Arthroscopic decompression of the suprascapular nerve

Definition of suprascapular nerve compression:

Suprascapular nerve compression is a rare pathology of the shoulder of nervous origin. This syndrome belongs to a group of diseases called compression syndromes, in which a nerve is compressed in one of the anatomic tunnels through which it runs. The most famous compression syndrome is the carpal tunnel syndrome.
The suprascapular nerve compression syndrome is a compression of the suprascapular nerve at the shoulder, where the coracoid notch is located.

Video of endoscopic suprascapular nerve decompression surgery:

Arthroscopic shoulder surgery video showing suprascapular nerve decompression surgery / Toulouse specialist

Anatomy and physiopathology of suprascapular nerve compression:

The suprascapular nerve only innervates 2 muscles: the supraspinatus muscle and the infraspinatus muscle, which are both essential rotator cuff muscles. This nerve’s function is motor and not sensory. Compression of the suprascapular nerve at the coracoid notch causes denervation and progressive paralysis of the shoulder at the supraspinatus and infraspinatus muscles (rotator cuff muscles) causing in turn gradual amyotrophy and tendon atrophy that can result in a secondary rupture: paralysis + rotator cuff tear.

Tendon atrophy associated with a tear in the context of suprascapular nerve paralysis, ToulouseMuscle atrophy in the context of suprascapular nerve compression

 

Amyotrophy of these shoulder muscles initially causes discomfort in the shoulder, rarely painful, then gradual loss of shoulder strength in elevation and external rotation.
In some slim subjects, muscle wasting (amyotrophy) is visible on the superior and posterior sides of the shoulder.
There is no sensory problem as this nerve has no sensory function.

Two main groups of people can be affected:

  • young patients, often athletic, whose complaints focus on loss of strength at the shoulder
  • much older patients with an associated rotator cuff tear pathology.

 

Endoscopic suprascapular nerve decompression surgery:

In this uncommon shoulder condition, the electromyogram (EMG) test confirms the diagnosis, an MRI can sometimes reveal specific signs: localized amyotrophy of the supra- and infraspinatus muscle with no tendinous tear and preserved trophicity of the teres minor.

Once the diagnosis is confirmed, arthroscopic shoulder surgery must be considered. Surgery begins with an exploration of the gleno-humeral joint (shoulder arthroscopy) and then nerve decompression takes place outside the joint (endoscopy); the surgeon refers to endoscopic decompression.

Suprascapular nerve decompression surgery setupMuscle atrophy in the context of suprascapular nerve compression

 

Surgery is performed on an outpatient basis under regional and general anaesthesia. Surgery begins with subacromial debridement (bursectomy), which can be combined with acromioplasty; dissection then proceeds more medially until the coracoclavicular ligaments are exposed anterior to the supraspinatus muscle. At the root of these shoulder ligaments, it is possible to see the origin of the transverse ligament of the coracoid notch that causes nerve compression

Arthroscopic view of the suprascapular artery and coracoid notch ligament.Examination of the notch's ligament; once the artery is reclined, the nerve at the bottom of the notch is visible.

 

Arthroscopic visualization makes it possible to see first the suprascapular artery coursing above the ligament, then the suprascapular nerve below. The transverse ligament of the notch is then severed and proper decompression of the suprascapular nerve can be confirmed.

The coracoid notch ligament is severedSuprascapular nerve decompressed after severing of the notch’s ligament

Additional shoulder surgery procedures can be performed on an individual basis: rotator cuff reattachment, calcification removal, 1-cm lateral clavicle resection can be carried out.  Hemostasis can be achieved on the bone surfaces at the end of the operation. The surgical incisions will be closed with absorbable sutures..

Shoulder recovery and recuperation after arthroscopic decompression of the suprascapular nerve

The following information applies to recovery in isolated forms without associated rotator cuff tear or subacromial impingement.
Non-strict shoulder immobilization will be suggested for a few days; it can be stopped on request depending on how much pain is felt. Specialized shoulder rehabilitation must start immediately after surgery, with a focus on range of motion preservation and rapid strengthening of the shoulder.

Most daily life activities involving the shoulder can resume in the days that follow surgery.
Driving often resumes within a week. Shoulder recovery and complete recuperation spread over 9 to 12 months. This long period is due firstly to the time nerve regeneration requires, secondly to the time needed to rebuild muscles (amyotrophy correction) in the shoulder.  

Sick leave obviously depends on the occupation: 8 days at least for office work and one month at least for occupations that are more demanding on the shoulder.