Cotter Eric J, Chang Joshua H, Khazi-Syed Daanish, Hand Catherine M, Bohn Camden J, Gornbein Chase, Forsythe Brian
Midwest Orthopaedics at RUSH, Chicago, Illinois, USA.
University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA.
Video J Sports Med. 2025 May 13;5(3):26350254241299841. doi: 10.1177/26350254241299841. eCollection 2025 May-Jun.
Suprascapular neuropathy is an uncommon but treatable cause of shoulder pain and dysfunction. The tortuous course of the suprascapular nerve puts it at risk for entrapment, particularly at the suprascapular and spinoglenoid notches. This video presents a reproducible method for suprascapular nerve decompression at the suprascapular notch.
Massive rotator cuff tears, compressive masses, or ligament hypertrophy warrants prompt intervention to prevent subsequent denervation in the face of suprascapular neuropathy. In the absence of these pathologies, a trial of conservative management is advised. Patients who have unsuccessful conservative management and evidence of worsening weakness, atrophy, and denervation by electromyography are indicated for surgical intervention.
Standard posterior, anterior, lateral, and anterolateral portals are established. The subdeltoid space is dissected following the coracoacromial (CA) ligament to the base of the coracoid to identify the transverse scapular ligament. In the presented case, the CA ligament has been debrided from a previous surgery, so an intra-articular approach was employed, opening the rotator interval to reach the base of the coracoid. A Neviaser portal is made for blunt dissection around the suprascapular notch, with care taken to protect the neurovasculature. A second medial Neviaser portal is used to pass a Kerrison to release the transverse scapular ligament. Nerve adhesions are then gently released with a probe.
A systematic review of 276 suprascapular nerve decompressions demonstrated good outcomes in terms of pain relief and function, and all athletes in the review returned to sport. A case series of 112 arthroscopic decompressions at the suprascapular notch found that patients achieved significant improvement in pain and strength, and none resulted in serious complications. These outcome studies support a level 4 video publication level of evidence.
DISCUSSION/CONCLUSION: The presented arthroscopic decompression technique treats suprascapular nerve entrapment at the suprascapular notch. Patients can expect to achieve a satisfactory outcome.
The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form of approval from the patient(s) with this submission for publication.
肩胛上神经病变是导致肩部疼痛和功能障碍的一种不常见但可治疗的病因。肩胛上神经走行迂曲，易发生卡压，尤其是在肩胛上切迹和冈盂切迹处。本视频展示了一种在肩胛上切迹进行肩胛上神经减压的可重复方法。
巨大肩袖撕裂、压迫性肿物或韧带肥厚等情况需要及时干预，以防止在肩胛上神经病变时继发失神经支配。若不存在这些病变，建议先进行保守治疗。经保守治疗效果不佳且肌电图显示肌无力、萎缩和失神经支配加重的患者，应考虑手术干预。
建立标准的后方、前方、外侧和前外侧入路。沿喙肩韧带向喙突基部解剖肩峰下间隙，以识别肩胛横韧带。在本病例中，由于之前的手术已切除喙肩韧带，因此采用关节内入路，打开旋转间隙以到达喙突基部。制作一个Neviaser入路用于在肩胛上切迹周围进行钝性分离，注意保护神经血管。使用第二个内侧Neviaser入路插入Kerrison咬骨钳以松解肩胛横韧带。然后用探子轻轻松解神经粘连。
一项对276例肩胛上神经减压术的系统评价表明，在缓解疼痛和改善功能方面效果良好，该评价中的所有运动员均恢复了运动。一项包含112例肩胛上切迹关节镜减压术的病例系列研究发现，患者的疼痛和力量有显著改善，且无一例出现严重并发症。这些结果研究支持证据等级为4级的视频出版物。
讨论/结论：所展示的关节镜减压技术可治疗肩胛上切迹处的肩胛上神经卡压。患者有望获得满意的疗效。
作者证明已获得本出版物中出现的任何患者的同意。如果个体可被识别，作者已随本稿件提交包含患者发布声明或其他书面批准形式。
