A comparison of functional outcomes in patients undergoing revision arthroscopic repair of massive rotator cuff tears with and without arthroscopic suprascapular nerve release

Savoie, Felix H.; Zunkiewicz, Mark; Field, Larry D.; Replogle, William H.; O’Brien, Michael J.

doi:10.2147/oajsm.s113020

Cited by 40 publications

(29 citation statements)

References 13 publications

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“…They concluded that the patients with nerve release presented with better functional recovery and less pain at the final follow-up. 21,22 However, Gerber et al, 23 in a prospective randomized trial of a small number of patients (N ¼ 19), did not find any difference between the release and non-release groups.…”

Section: Discussionmentioning

confidence: 94%

“…Many researchers have reported significant differences comparing postoperative clinical improvements after rotator cuff repairs with versus without SSN release. 6,8,9 Zunkiewicz et al 21 and Savoie et al 22 are the only researchers who reported the results of patients undergoing revision cuff repair and compared the results in 2 groups: patients with SSN release and those without SSN release. They concluded that the patients with nerve release presented with better functional recovery and less pain at the final follow-up.…”

Section: Discussionmentioning

confidence: 99%

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Suprascapular Nerve Release: Technique Based on Anatomic Landmarks

Arce

Calvo²,

Golanó

2021

Arthroscopy Techniques

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Dysfunction of the suprascapular nerve (SSN) is closely related to rotator cuff pathology; nerve dysfunction can lead to cuff disease and vice versa. Owing to repetitive microtrauma during overhead sports or massive cuff tears with significant tendon retraction, the SSN may suffer compression or traction neuropathy at the suprascapular notch. The SSN release technique has already been described. However, on the basis of the many hands-on cadaveric laboratories in which we have participated in the past 20 years, only a few instructors and almost none of the attendants have shown the experience and skill set needed to release the SSN at the suprascapular notch. Therefore, a review of the surgical technique following the anatomic descriptions of an expert anatomist (P.G.) of the shoulder girdle is quite valuable.

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Section: Discussionmentioning

confidence: 94%

Section: Discussionmentioning

confidence: 99%

Suprascapular Nerve Release: Technique Based on Anatomic Landmarks

Arce

Calvo²,

Golanó

2021

Arthroscopy Techniques

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“…For patients with suprascapular neuropathy in the setting of MRCT, there is no unified treatment standard at present [ 6 , 20 , 27 , 28 ]. For the treatment of suprascapular neuropathy, Lafosse et al described the technique of arthroscopic transverse scapular ligament dissection in 2007 and nine out of ten patients had satisfactory outcomes [ 24 ].…”

Section: Discussionmentioning

confidence: 99%

“…The suprascapular nerve (SSN) is often compressed along its course, especially at the suprascapular notch and the spinoglenoid region [ 4 , 5 ]. The mechanism of nerve injury can be roughly classified as compression or traction resulting from massive rotator cuff tears [ 6 , 7 ], space-occupying leisongs [ 8 – 11 ], anatomic variations of suprascapular ligament [ 12 ] and spinoglenoid ligament [ 9 , 13 ], distal clavicle [ 14 ] or scapular fractures [ 15 ], vascular compression [ 16 , 17 ] and dynamic compression in athletes [ 17 – 20 ].…”

Section: Introductionmentioning

confidence: 99%

Comparison of clinical outcome of decompression of suprascapular nerve at spinoglenoid notch for patients with posterosuperior massive rotator cuff tears and suprascapular neuropathy

Yang

Wang

Zhang

et al. 2021

BMC Musculoskelet Disord

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Purpose In the present study, we aimed to determine whether decompression of suprascapular nerve (SSN) at the spinoglenoid notch could lead to a better functional outcome for the patients who underwent repairment of rotator cuff due to posterosupeior massive rotator cuff tear (MRCT) and suprascapular neuropathy. Methods A total of 20 patients with posterosuperior MRCT and suprascapular neuropathy were analyzed in the present work. The preoperative magnetic resonance imaging (MRI) showed rotator cuff tear in supraspinatus and infraspinatus. All patients underwent arthroscopic rotator cuff repair. Patients were divided into two groups (group A: non-releasing, group B: releasing) according to whether the SSN at the spinoglenoid notch was decompressed. The modified University of California at Los Angeles shoulder rating scale (UCLA) and visual analog scale (VAS) questionnaire were adopted to assess the function of the affected shoulder preoperatively and 12 months after the operation. Electromyography (EMG) and nerve conduction study (NCS) were used to evaluate the nerve condition. Patients underwent MRI and EMG/NCS at 6 months after operation and last follow-up. Results All patients were satisfied with the treatment. MRI showed that it was well-healed in 19 patients at 6 months after the operation. However, the fatty infiltration of supraspinatus and infraspinatus was not reversed. Only one patient in the non-releasing group showed the retear. The retear rate of group A and group B were 30% (3/10) and 20% (2/10) respectively at 12 months after the operation. One patient undergoing SSN decompression complained of discomfort in the infraspinatus area. His follow-up EMG after 6 months showed fibrillation potentials (1+) and positive sharp waves (1+) in the infraspinatus. The other patients’ EMG results showed no abnormality. The postoperative UCLA and VAS scores were improved in both groups, and there was no significant difference in the follow-up outcomes between the two groups. Conclusions Patients with postersuperior MRCT and suprascapular neuropathy, decompression of suprascapular nerve at spinoglenoid notch didn’t lead to a better functional outcome with the repairment of rotator cuff. Arthroscopic rotator cuff repair could reverse the suprascapular neuropathy. Level of evidence Level III.

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“…Some authors reported better clinical outcomes by additional decompression of the nerve. 35,39 Others reported excellent clinical outcome and reversal of a suprascapular nerve pathology by RC repair without additional decompression. 8,28 The risk of suprascapular nerve decompression, however, has never been assessed quantitatively.…”

mentioning

confidence: 99%

Suprascapular nerve decompression in addition to rotator cuff repair: a prospective, randomized observational trial

Gerber

Meyer

Wieser

et al. 2020

Journal of Shoulder and Elbow Surgery

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Background: Tear and retraction of the supraspinatus (SS) and infraspinatus (IS) musculotendinous units and/or their repair may be associated with traction damage to the suprascapular nerve, potentially responsible for pain or weakness of the rotator cuff (RC). Arthroscopic release of the transverse scapular ligament at the suprascapular notch has been advocated to prevent or treat suprascapular nerve impairment associated with RC retraction and/or repair. The effect of this procedure on preoperative normal nerve function is, however, not well studied.We hypothesize that (1) decompression of the suprascapular nerve without preoperative pathologic neurophysiological findings will not improve clinical or imaging outcome and (2) suprascapular decompression will not measurably change suprascapular nerve function. Methods: Nineteen consecutive patients with a magnetic resonance arthrography documented RC tear involving SS and IS but normal preoperative electromyography (EMG)/nerve conduction studies of the SS and IS were enrolled in a prospective, controlled trial involving RC repair with or without suprascapular nerve decompression at the suprascapular notch. Nine patients were randomized to undergo, and 10 not to undergo, a decompression of the suprascapular nerve. Patients were assessed clinically (Constant score, mobility, pain, strength, subjective shoulder value), with magnetic resonance imaging and neurophysiology preoperatively and at 3-and 12-month follow-up. Results: There was no clinically relevant difference between the release and the non-release group in any clinical parameter at any time point. At magnetic resonance imaging, there was a slightly greater increase of fatty infiltration of the IS in the release group without any other differences between the 2 groups. Electromyographically, there were no pathologic findings in the non-release group at any time point. Conversely, 3 of the 9 patients of the release group showed pathologic EMG findings at 3 months, of whom 2 had recovered fully and 1 only partially at 12 months. Conclusion: In the presence of normal EMG findings, suprascapular nerve release added to arthroscopic RC repair is not associated with any clinical benefit, but with electromyographically documented, postoperative impairment of nerve function in 1 of 3 cases. Suprascapular nerve release does not therefore seem to be justified as an adjunct to RC repair if preoperative EMG findings document normal suprascapular nerve function. Based on these findings, the ongoing prospective randomized trial was terminated.

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A comparison of functional outcomes in patients undergoing revision arthroscopic repair of massive rotator cuff tears with and without arthroscopic suprascapular nerve release

Cited by 40 publications

References 13 publications

Suprascapular Nerve Release: Technique Based on Anatomic Landmarks

Suprascapular Nerve Release: Technique Based on Anatomic Landmarks

Comparison of clinical outcome of decompression of suprascapular nerve at spinoglenoid notch for patients with posterosuperior massive rotator cuff tears and suprascapular neuropathy

Suprascapular nerve decompression in addition to rotator cuff repair: a prospective, randomized observational trial

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