunction. It is common to release the suprascapular ligament concomitantly with repair of these massive retracted tears of the rotator cuff since Neuropathy is reported as much as 70% of the time in this situation.
Suprascapular Notch and Paralabral Cyst
A pinched nerve in shoulder (compression) commonly occurs with a paralabral cyst. These often happen 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, releasing 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
An MRI scan is used to diagnose paralabral cysts (fig 1b). In conjunction with the MRI scan, EMG is commonly used to diagnose suprascapular neuropathy. Physical examination of the infraspinatous muscle often appreciates weakness. Sometimes, if the neuropathy is severe, atrophy of the supra and infraspinatous muscles can be seen.
Suprascapular Nerve Treatment
Before the advent of modern arthroscopic techniques, an extensive open surgical approach was used to treat severe lesion cases. Decompressing the suprascapular nerve at the same time of the index arthroscopic surgery procedure leads to better outcomes for a massive retracted rotator cuff repair and paralabral cysts.
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