Orthopedics & Orthopedic Surgery
Area of Focus: Shoulder & Upper Extremity
Suprascapular neuropathy is a well documented cause of pain and weakness. Open nerve decompression has achieved good results, and all-arthroscopic techniques have been described. Drs. Krishnan, Lin, and Burkhead report a simplified technique for arthroscopic suprascapular nerve decompression.
Methods: Ten consecutive patients (mean age 55 years) who had failed at least 6 months of conservative management and had clinical and electrodiagnostic evidence of suprascapular neuropathy localized to the scapular notch underwent arthroscopic decompression.
Surgical technique: After standard glenohumeral arthroscopy, the scope was moved to the subacromial space where a bursoscopy was performed. An anterolateral portal was established to provide visualization of the work that was to be performed in a standard anterior portal. An electrocautery ablation device was used to follow the coracoacromial ligament from the acromion to the coracoid. Once the coracoid was visualized, the scope was placed in the anterior portal and, under direct visualization, an anterior accessory portal was established medial to the coracoid for direct access to the scapular notch. The suprascapular nerve was dissected back under the ligament and protected, and the ligament was released.
Results: All patients reported significant improvements in pain scores from 8.7 to 1.3. External rotation strength was symmetric in 90% of patients. All patients regained full range of motion, and there were no complications.
Discussion: Arthroscopic techniques for suprascapular nerve decompression are attractive given their limited morbidity. The approach described here uses anterior portals and references bony anatomy for nerve decompression. Early results compare favorably with other techniques.