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Arthroscopic Suprascapular Nerve Release

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Shoulder Arthroscopy

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Abstract

Suprascapular neuropathy is a rare source of pain in the shoulder, but can cause debilitating weakness and disability. This pathology includes pain and weakness in forward elevation, abduction and external rotation, muscle wasting, and possible sensory deficits. This condition has been associated with overhead athletes, concomitant rotator cuff tears, labrum tear with associated cyst, or penetrating injuries. Also, morphology of the suprascapular notch plays an important role in the pathophysiology of this condition. Suprascapular neuropathy is usually diagnosed clinically, MRI serves to rule out any other causes of shoulder pain. Electromyography (EMG) examination of the suprascapular nerve is part of the standard work-up for suprascapular nerve neuropathy. Rarely, the neuropathy can be confirmed electrophysiologically. Often, the EMG examination is unremarkable, but this does not exclude suprascapular nerve neuropathy. Fluoroscopic-guided injection near the suprascapular nerve proves to be a useful tool to diagnose suprascapular neuropathy. Conservative management must be tried first consisting of lifestyle modifications, optimization of mechanics in overhead athletes, scapular stabilizer exercises, and anti-inflammatory drugs. Fluoroscopic injection at the suprascapular notch may also have some therapeutic effects and is part of the treatment algorithm. If patient remains symptomatic with a positive EMG, has profound weakness or muscle atrophy, surgical intervention is indicated. Surgical intervention involves arthroscopic release of the transverse ligament. This is possible with the use of accessory portals, which will allow for adequate visualization of the suprascapular nerve and the transverse ligament. Also, decompression of the spinoglenoid notch is also performed in the case of a spinoglenoid cyst. This procedure provides excellent results with improved pain, range of motion, and patient-reported outcomes.

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Authors and Affiliations

  1. Department of Orthopedic Surgery, Shoulder Service, Massachusetts General Hospital, Boston, MA, USA

    Andres Muniz, Florian Grubhofer & Jon J. P. Warner

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  1. Andres Muniz
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  2. Florian Grubhofer
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  3. Jon J. P. Warner
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Correspondence to Andres Muniz .

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Editors and Affiliations

  1. Department of Joint and Bone Surgery, University of Brescia, Brescia, Brescia, Italy

    Giuseppe Milano

  2. Department of Orthopaedics and Traumatology, Casa di Cura Villa Valeria, Rome, Roma, Italy

    Andrea Grasso

  3. Shoulder and Upper Limb Department, St. Luke's Hospital, Bielsko-Biała, Poland

    Roman Brzóska

  4. Department of Traumatology, University Medical Centre Ljubljana, Ljubljana, Slovenia

    Ladislav Kovačič

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Muniz, A., Grubhofer, F., Warner, J.J.P. (2023). Arthroscopic Suprascapular Nerve Release. In: Milano, G., Grasso, A., Brzóska, R., Kovačič, L. (eds) Shoulder Arthroscopy. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-662-66868-9_43

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  • DOI: https://doi.org/10.1007/978-3-662-66868-9_43

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