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

Abstract

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.

Suprascapular Nerve Release: Technique Based on Anatomic Landmarks

“…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.…”

Editorial Commentary: Suprascapular Nerve Decompression Can Be Effective, But Should You Have the Nerve to Do It?

“…In the cases of rotator cuff tear and spinoglenoid notch cyst from a superior labrum tear, there is compelling evidence that suprascapular nerve decompression is unnecessary in most cases. 9,10 Moreover, transverse scapular ligament release before rotator cuff repair with confirmation of free mobility of the suprascapular nerve after release can result in subtle nerve injury detectable on electromyography, even in expert hands. 10 While we do not decompress the suprascapular nerve at the time of rotator cuff repair, we do decompress any large spinoglenoid notch cyst that is causing compressive neuropathy even if we perform a SLAP repair.…”

“…9,10 Moreover, transverse scapular ligament release before rotator cuff repair with confirmation of free mobility of the suprascapular nerve after release can result in subtle nerve injury detectable on electromyography, even in expert hands. 10 While we do not decompress the suprascapular nerve at the time of rotator cuff repair, we do decompress any large spinoglenoid notch cyst that is causing compressive neuropathy even if we perform a SLAP repair. 11 We firmly believe that opening the lateral aspect of a large spinoglenoid notch cyst has negligible downside and ensures immediate relief of the compressive neuropathy, which is the indication for surgery in these patients.…”

What’s New in Shoulder and Elbow Surgery

“…The efficacy of concomitant suprascapular nerve decompression at the time of rotator cuff repair remains controversial. Gerber et al 7 investigated shoulder function, magnetic resonance imaging (MRI), and electromyography (EMG) and nerve conduction studies in 19 patients undergoing rotator cuff repair randomized into 2 groups: 1 group with concomitant suprascapular nerve decompression and 1 group without such decompression. All patients had normal preoperative EMG and nerve conduction studies and mild fatty degeneration of the supraspinatus and infraspinatus muscles (Goutallier grade 1 or 2).…”