AANA Lab Course 1002 -3rd Annual Fellows/Chief Residents-Suprascapular Nerve Release-Kevin W. Farmer, M.D.

Suprascapular Nerve Release-Kevin W. Farmer, M.D.

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This presentation by Dr. Kevin W. Farmer focuses on suprascapular nerve (SSN) release, addressing nerve anatomy, compression sites, clinical presentation, diagnostic strategies, and arthroscopic surgical techniques.<br /><br />Anatomically, the SSN arises primarily from the C5 nerve root off the upper trunk, providing motor innervation to the supraspinatus and infraspinatus muscles and sensory input to the AC and glenohumeral joints. The nerve passes through two common compression sites: the suprascapular notch and the spinoglenoid notch, with variable anatomy at the suprascapular notch.<br /><br />Compression often presents as vague posterior shoulder pain and muscle wasting, particularly infraspinatus atrophy. MRI can detect muscle atrophy, while EMG assists in localizing compression. Spinoglenoid notch compression often results from labral cysts associated with posterior superior labral tears.<br /><br />Arthroscopic management involves labral repair with cyst decompression using established portals (antero-superior viewing, posterior working, antero-inferior suture management, Wilmington portal). Elevation of the labral tear allows decompression of the cyst, sometimes necessitating a capsular release to ensure complete nerve decompression. Outcomes in 20 patients showed 90% cyst resolution on MRI, significant clinical improvements, and excellent outcomes in 18 of 20 cases.<br /><br />In older patients, cyst decompression combined with biceps tenodesis may be performed. For small cysts, labral repair alone yields similar results.<br /><br />Regarding suprascapular notch compression, often seen in athletes (e.g., throwers) or with massive rotator cuff tears, nerve release improves pain, strength, and active forward flexion. However, only a small percentage benefit based on EMG and MRI findings; thus, SSN release is not indicated routinely with rotator cuff repair.<br /><br />The arthroscopic technique for suprascapular notch decompression involves subacromial bursectomy, identification of the coracoacromial ligament and coracoid, and ligament release using portals including the Neviaser portal. Careful identification of anatomy is critical to avoid neurovascular injury.<br /><br />In conclusion, surgical management includes labral repair with cyst decompression for spinoglenoid notch lesions and selective suprascapular nerve release for clear compressive neuropathy, resulting in favorable outcomes and return-to-sport rates.

Keywords

suprascapular nerve release

nerve anatomy

compression sites

clinical presentation

diagnostic strategies

arthroscopic surgical techniques

spinoglenoid notch cyst

labral repair

EMG localization

rotator cuff tears