Suprascapular neuropathy caused by nerve compression or tension at the suprascapular notch is an uncommon but often underappreciated source of shoulder pain and weakness, with limited reporting of presentation types, diagnostic algorithms, and outcomes of surgical treatment. (1) How does suspected suprascapular nerve compression without rotator cuff tear or space-occupying lesion present in a predominantly young and active military population? (2) How does arthroscopic suprascapular nerve decompression affect VAS pain scores, shoulder motor grading, and return to military duty or sport in this population? Between 2013 and 2020, two surgeons treated 29 patients for symptoms attributed to suprascapular nerve lesions with arthroscopic suprascapular nerve decompression. The diagnosis was made by a combination of history, physical examination, MRI, and selective use of EMG and diagnostic injection. Ultrasound-guided suprascapular nerve injection at the suprascapular notch with local anesthetic was performed in all patients presenting predominantly with pain to support the diagnosis. Patients who had positive findings from this work-up were offered surgical decompression, with patients presenting predominantly with pain having completed at least 7 months of nonoperative treatment at the time of final diagnosis. Although we do not have the exact numbers, the large majority of patients whose work-up suggested the presence of these nerve lesions underwent surgical decompression. We excluded nine of the original 29 patients because they had concomitant procedures and/or were over the age of 60 years. The remaining 20 patients (median [IQR] age 23 years [21 to 28]; 15 were men) were treated with isolated arthroscopic suprascapular nerve decompression at the suprascapular notch with necessary concomitant subacromial decompression, and all of them had follow-up of a minimum of 2 years (median [range] 6 years [2 to 10]) with respect to the endpoint of VAS pain, motor grading, and return to duty or sport. To answer our first research question, we characterized the patients' presentations descriptively based on whether they presented principally with pain or with weakness. Patients presenting predominantly with pain had VAS pain scores ranging from 4 to 8 with motor grades no worse than 4+ of 5, while patients presenting predominantly with weakness had a motor grading of 4 of 5 or worse and VAS pain scores ranging from 0 to 5 (median and mode 0). To answer our second research question, we collected the following outcome measures: return to active-duty military service, shoulder abduction and external rotation strength (by motor grade), and VAS pain score (worst level at rest or activity). These outcomes were compared with Wilcoxon rank sum tests. We found two clinical patterns. A primary symptom of weakness was present in 10 of 20 patients, and pain was the main symptom in 10 of 20 patients. Supraspinatus and/or infraspinatus edema and/or atrophy were present on MRI in 10 of 10 patients with weakness and 0 of 10 patients with pain. EMG had denervation changes in 8 of 8 patients with weakness and 0 of 4 patients with pain. Postoperatively, patients who primarily reported pain had improvement in median (IQR) VAS scores (6 [4 to 7] to 1 [0 to 1]; p = 0.009), whereas those who primarily reported weakness had improvement in abduction and external rotation motor grading (4.0 [3.6 to 4.0] to 5.0 [4.8 to 5.0] and 3.3 [3.0 to 3.9] to 4.3 [4.0 to 5.0], respectively; p = 0.004 and p = 0.008). Return to duty or sport occurred in 8 of 10 patients presenting predominantly with pain and 9 of 10 patients presenting predominantly with weakness at a median (IQR) of 13 weeks (13 to 17) and was maintained past at least 1-year follow-up. In this young, active cohort, suspected suprascapular neuropathy caused by compression at the suprascapular notch presented with one of two primary symptoms: pain or weakness. Diagnosis can be supported by concordant findings on history, physical examination, and MRI, with selective use of EMG for weakness and diagnostic injection for pain. Outcomes after arthroscopic suprascapular nerve release with necessary concomitant subacromial decompression involved successful pain relief and strength improvement in patients presenting with pain and weakness, respectively. Future studies could provide valuable insight into the epidemiology of suprascapular neuropathy and further define thresholds for surgical treatment, especially for patients presenting predominantly with pain. Level III, therapeutic study.

Reverse shoulder arthroplasty (RSA) is increasingly used for complex proximal humerus fractures (PHFs). Although lateralized designs have demonstrated advantages in elective indications, their role in acute PHFs remains uncertain. This study evaluated functional outcomes following RSA for acute PHFs, with particular focus on the influence of greater tuberosity (GT) healing and prosthesis design. In this multicenter retrospective study, 122 patients with acute PHFs treated with RSA and a minimum follow-up of two years were included. Two centers used lateralized designs, and two centers used medialized designs. Functional outcomes (Constant score) and rates of GT healing, scapular notching, dislocation, infection, and revision surgery were recorded. Welch's and two-proportion z tests compared groups, and multivariate regression identified independent predictors. The mean Constant score at the 2-year follow-up was 57.9 ± 14.1 points, with no significant differences between the medialized (58.4 ± 11.6) and lateralized models (57.4 ± 16.7). No statistically significant differences were observed in GT healing, scapular notching, dislocation, infection or revision surgery between designs. Overall, the GT healed in 65% of patients, and scapular notching was reported in 24.6%. There were significant differences in the Constant score between patients with (61.6 ± 12.3) and without (51.2 ± 14.9) GT healing (p < 0.001) and patients with (52.2 ± 15.5) and without (59.8 ± 13.2) scapular notching (p = 0.010). GT healing was the only independent predictor of higher Constant scores. Greater tuberosity healing was the only independent predictor of functional outcome. Differences between prosthesis designs were not significant and should be interpreted in the context of center-specific treatment strategies.

Clinical and radiological outcomes when using standard versus retentive polyethylene humeral cups in Delta III reverse shoulder arthroplasty.

Antegrade intramedullary nailing via a deltoid-splitting approach is standard for humeral shaft fractures but may compromise the rotator cuff tendon. The Neviaser portal provides a superomedial entry through the supraspinatus muscle belly; however, its safety for nailing, particularly the risk of suprascapular nerve injury, remains uncertain. We aimed to quantify the safety margin between the Neviaser nailing trajectory and the suprascapular nerve in cadavers and to assess the clinical feasibility of the technique. Eight fresh-frozen cadaveric shoulders underwent standardised dissection with simulation of the Neviaser portal using an 11-mm protective sheath. Four morphometric parameters were measured. A retrospective cohort of nine patients with humeral shaft fractures was analysed. Median distances were 45 mm (35-55) from the acromion to the suprascapular notch, 21.5 mm (16-28) for the portal interval, from the sheath to the nerve 32.5 mm (21-34) at the suprascapular notch, and 19.5 mm (16-25) at the spinoglenoid notch. All trajectories traversed the supraspinatus muscle belly. Clinically, all fractures united by a median ofthree months, with low pain, good function, and no suprascapular nerve complications. The Neviaser portal provides a safe anatomical corridor for percutaneous antegrade humeral nailing, and early clinical experience supports its feasibility; comparative studies are required to establish functional benefit.

Arthroscopic Dissection and Protection of an Aberrant Suprascapular Nerve During Massive Rotator Cuff Repair.

Abstract Background Scapular notching (SN) is a unique complication of Grammont-type reverse shoulder arthroplasty (RSA). Avoiding superior inclination of the glenoid component is one of several strategies proposed to minimize the incidence of SN. Preoperative measurement of glenoid inclination across the entire glenoid surface may underestimate the potential superior inclination of the RSA baseplate, which is typically implanted in the inferior part of the glenoid fossa. Therefore, a specific RSA angle was introduced. Materials and methods A two-center retrospective study was conducted in 121 patients treated with a primary Grammont-type reverse shoulder arthroplasty between January 2018 and December 2022, with a mean radiographic follow-up of 4.1 years (range, 2–5.9 years). Global glenoid inclination, as well as preoperative and postoperative RSA angles, were measured on plain anteroposterior shoulder radiographs. Scapular notching was assessed according to the Sirveaux classification. Results The mean global glenoid inclination was 11° ± 6°, and the mean preoperative RSA angle was 17° ± 6°. Scapular notching was observed in 36 shoulders (29.75%). Patients with SN had a statistically significantly higher postoperative RSA angle (17° ± 5°) than patients without SN (5° ± 5°) ( p &lt; 0.001). Patients without SN demonstrated a significantly greater change from preoperative to postoperative RSA angle (12° ± 5°) compared with patients with SN (6° ± 5°) ( p &lt; 0.001). Conclusion The inclination of the inferior part of the glenoid fossa is variable and significantly higher than the global glenoid inclination. Insufficient correction of glenosphere inclination by asymmetrical glenoid reaming in medialized Grammont-type RSA is associated with a higher incidence of scapular notching, and measurement of the RSA angle during preoperative planning may be recommended.

Trabecular titanium metaglene is associated with improved clinical outcomes in reverse shoulder arthroplasty for proximal humeral fractures in elderly patients.

The aim of this study was to evaluate the clinical value of single-photon emission CT (SPECT)/CT in detecting postoperative complications following reverse shoulder arthroplasty (RSA). This was a retrospective study involving 87 patients who underwent SPECT/CT after RSA. Of these, 73 presented with pain affecting the RSA, and 14 served as a control group with an asymptomatic RSA on one side. SPECT/CT images were analyzed using standardized anatomoclinical zones, and the uptake of tracer was graded from 0 to 3. Grades 0 and 1 were considered as minor, whereas grades 2 and 3 were classified as major uptake. The SPECT/CT findings were correlated with previous clinical evaluation and classified as those in symptomatic or asymptomatic patients. Major tracer uptake was frequently seen in symptomatic patients around the acromion and spine of the scapula, with intense uptake in those with a fracture. In contrast, asymptomatic patients had minimal uptake around the scapula. There was major uptake in the glenoid in most patients, gradually declining over time in asymptomatic findings. Patterns of uptake in symptomatic patients were seen in association with infection, heterotopic ossification, scapular notching, and aseptic humeral loosening. The uptake was low in the humeral shaft in asymptomatic patients but increased after eight to 12 months in association with aseptic humeral loosening. Major uptake was also often seen in the acromioclavicular and sternoclavicular joints and the cervicothoracic spine in both symptomatic and asymptomatic patients. SPECT/CT effectively detects (stress) fractures, particularly involving the acromion and spine of the scapula. Its clinical value is more limited for differentiating infection, heterotopic ossification, scapular notching, and aseptic humeral loosening, especially during the first postoperative year. Aseptic loosening can be assessed more reliably by focusing on the humeral shaft. Differentiating the findings in symptomatic and asymptomatic patients in the acromioclavicular, sternoclavicular, and cervicothoracic regions remains difficult. Targeted infiltrations of local anaesthetic and steroid remain primarily diagnostic, with SPECT/CT providing anatomical localization when the source of the pain remains unclear.

Reverse shoulder arthroplasty (RSA) has transformed significantly over the past forty years, progressing from a salvage intervention for cuff tear arthropathy to a fundamental component of contemporary shoulder reconstruction. The initial design, pioneered by Grammont, fundamentally reconfigured shoulder biomechanics through the medialisation and distalisation of the centre of rotation, thereby engaging the deltoid as the primary mover in cases of cuff deficiency. This biomechanical advancement has facilitated dependable pain alleviation and functional restoration in patients for whom traditional arthroplasty procedures have historically been inadequate or failed. The clinical indications for RSA have significantly expanded. Historically restricted to elderly patients with extensive cuff tears. Its current applications include complex proximal humeral fractures, failed anatomical arthroplasty, inflammatory arthritis, tumour reconstruction and even select younger patients when joint preservation is unfeasible. Long-term studies demonstrate consistent improvements in pain and function, with implant survivorship exceeding 85% at ten years. Nevertheless, the rates of complications remain a concern, with scapular notching, instability, acromial and scapular fractures, and peri-prosthetic joint infections constituting the most significant issues challenges. Recent years have witnessed significant technological advancements in RSA, including three-dimensional preoperative planning, patient-specific instrumentation, augmented baseplates, 3D printing, navigation and robotic-assisted implantation. These innovations improve precision, broaden indications, and have the potential to enhance long-term outcomes. However, the use of these technologies is largely limited to institutions with high financial capacity. In low- and middle-income countries, obstacles such as high implant costs, limited availability, delayed presentation, and inadequate surgical expertise persistently impede widespread adoption. Nonetheless, evidence indicates that, with appropriate patient selection and tailored strategies, outcomes in resource-limited settings can approach those achieved in high-income countries. RSA now constitutes one of the most substantial advancements in shoulder surgery, providing durable outcomes across various pathologies. The future of RSA involves enhancing implant longevity, minimising complications, and ensuring equitable global access to this transformative technology procedure.

Pulsed radiofrequency of the suprascapular nerve is an established treatment for chronic shoulder pain, commonly targeting the suprascapular notch. An alternative approach targets the spinoglenoid notch, but the comparative efficacy of these 2 distal targets remains unclear. To compare the efficacy and safety of ultrasound-guided distal suprascapular nerve pulsed radiofrequency performed at the suprascapular vs the spinoglenoid notch in patients with chronic shoulder pain. A retrospective, observational cohort study. The pain medicine outpatient clinic of a tertiary care center. We examined the records of 95 patients with chronic unilateral shoulder pain who underwent suprascapular nerve pulsed radiofrequency. Patients were categorized into 2 groups based on the pulsed radiofrequency target: the suprascapular notch (Group 1) or the spinoglenoid notch (Group 2). Outcomes were assessed using the Shoulder Pain and Disability Index (SPADI) and the Visual Analog Scale (VAS) at baseline, and at 4 and 12 weeks postprocedure. Both groups demonstrated a statistically significant reduction in VAS and SPADI scores at 4 and 12 weeks postprocedure compared to baseline (P < 0.05). However, Group 2 showed statistically significant lower (better) scores than Group 1 for activity-related VAS and nighttime VAS at 4 weeks, as well as for activity-related VAS and total SPADI scores at the 12-week follow-up (P < 0.05 for all). The retrospective nature of our study contributing to bias and the short-term follow-up are the primary limitations. Both distal suprascapular nerve pulsed radiofrequency approaches were statistically significant for improving pain and disability scores in patients with chronic shoulder pain. Our findings indicate that pulsed radiofrequency performed at the spinoglenoid notch may yield superior outcomes according to some evaluations compared to the suprascapular notch approach. Therefore, suprascapular nerve pulsed radiofrequency at the spinoglenoid notch appears to be at least as effective and safe as, and potentially a more advantageous alternative to, the conventional suprascapular notch technique.

Incidence and risk factors for aseptic glenoid baseplate loosening in primary reverse shoulder arthroplasty using the Aramis implant baseplate with a minimum of 2 years follow-up.

The microanatomy of the suprascapular nerve is incompletely described, yet it may be relevant to the safety and performance of regional anesthetic techniques targeting this nerve. We characterized the macroanatomy and microanatomy of the suprascapular nerve across three clinically relevant regions: (1) the anterior cervical course towards the suprascapular notch, (2) the supraspinous fossa and (3) the infraspinous fossa. Three intact suprascapular nerves were dissected along their entire course from three fresh human cadavers. Each nerve underwent gross anatomical assessment, followed by a bloc excision and histologic evaluation to define fascicular architecture, connective-tissue organization and regional structural relationships relevant to procedural targeting. Across specimens, the suprascapular nerve showed a proximal-to-distal increase in fascicular complexity. The cervical segment was predominantly monofascicular, with a transition to a more multifascicular organization within the supraspinous and infraspinous fossae. Regional branching patterns and relationships to adjacent vascular and connective tissues were documented and interpreted in the context of commonly performed suprascapular block techniques. The suprascapular nerve shows clinically meaningful regional variation in fascicular architecture: a proximal-to-distal transition from predominantly monofascicular to increasingly multifascicular architecture. These findings expand the current anatomical understanding of the nerve and may inform technique selection and future comparative safety studies.

Accurate quantification of fatty infiltration (FI) after rotator-cuff tear (RCT) is critical for therapeutic planning. The conventional Goutallier classification, based on the oblique-sagittal “Y-view,” is subjective, shows only moderate inter-observer agreement, and frequently underestimates the degree of infiltration when the tendon is severely retracted. Recently, evaluation at a more medial level—the suprascapular notch (“R-view”)—has been proposed because it better visualizes the retracted muscle belly, yet it has not been combined with quantitative analysis. To determine (1) the agreement between quantitative FI (Fat%) measured on the R-view and the traditional Goutallier grade, and (2) the diagnostic value of this quantitative approach in patients with Patte stage 3 retraction. Patients who underwent arthroscopic rotator-cuff repair (ARCR) between 2022 and 2024 were retrospectively enrolled and stratified by Patte classification. On both the Y-view and the R-view, we measured supraspinatus cross-sectional area (CSA), Fat%, and Goutallier grade. Intraclass correlation coefficients (ICC) were calculated for reliability, receiver operating characteristic (ROC) curves were constructed for diagnostic performance, and the two views/methods were compared. A total of 192 patients were included. CSA was significantly larger on the R-view than on the Y-view (P < 0.05), whereas both Fat% and Goutallier grade were significantly lower (P < 0.05). Fat% and Goutallier grade were strongly correlated on both views (R = 0.781 vs. 0.826, P < 0.001). In Patte stage-3 patients, Fat% derived from the R-view achieved the highest diagnostic performance (Area Under the Curve(AUC), AUC = 0.73); the optimal cutoff was 56%, yielding 86% specificity and a Youden index(YI) of 0.41. The R-view more accurately depicts the true status of the retracted supraspinatus. Combining this imaging plane with quantitative Fat% measurement significantly improves objectivity and reliability in the assessment of FI, especially in cases of severe tendon retraction, and offers surgeons a superior pre-operative imaging strategy.

BackgroundSuprascapular nerve entrapment is a medical condition characterized by clinical symptoms such as neck and shoulder pain, discomfort, upper limb weakness, and heaviness. These symptoms are caused by the compression of the suprascapular nerve at the suprascapular notch. The treatment of this nerve entrapment has been a long-standing challenge. Intelligent-assisted radiofrequency neurolysis is a novel and promising non-pharmacological treatment. Herein, we presented the therapeutic efficacy of this technique in 40 patients.ObjectiveThis study was designed to evaluate the feasibility of three-dimensional (3D) CT imaging integrated with intraoperative intelligence-assisted calibration for radiofrequency ablation of the suprascapular nerve.MethodsA total of 40 patients were enrolled. The control group received the conventional surgery, while the treatment group was given 3D CT imaging plus the intraoperative intelligence-assisted calibration. Intelligence-assisted refers to the use of a smartphone app based on gravity calibration to realize the precise measurement and correction of the puncture needle angle during the operation, combined with 3D CT imaging to achieve the accurate positioning of the suprascapular nerve entrapment site. Data was analyzed on the two groups, including the time taken from starting positioning to successful puncture, Visual Analogue Scale (VAS) scores and ROWE scores before and after treatment, the therapeutic effect, complications, and number of cases with abnormal electromyography (EMG) items before and after treatment.ResultsTime of puncture completion in the treatment group was significantly shorter than that in the control group (8.06 vs 15.98 min, p < 0.05). Postoperative therapeutic effect in the treatment group was also superior to that in the control group. The treatment group had significant differences between pre- and post-treatment VAS scores and had superior ROWE scores compared to the control group.ConclusionThe application of 3D CT imaging combined with intraoperative intelligence-assisted calibration for suprascapular nerve radiofrequency ablation can effectively shorten the operation time, improve the procedural efficiency and therapeutic effect and significantly reduce patients’ clinical symptoms.

Ganglion cysts are benign, fluid-filled masses that are commonly found in the spinoglenoid and suprascapular notches of the shoulder. However, they are seldom seen in proximity to the long head of the biceps tendon (LHBT). We introduce an exceptionally uncommon cause of severe shoulder discomfort: a ganglion cyst located within the joint of the LHBT, which was inadvertently identified as stemming from the bicipital groove. This unusual biceps tendon ganglion cyst was discovered during a routine ultrasound examination of the shoulder, characterized through ultrasonography, and later validated through arthroscopy. This case underscores the increasing importance for rheumatologists and physiatrists to familiarize themselves with bedside ultrasound and recognize its value as an enhancement to standard musculoskeletal assessments.

Ultrasound-guided intra-articular steroid injection or ultrasound-guided suprascapular notch steroid injection for frozen shoulder? A sequential comparative study with a 1-year follow-up.

Background: Reverse shoulder arthroplasty (RSA) relies on secure baseplate fixation to the glenoid. This carries a risk of suprascapular nerve (SSN) injury during peripheral screw insertion. Although fixed safe zones have been described, it remains unclear whether these scale with scapular morphometry or whether common screw positions confer differential SSN risk. Methods: Twenty cadaveric shoulders (ten pairs) were dissected. The superior safe zone (distance from the supraglenoid tubercle to SSN at the suprascapular notch) and posterior safe zone (distance from the glenoid rim to SSN at the spinoglenoid notch) were measured. Scapular dimensions (height, spine length, width) were measured. In ten shoulders, simulated RSA baseplate fixation was performed with superior screws placed at 11, 12, or 1 o'clock and posterior screws at 8, 9, or 10 o'clock. Screw lengths were based on glenoid depth. Cortical breach and SSN proximity were recorded. Linear regression assessed relationships between scapular dimensions and safe zones. Results: The superior safe zone (mean 2.9 ± 0.5 cm) significantly correlated with scapular dimensions (r = 0.78-0.86; p < 0.0001). All superior screws remained intraosseous across configurations. The posterior safe zone (1.9 ± 0.6 cm) showed no correlation. Posterior cortical breach occurred in 50% of specimens across all tested positions and was associated with smaller scapular spine length (p = 0.027). No significant difference in SSN proximity was observed between posterior screw positions. Conclusions: Scapular dimensions predict the superior, but not posterior, safe zone. Scapulae with shorter spine lengths demonstrated increased risk of posterior cortical breach, independent of screw position. These findings establish anatomical scalability of the superior safe zone and suggest that scapular morphometry may inform preoperative RSA planning; however, prospective validation is needed before routine clinical implementation.

While the original Paul Grammont Inlay design had a 155° neck-shaft angle (NSA), developments in humeral stem designs have led to the emergence of the Onlay design with a more vertical angle. The purpose of the study is to compare threeyear clinical and radiological outcomes of two humeral stem designs, namely Inlay versus Onlay designs, with a 145° NSA and identical glenoid component. In this multicentric retrospective study, 227 patients (141 Inlay versus 86 Onlay) that underwent primary reverse shoulder arthroplasty (RSA) between March 2019 and April 2020, were reviewed at a minimum follow-up of threeyears. Clinical evaluation included pain on visual analogue scale (VAS), active range of motion, subjective shoulder value (SSV), and Constant score. Radiological assessment included in situ stem inclination, cortical contact bone remodelling, and scapular notching. The two groups were comparable in terms of age, sex, diagnosis, and follow-up (mean follow-up, 3.3 ± 0.5years). No significant differences were found for pain on VAS, SSV or Constant score. The Onlay group had significantly greater external rotation with 90° of abduction (ISA-Inlay, 52.2 ± 24.2; versus ISA-Onlay, 59.2 ± 25; p = 0.037), more valgus alignment (ISA-Inlay, -0.573; versus ISA-Onlay, -5.55; p < 0.001), and a higher rate of cortical contact (ISA-Inlay, 9%; versus ISA-Onlay, 39%; p < 0.001). No significant differences were found in terms of bone remodelling around the stem and scapular notching. At a follow up of threeyears, both humeral stem designs resulted in comparable clinical and radiological outcomes, while the Onlay design seemed to improve external rotation without increasing the risk of bony complications. The choice of stem design should be motivated by patient specific functional needs and surgeon experience. However, the conclusions of the present study are limited to mid-term follow-up.

Analysis of mechanical factors related to scapular notching and medial scapular bone spurs with reverse total shoulder arthroplasty and the reduction of their appearance with inferior glenosphere offset

Sonographic visualization of the suprascapular canal with focus on the suprascapular notch: anatomical description and ultrasound-probe techniques.