Arthroscopic Release of Suprascapular Nerve Entrapment at the Suprascapular Notch: Technique and Preliminary Results

Abstract

We describe a novel all-arthroscopic technique for suprascapular nerve (SSN) decompression and present our preliminary results for this procedure. A prospective series of 10 patients with preoperative electromyographic findings consistent with chronic SSN compression, posterior shoulder pain, and subjective weakness were treated with arthroscopic SSN decompression. There were 8 men and 2 women, with a mean age of 50 years. The mean follow-up was 15 months (range, 6 to 27 months). In 8 of 10 patients, we performed an electromyographic examination postoperatively to evaluate nerve recovery after decompression. The clinical outcomes measures used to assess preoperative and postoperative function were the visual analog scale for pain, the Constant score, strength testing of the supraspinatus and infraspinatus, and a subjective satisfaction questionnaire. In all patients preoperative and postoperative computed tomography arthrograms were obtained to document the absence of a rotator cuff tear. There were no complications resulting from SSN decompression. Of 10 patients, 8 had postoperative electromyography at a mean of 6 months after SSN release and 2 refused to undergo this study after surgery. Of the 8 postoperative electromyograms, 7 had complete normalization of the latency in the motor fibers of the SSN and normalization of the voluntary motor action potential for the supraspinatus and infraspinatus muscles. Two of the electromyograms showed evidence of partial recovery. The preoperative and postoperative Constant scores for these patients were 60.3 and 83.4, respectively (P < .001). All patients returned to their normal work and sports activity at a mean of 3 weeks (range, 2 days to 3 months). The abduction and external rotation strength also significantly improved. At the time of last follow-up, 9 patients graded their clinical outcome as excellent and responded that they had complete relief of pain. One of the study subjects reported a satisfactory result with moderate relief of pain. Arthroscopic release of the SSN can be performed safely and effectively. All of the patients in this preliminary study had improvement in their postoperative electromyographic findings and had marked improvement in pain relief and function. Level IV, therapeutic case series.