Arthroscopic and open decompression of the suprascapular nerve

Suprascapular nerve compression at the suprascapular notch and spinoglenoid notch can cause a significant shoulder pathology. This can be surgically managed with arthroscopy, open release of the transverse suprascapular ligament (TSL), or excision of a pathology in the spinoglenoid notch.

Superior and posterolateral shoulder pain is common.

Space-occupying lesions or dynamic conditions can cause suprascapular neuropathy.

It is important to rule out other, more common causes of shoulder pathology.

Electromyography can support diagnosis. Ultrasound guided anesthetic and cortisone injection should be used to confirm diagnosis.

Follow the five easy steps to safely release the TSL arthroscopically.

• 1.

  Thorough subacromial bursectomy.

• 2.

  Follow coracoacromial (CA) ligament to the coracoid base.

• 3.

  Identify the trapezoid ligament medial to the CA ligament attachment.

• 4.

  Follow anterior supraspinatus muscle belly and pierce fascial band to visualize the conoid ligament which blends into the TSL.

• 5.

  Protect the nerve and vessels during nerve release.

Inadequate visualization:

Perform a thorough subacromial bursectomy.

Use arthroscopic instrumentation to retract during exploration and suprascapular nerve release.

Difficulty identifying the transverse suprascapular ligament:

Mark out surface anatomy; use landmarks (anterior border of the supraspinatus, the coracoclavicular ligaments, and the coracoid base), start laterally, and proceed medially. Localization with a spinal needle is very helpful.