Arthroscopic Decompression of the Suprascapular Nerve at the Spinoglenoid Notch and Suprascapular Notch Through the Subacromial Space
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Suprascapular nerve (SSN) entrapment is a cause of shoulder pain and weakness. Suprascapular neuropathy is infrequent, causing only 1% to 2% of diagnoses for shoulder pain. It occurs at either the suprascapular notch, resulting in weakness and atrophy of both the infraspinatus and the supraspinatus, or at the spinoglenoid notch, resulting in only infraspinatus weakness. Constraint of the nerve is commonly caused by its course through the suprascapular notch under the transverse scapular ligament (TSL) or through the spinoglenoid notch under the spinoglenoid ligament, as well as compression by supraglenoid and paralabral cysts. Although conservative treatment such as physical therapy can be recommended for SSN entrapment, it is commonly only successful in cases of overuse and is not successful in cases of nerve compression or space-occupying lesions, which require surgery for pain relief. Whereas pain relief after surgery has been consistent, the return of muscle strength and shoulder function is less predictable.
The literature reports the advantages of the arthroscopic techniques over the traditional open procedure for SSN decompression. Similar to other reported arthroscopic techniques to decompress the SSN at the suprascapular notch, our technique relies on a subacromial approach and direct visualization of the relevant anatomy of the coracoclavicular (CC) ligaments, suprascapular neurovascular structures, and TSL. In contrast to other described techniques of arthroscopic SSN decompression at the spinoglenoid notch, our surgical technique describes SSN decompression through the subacromial space. This technique allows direct visualization of the medial neck of the glenoid and helps avoid complications of iatrogenic SSN nerve injury from overly aggressive medial capsule dissection through the glenohumeral joint. With a thorough understanding of shoulder anatomy, the orthopaedic surgeon should be able to identify the spinoglenoid notch and the suprascapular notch in the subacromial space and decompress the SSN without injury to the nerve or surrounding structures. The purpose of this article is to provide our surgical technique to safely and successfully decompress the SSN at the suprascapular notch or the spinoglenoid notch through the glenohumeral joint and subacromial space.
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