Diagnosis and treatment of suprascapular neuropathy with massive rotator cuff tear

Abstract

Objective To evaluate diagnosis and treatment outcomes about suprascapular neuropathy with massive rotator cuff tear. Methods Fifty patients with massive rotator cuff tear underwent arthroscopic surgery from January 2011 to June 2014. The mean age was 51.50±11.50 years with average disease duration 4.60±6.70 months. Preoperative fat infiltration Goutallier grade was 3 cases in grade 0, 18 in grade 1, 18 in grade 2, 9 in grade 3 and 2 in grade 4. Based on medical history, physical examination and electromyogram, six cases were diagnosed with Neuropathy. Compression of scapular transverse ligament and ganglion notch cyst were not founded before and during rotator cuff repairing. Only neurotrophic drugs were admitted after arthroscopy. The clinical outcomes (range of motion, muscle strength in flexion and in rotation, electromyogram, Constant-Murley score, ASES score and VAS) and MRI results were collected. The differences between suprascapular neuropathy and normal group were compared at pre-operation and 2 years after operation. Results There was no complication like axillary nerve injury, infection and instability during the 27.90±6.70 months follow-up. All patients of Goutallier grade 4 (2/2) and partial patients of grade 3(4/9) showed delayed conduction with suprascapular neuropathy. The muscle strength in flexion and bodyside external/internal rotation improved. The VAS decreased from 7.70±2.50 to 1.20±1.80 (t=14.670, P=0.000), and ASES score improved from 45.80±9.50 to 92.50±6.30 (t=-18.450, P=0.000). Furthermore, Constant-Murley score improved from 41.40±8.70 to 90.20±4.70 (t=-20.790, P=0.000). Compared with the normal group, the patients with suprascapular neuropathy showed higher pain and worse functional score preoperatively (P 0.05). Conclusion The incidence of suprascapular neuropathy is 12% (6/50) in patients with massive rotator cuff tear. The preoperative function is worse in patients with neuropathy. Diagnosis for suprascapular neuropathy with massive rotator cuff tear can be based on the pain in posterior superior scapular region, severe infraspinatus muscular atrophy, MRI and EMG. Reversal of suprascapular neuropathy is founded with good curative effects after neurotrophic therapy during short-term follow-up. Arthroscopic release is not needed for patients without suprascapular nerve entrapment. Key words: Rotator cuff; Wounds and injuries; Arthroscopy; Reconstructive surgical procedures; Electrophysiology