AANA Lab Course 902 - Foundations in Arthroscopy (Resident/Fellow)-Suprascapular Nerve, including Common Approached to the Shoulder-Dr. Robin M. Gehrmann, M.D.

Suprascapular Nerve, including Common Approached to the Shoulder-Dr. Robin M. Gehrmann, M.D.

Pdf Summary

This presentation by Dr. Robin M. Gehrmann focuses on shoulder anatomy, surgical approaches, and related nerve considerations. Key shoulder muscles—supraspinatus, infraspinatus, teres minor, and subscapularis—are innervated by the suprascapular, axillary, and subscapular nerves. Three primary surgical approaches to the shoulder are discussed: the anterior (deltopectoral), lateral, and posterior approaches.<br /><br />The anterior deltopectoral approach is commonly used for shoulder reconstructions such as recurrent instability repairs, arthroplasty, and fracture fixation. Important anatomical landmarks include the coracoid process and deltopectoral groove. Careful dissection respects the internervous planes between the deltoid (axillary nerve) and pectoralis muscles (medial and lateral pectoral nerves), avoiding injury to the musculocutaneous nerve, axillary nerve, and cephalic vein. Anterior instability cases often involve Bankart repairs and postoperative care focuses on protecting subscapularis and labral repairs while gradually restoring motion and strength.<br /><br />The quadrangular space, bordered by teres minor, teres major, subscapularis, humerus, and the long head of the triceps, contains the axillary nerve and posterior circumflex humeral artery. The triangular space and triangular interval contain other important vascular and nerve structures relevant to surgery.<br /><br />The lateral approach involves splitting the deltoid (with caution to the axillary nerve) and is used for greater tuberosity fractures, mini-open rotator cuff repairs, humeral neck fractures, and reverse total shoulder arthroplasty. The posterior approach, useful for posterior instability and fracture ORIF, involves the interval between the infraspinatus and teres minor muscles.<br /><br />Suprascapular nerve anatomy is highlighted, noting its path through the suprascapular notch under the transverse ligament and through the spinoglenoid notch, where nerve entrapment and cysts can cause pain and weakness. Surgical decompression and appropriate rotator cuff repair are favored interventions for such cases.<br /><br />Overall, the presentation emphasizes the importance of anatomy knowledge, careful surgical technique to avoid nerve injury, and tailored postoperative rehabilitation in managing shoulder disorders.

Keywords

shoulder anatomy

surgical approaches

supraspinatus muscle

infraspinatus muscle

teres minor muscle

subscapularis muscle

suprascapular nerve

axillary nerve

deltopectoral approach

rotator cuff repair