Suprascapular Nerve Decompression With Rotator Cuff Repair; Indications, and Techniques

Repair of the rotator cuff is a common procedure with a relatively high success rate. Failures do occur for a variety of issues, most related to healing and trauma. Neuropathy may also be a cause of failure of repair, more often related to cervical myelopathy or nerve root compression, but also due to compression, traction, or scarring of the suprascapular nerve at either the suprascapular notch or the spinoglenoid notch. In primary cases, the patient presents with weakness out of proportion to the history and physical examination. In revision cases one may observe progressive atrophy with eventual failure of the repair. Early imaging may show edema in the muscle and inflammation around the suprascapular or spinoglenoid notch, with later imaging showing significant atrophy of the muscle of the supraspinatus and/or infrapinatus. Electromyography should demonstrate evidence of nerve compression or inflammation with changes in the muscle consistent with compromise of the nerve. Operative indications include proper diagnosis, and the suprascapular nerve may be decompressed at both the suprascapular notch and spinoglenoid notch.