Ghodadra Neil, Nho Shane J, Verma Nikhil N, Reiff Stefanie, Piasecki Dana P, Provencher Matthew T, Romeo Anthony A
Department of Orthopedic Surgery, Rush University Medical Center, Rush Medical College of Rush University, Chicago, Illinois 60612, USA.
Arthroscopy. 2009 Apr;25(4):439-45. doi: 10.1016/j.arthro.2008.10.024.
Suprascapular nerve entrapment can cause disabling shoulder pain. Suprascapular nerve release is often performed for compression neuropathy and to release pressure on the nerve associated with arthroscopic labral repair. This report describes a novel all-arthroscopic technique for decompression of the suprascapular nerve at the suprascapular notch or spinoglenoid notch through a subacromial approach. Through the subacromial space, spinoglenoid notch cysts can be visualized between the supraspinatus and infraspinatus at the base of the scapular spine. While viewing the subacromial space through the lateral portal, the surgeon can use a shaver through the posterior portal to decompress a spinoglenoid notch cyst at the base of the scapular spine. To decompress the suprascapular nerve at the suprascapular notch, a shaver through the posterior portal removes the soft tissue on the acromion and distal clavicle to expose the coracoclavicular ligaments. The medial border of the conoid ligament is identified and followed to its coracoid attachment. The supraspinatus muscle is retracted with a blunt trocar placed through an accessory Neviaser portal. The transverse scapular ligament, which courses inferior to the suprascapular artery, is sectioned with arthroscopic scissors, and the suprascapular nerve is decompressed.
肩胛上神经卡压可导致肩部疼痛致残。肩胛上神经松解术常用于治疗压迫性神经病变，并在关节镜下盂唇修复时减轻神经所受压力。本报告描述了一种通过肩峰下入路在肩胛上切迹或肩胛冈盂切迹对肩胛上神经进行减压的新型全关节镜技术。通过肩峰下间隙，可在肩胛冈基部的冈上肌和冈下肌之间看到肩胛冈盂切迹囊肿。在通过外侧入路观察肩峰下间隙时，外科医生可通过后入路使用刨削器对肩胛冈基部的肩胛冈盂切迹囊肿进行减压。为在肩胛上切迹对肩胛上神经进行减压，通过后入路使用刨削器去除肩峰和锁骨远端的软组织，以暴露喙锁韧带。识别圆锥韧带的内侧边界并追踪至其喙突附着处。通过辅助内维亚泽尔入路置入钝头套管针，将冈上肌牵开。用关节镜剪刀切断位于肩胛上动脉下方的肩胛横韧带，对肩胛上神经进行减压。
