Management of large and diffuse distal neuroma of suprascapular nerve by nerve transfer: A case report and review of literature

Abstract

AimOwing to its peculiar anatomical location, circuitous pathway with acute angles and several sites of relative fixation, suprascapular nerve (SSN) is vulnerable to both traction and compression forces along its course from the upper trunk to its terminal insertion on the infraspinatus muscle. We report a case of a large neuroma in the distal part of SSN, managed by direct transfer of the distal part of spinal accessory nerve into the SSN. SubjectA 26-year-old man presented with restricted shoulder abduction and wasting of the supraspinatus and infraspinatus muscles. Electromyography (EMG) revealed complete denervation of the infraspinatus muscle, while the deltoid and paraspinal muscles were normal. On anterior exploration all components of supraclavicular plexus appeared essentially normal. SSN, though appeared normal, failed to respond to electrical stimulation. Distal part of the SSN approach through a dorsal approach, revealed a long neuroma-in-continuity. Resection of the neuroma created a 4.5 cm nerve defect. Neuronal continuity was restored by a direct transfer of the distal part of SAN to the distal stump of SSN. ResultAt 24 months follow-up patient had restored a full range of shoulder abduction and about 70° of external rotation.