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Abstract

Purpose: Spinoglenoid ligament entrapment of the suprascapular nerve presents with acute onset of deep, diffuse, posterolateral shoulder pain. Patients demonstrate consistent findings of pain with palpation over the suprascapular notch, spinati muscle atrophy, or isolated infraspinatus muscle atrophy often secondary to a ganglion at the spinoglenoid notch. The current trend is toward early surgical decompression through an open posterior approach. The purpose of this study was to determine the outcome following endoscopic release of the spinoglenoid ligament, in treatment of suprascapular nerve entrapment syndromes (SNES). Methods: Between 1/1998 and 3/2006, 16 patients presented with posterior shoulder pain, presumed to have SNES. Diagnosis was determined by physical exam, and confirmed by MRI and EMG/NCV studies. The average patient age was 39 (range 23 to 69). There were 6 males and 10 females. All patients had limited use of their shoulder prior to surgery. All patients underwent endoscopic spinoglenoid ligament release performed by one surgeon, in the beach chair position using standard posterior, lateral, and accessory portals as needed. Pre-operative and post-operative ASES score, shoulder pain, strength, and ROM were documented. A paired sample t-test was applied to preoperative and postoperative measurements which were continuous variables. Results: Four patients were excluded from the study secondary to concomitant open supraspinatus medial wedge resection. At 4 years average follow-up (range 1 to 8 years), 11 of the 12 (94%) remaining patients had relief of their shoulder pain. All had full range of motion, and improvement in ASES score (p<0.05). All patients returned to full activities of daily living. The average time of return to full function was 6 months. No nerve or vascular complications were noted. Seven of the patients did not have full return of function of the infraspinatus; however these patients had significantly longer time from injury to surgery. No patient required open decompression of the spinoglenoid notch. Conclusions: Entrapment of the suprascapular nerve by the spinoglenoid ligament can be a common cause of posterior shoulder pain. This simple minimally invasive technique of endoscopic release of the spinoglenoid ligament can provide for patients symptomatic relief and allow them to return to function faster and with less complications than traditional open posterior release. Early treatment is recommended to improve return of function of the infraspinatus. If noted, the author indicates something of value received. The codes are identified as follows: a, research or institutional support; b, miscellaneous funding; c, royalties; d, stock options; e, consultant or employee. *The Food and Drug Administration has not cleared the drug and/or medical device for the use described in this presentation (ie, the drug or medical device is being discussed for an “off-label” use). If noted, the author indicates something of value received. The codes are identified as follows: a, research or institutional support; b, miscellaneous funding; c, royalties; d, stock options; e, consultant or employee. *The Food and Drug Administration has not cleared the drug and/or medical device for the use described in this presentation (ie, the drug or medical device is being discussed for an “off-label” use).