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Suprascapular Neuropathy
Updated: Oct 4 2016

Suprascapular Nerve Decompression (Spinoglenoid Notch)

Preoperative Patient Care
Operative Techniques

Preoperative Plan


Radiographic templating


Execute surgical walkthrough

  • describe steps of the procedure verbally to the attending prior to the start of the case
  • describe potential complications and steps to avoid them

Room Preparation


Make sure tower working

  • 30° arthroscope
  • fluid pump system
  • standard arthroscopic instruments
  • arthroscopic shavers and burrs
  • radiofrequency ablation wand
  • arthroscopic scissors


Room setup and Equipment

  • standard OR table for lateral decubitus position


Patient Positioning

  • lateral decubitus position
  • pad any prominences of the extremities
  • position the head and neck in neutral alignment

Scope Insertion


Outline landmarks

  • Outline the acromion, distal clavicle, coracoid process and portal placement


Place posterior portal

  • mark portal 1 to 3 cm distal and 1 to 2 cm medial to the posterior lateral tip of the acromion
  • make small skin incision
  • place blunt trocar with the arm in 15° of abduction and 30° of forward flexion
  • use lateral traction to avoid damage to the articular surface
  • place the 30° arthroscope.


Place anterior portal

  • halfway between acromioclavicular joint and the lateral aspect of the coracoid
  • pierce the anterior fibers of the deltoid and enter the joint in the interval between the supraspinatus and subscapularis


Place lateral portal

  • place laterally in line with the mid clavicle and 2 to 3 cm lateral to its lateral edge


Place medial portal

  • place 3-3.5 cm medial to the bisecting line at the midclavicle

Diagnostic Arthroscopy


Visualize the anatomy

  • articular cartridge of the humeral head and glenoid
  • labrum
  • biceps tendon
  • inferior recess
  • articular surface
  • insertion of the subscapularis, supraspinatus, infraspinatus and teres minor


Establish anterior portal

  • localize portal with an 18 gauge spinal needle placement
  • place a seven millimeter cannula using the outside-in technique

Notch Identification


Incise the labrum

  • with an intact labrum, the joint capsule above the superior-posterior labrum is incised
  • start posterior to the biceps root and extend posteriorly for 2 to 3 cm


After incision of the capsule, identify the spinoglenoid notch

  • the fibrous raphe between the supraspinatus and infraspinatus that is seen lateral to the spinoglenoid notch is a good landmark
  • palpate the notch with an arthroscopic instrument
  • this provides a bony landmark that can be correlated with the cyst position that is seen on the preoperative MRI

Ganglion Cyst Excision


Place a posterolateral accessory portal

  • through this portal bluntly dissect through the fibrovascular tissue that covers the neurovascular bundle
  • this can be done with a switching stick or with a similar tool
  • the suprascapular nerve is positioned medially in direct contact with the bone of the spinoglenoid notch
  • the vascular structures are positioned more laterally and closer to the glenoid


Excise the ganglion cyst

  • ganglion cysts are typically found posterior to the nerve
  • remove the cyst in its entirety including the lining


Inspect the nerve

  • inspect the nerve for any additional sites of decompression

Wound Closure


Irrigation and hemostasis

  • irrigate the portals


Deep closure

  • use 3-0 biosyn for closure


Superficial closure

  • use 4-0 biosyn for skin


Dressing and immediate immobilization

  • place sling
Postoperative Patient Care
Private Note

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