AANA Lab Course 904 - Shoulder Superstars: Everything You Can Do in a Shoulder Through the Scope! (APEx)-Suprascapular Nerve Release_ Suprascapular Notch and Spinoglenoid Notch

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This document from Tulane Orthopaedic Surgery, led by Dr. Felix H. Savoie III, focuses on the suprascapular (SS) nerve, its anatomy, entrapment sites, clinical presentation, diagnosis, and arthroscopic nerve release management.<br /><br />The SS nerve originates from the upper trunk of the brachial plexus, mainly C5 and C6 nerve roots. Entrapment occurs commonly at the suprascapular notch, the supraspinatus fossa (often due to cysts), or the spinoglenoid notch.<br /><br />Clinical presentation includes isolated neuropathy with symptoms that mimic rotator cuff (RC) disease: acute, severe, short-lived pain and weakness, particularly during overhead activity and external rotation, often painless on testing. Weakness is usually disproportionate to any RC tear and may be accompanied by atrophy and edema of the supraspinatus (SS) and infraspinatus (IS) muscles seen on MRI. Neuropathy is also seen in older patients post-dislocation with concomitant RC tear and brachial plexopathy.<br /><br />Exam findings that raise suspicion of SS nerve involvement include weakness patterns unexplained by RC disease alone, localized supraspinatus and infraspinatus weakness or atrophy out of proportion to symptoms, and slight scapular winging. Radiographic evaluation includes X-ray assessment of notch configuration and MRI for muscle edema/atrophy and signal changes around the nerve. Electromyography and nerve conduction studies, when performed by experienced neurologists, can confirm SS nerve compression and localize the site.<br /><br />Management involves arthroscopic SS nerve release at the notch, with specific stepwise surgical technique for nerve decompression while protecting surrounding structures. When indicated, additional procedures include cyst excision or labral repair at the SS fossa and spinoglenoid notch release, especially in athletes or after SLAP repair scarring.<br /><br />In conclusion, arthroscopic decompression of the SS nerve is an effective treatment for entrapment neuropathy, often improving pain and function. Careful assessment including history, exam, imaging, and electrodiagnosis is crucial for accurate diagnosis and surgical planning.

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Dr. Felix H. "Buddy" Savoie, III, M.D.

Keywords

suprascapular nerve

nerve entrapment

brachial plexus

suprascapular notch

rotator cuff disease

arthroscopic nerve release

MRI muscle edema

electromyography

spinoglenoid notch

cyst excision