AANA Lab Course 912 - Arthroscopic Shoulder Solutions-Suprascapular Nerve Releases-Larry D. Field, MD

Suprascapular Nerve Releases-Larry D. Field, MD

Pdf Summary

This presentation by Dr. Larry D. Field focuses on suprascapular nerve (SSN) neuropathy, an increasingly recognized but challenging cause of shoulder pain, especially in overhead athletes. The SSN, originating mainly from C5 and C6 nerve roots, passes through the anatomically variable suprascapular notch and spinoglenoid notch, common sites for nerve compression due to structural anomalies, paralabral cysts, retracted rotator cuff (RC) tears, or repetitive microtrauma.<br /><br />Diagnosing SSN neuropathy is difficult due to vague symptoms that mimic other shoulder conditions and possible coexisting pathologies. Characteristic signs include deep, dull posterior shoulder pain, worsened by overhead activity, with abduction/external rotation weakness depending on compression site. Imaging (X-rays, MRI, 3D CT) assists in visualizing anatomical variations, cysts, and muscle atrophy; EMG/NCS remains the “gold standard” though its reliability is debated. Diagnostic nerve injections are valuable in confirming SSN involvement.<br /><br />Treatment depends on etiology. Non-operative management—NSAIDs, activity modification, rehabilitation—is first-line for dynamic compression without space-occupying lesions. Surgical decompression is reserved for persistent symptoms, structural causes, or space-occupying lesions like paralabral cysts. Surgical techniques include arthroscopic or open release of the transverse scapular ligament at the suprascapular notch, cyst decompression, and labral repair. The necessity of direct SSN decompression during massive retracted RC tear repairs remains controversial, with studies showing mixed outcomes.<br /><br />Paralabral cysts causing nerve compression often require surgical intervention after failed conservative care. Arthroscopic management is preferred due to better visualization and less morbidity. Recurrence rates vary depending on approach.<br /><br />In summary, SSN neuropathy is a relatively rare but important diagnosis in shoulder pain work-up. Non-operative treatment is often effective for dynamic causes; however, surgical decompression techniques are effective yet debated. Further research is needed to clarify indications for different surgical interventions, particularly in the context of massive rotator cuff tears.

Keywords

suprascapular nerve neuropathy

shoulder pain

overhead athletes

suprascapular notch

spinoglenoid notch

paralabral cysts

rotator cuff tears

diagnostic imaging

EMG/NCS

surgical decompression