Motor Recovery of the Suprascapular Nerve after Arthroscopic Decompression in the Scapular Notch – a Systematic Review

Abstract

Background The suprascapular nerve can be compromised as a result of a compression syndrome in different locations. A (proximal) compression within the scapular notch can lead to dorsal shoulder pain and simultaneous weakness of the infraspinatus and supraspinatus muscles. By transection of the lig. transversum this compression syndrome can be treated. By means of a systematic review, the present work analyzes the motor recovery potential after arthroscopic decompression.

Material and Methods A systematic review of the U. S. National Library of Medicine/National Institutes of Health (PubMed) database and the Cochrane Library was performed using the PRISMA checklist. The search words used were “suprascapular” and “arthroscopic”; “suprascapular” and “arthroscopy”. Based on the evaluated literature, articles in English with at least a partial arthroscopic case series from 4 cases on and a compression syndrome of the suprascapular nerve treated with arthroscopic decompression in the scapular notch were identified. Motor recovery was described by means of EMG, clinical strength and MRI.

Results Primarily 408 hits were generated. Six articles met the inclusion criteria and were further analyzed. The number of arthroscopic cases was between 4 and a maximum of 27. The level of evidence was between III and IV. The majority of the reported clinical results were good. Motor recovery as measured by EMG was observed, recovery of full strength was not achieved in the majority of reported cases (60%), neither was regression of structural (fatty) degeneration of the muscle bellies.

Conclusion Arthroscopic decompression of the suprascapular nerve in the scapular notch provides good clinical results and considerable pain relief. However, in the majority of cases it does not lead to a complete recovery of the strength of the supra- and infraspinatus muscles. Patients should be informed about this. An early decompression after diagnosis in the event of proximal compression within the suprascapular notch combined with beginning EMG or MRI changes appears reasonable. These beginning changes should be further defined. Future studies should develop prognostic criteria for motor recovery. Awareness regarding the diagnosis needs to be improved due to the probably time-dependent irreversibility of resulting muscular weakness.

Key words

suprascapular nerve - scapular notch - decompression - recovery - arthroscopic

Publikationsverlauf

Artikel online veröffentlicht:
11. Mai 2020

• References/Literatur

• 1 Lafosse L, Tomasi A, Corbett S. et al. Arthroscopic release of suprascapular nerve entrapment at the suprascapular notch: technique and preliminary results. Arthroscopy 2007; 23: 34-42
• 2 Leclere LE, Shi LL, Lin A. et al. Complete fatty infiltration of intact rotator cuffs caused by suprascapular neuropathy. Arthroscopy 2014; 30: 639-644
• 3 Memon M, Kay J, Ginsberg L. et al. Arthroscopic management of suprascapular neuropathy of the shoulder improves pain and functional outcomes with minimal complication rates. Knee Surg Sports Traumatol Arthrosc 2018; 26: 240-266 doi:10.1007/s00167-017-4694-4
• 4 Momaya AM, Kwapisz A, Choate WS. et al. Clinical outcomes of suprascapular nerve decompression: a systematic review. J Shoulder Elbow Surg 2018; 27: 172-180
• 5 Liberati A, Altman DG, Tetzlaff J. et al. The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration. PLoS Med 2009; 6: e1000100
• 6 von Knoch M, Frosch S, Lehmann W. Arthroscopic reconstruction of intratendinous lesions of the supraspinatus tendon – a systematic review. Z Orthop Unfall 2018; 156: 547-553
• 7 Shah AA, Butler RB, Sung SY. et al. Clinical outcomes of suprascapular nerve decompression. J Shoulder Elbow Surg 2011; 20: 975-982
• 8 Oizumi N, Suenaga N, Funakoshi T. et al. Recovery of sensory disturbance after arthroscopic decompression of the suprascapular nerve. J Shoulder Elbow Surg 2012; 21: 759-764
• 9 Garcia Júnior JC, Paccola AM, Tonoli C. et al. Arthroscopic release of the suprascapular nerve: surgical technique and evaluation of clinical cases. Rev Bras Ortop 2015; 46: 403-407
• 10 Tsikouris GD, Bolia IK, Vlaserou P. et al. Shoulder Arthroscopy with versus without suprascapular nerve release: clinical outcomes and return to sport rate in elite overhead athletes. Arthroscopy 2018; 34: 2552-2557
• 11 Antoniadis G, Richter HP, Rath S. et al. Suprascapular nerve entrapment: experience with 28 cases. J Neurosurg 1996; 85: 1020-1025
• 12 Ma CH, Omura T, Cobos EJ. et al. Accelerating axonal growth promotes motor recovery after peripheral nerve injury in mice. J Clin Invest 2011; 121: 4332-4347