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Dx and Tx of Suprascapular Nerve Pathology

Matt Bahu, M.D.

Detroit Sports Symposium

July 13, 2017

Disclosures- None

Overview

• Scapular anatomy

• Presentation

• Imaging

• Treatment

• Post op rehab

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Anatomy of the Scapula

• Glenoid

• Coracoid

• Acromion

Anatomy of the Scapula

• Rotator cuff

Anatomy of the Scapula

• Suprascapular Notch

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Anatomy of the Scapula

• SpinoglenoidNotch

Anatomy of the Scapula

• SS Nerve

• SS Artery

• TSL

Suprascapular Nerve Entrapment

• 1-2% of shoulder pain

• Suprascapular

• Spinoglenoid

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Suprascapular Nerve Entrapment

• Non-op Tx for overuse

• Usually not successful for entrapment or space occupying lesions

Suprascapular Nerve Entrapment

• Operative intervention

• Pain relief

• Variable return of strength and function

Case Presentation #1

• HISTORY

• 57 y.o. F

• 6 weeks of pain

• Repetitive overhead activity

• PE

• 90/80/5 150/100/30

• +Neer, +Hawk

• 4/5 abd, and erwith pain

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Case Presentation

• Injection

• PT

• Patient called for MRI in 4 weeks

Imaging- X-ray

Imaging- MRI

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Case Presentation

• HISTORY

• Did 2 weeks of PT

• Feeling worse

• Shaking and dropping things

• PE

• 45/30/5 100/70/30

• +Neer, +Hawk

• 4/5 abd, and erwith pain

EMG

“Incomplete suprascapular neuropathy with EMG evidence of moderately severe acute denervation in supra and infra. Etiology uncertain”

Imaging- MRI

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Operative Intervention

Surgical Anatomy/ Technique

• CA ligament

• Conoid

• TSL

Operative Intervention

Arthoscopic Decompresion of the Suprascapular Nerve at the Spinoglenoid Notch and Suprascapular Notch Through the Subacromial Space. Arthroscopy April 2009 Vol. 25, Issue 4, Pg. 439-445. Ghodadra, Provencher, Romeo

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Operative Intervention

Operative Intervention

Operative Intervention

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Operative Intervention

6 Weeks Post Op

• HISTORY

• Done passive motion in PT

• “I feel I’m finally getting better”

• PE

• 45/80/0 110/110/30

Case Presentation #2

• HISTORY

• 54 y.o. M

• 4 mnths of pain

• Notices weakness

• PE

• 180/120/20 180/120/40

• +Neer, +Hawk

• 5/5 abd, 3/5 erwith pain

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Imaging- X-ray

Imaging- MRI

Imaging- MRI

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Operative Intervention

Decompress Cyst

Decompress Cyst?Treatment of Patients with SpinoglenoidCysts Associated With Superior Labral Tears Without Cyst Aspiration, Debridement, or Excision. May 2006 Volume 22,

Issue 5, Pages 548-552. Youm, El Attracheetal.

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Operative Intervention

With Rotator Cuff Repair

• Some authors suggest SSN role in pain with massive rotator cuff tears

With Rotator Cuff Repair

• 20 patients in each cohort

• 3B atrophy

• Pain and strength 2 grades in SSN release group vs. one grade in comparison group

A Comparison of Short Term Functional Outcomes in Patients Undergoing Revision Arthroscopic Repair of Massive Rotator Cuff Tears With and Without Arthroscopic Suprascapular Nerve Release. June 2010 Volume 26, Issue 6. Zunkiewicz, Savoie etal.

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Conclusion

• Rare cause of shoulder pain

• Suprascapular or spinoglenoid

• High index of suspicion

• Start non-operative, but usually unsuccessful

• Operative intervention for pain, not as consistent for strength/ function

Thank You!