Comparison of clinical outcome of decompression of suprascapular nerve at spinoglenoid notch for patients with posterosuperior massive rotator cuff tears and suprascapular neuropathy

Outcomes After Rotator Cuff Repair With Transverse Scapular Ligament Release in Patients With Severe Fatty Degeneration of the Infraspinatus

BACKGROUND

In some large to massive rotator cuff tears (RCTs), fatty degeneration (FD) is more severe in the infraspinatus than the supraspinatus muscle, and in such cases, suprascapular neuropathy is highly suspected. Nerve release at the suprascapular notch might alleviate this problem.

PURPOSE

To evaluate the effects of the transverse scapular ligament (TSL) release in patients with large to massive RCTs with more severe FD of the infraspinatus than the supraspinatus.

STUDY DESIGN

Cohort study; Level of evidence, 3.

METHODS

Between September 2017 and January 2022, arthroscopic TSL release with rotator cuff repair was performed in patients with large to massive RCTs and more severe FD of the infraspinatus muscle than the supraspinatus muscle (TSL group). Cuff integrity, FD, and atrophy of cuff muscles were evaluated using preoperative and 1-year postoperative magnetic resonance imaging. In addition, results were compared with those of patients who did not undergo TSL release during arthroscopic large to massive rotator cuff repair (NTSL group).

RESULTS

A total of 103 patients-20 in the TSL group and 83 in the NTSL group-were included. Group preoperative characteristics, including tear size and supraspinatus FD, were not significantly different, but infraspinatus FD (TSL vs NTSL; grade, 0-4, 0/0/5/10/5 vs 1/33/42/4/3) and atrophy (grade, 1-3. 3/9/8 vs 56/20/7) differed significantly (P < .001). Healing failure occurred in 13 of 20 (65%) patients in the TSL group and 30 of 83 (36%) patients in the NTSL group, which was a statistically significant difference (P = .019). Postoperatively, infraspinatus FD and atrophy were more severe in the TSL group than in the NTSL group (P < .001), and supraspinatus FD was more severe in the TSL group (P = .029). Seven patients in the TSL group achieved healing, but FD and atrophy of the supraspinatus and the infraspinatus showed no improvement in this group (all, P > .05).

CONCLUSION

In patients with more FD in the infraspinatus than the supraspinatus muscle, TSL release appeared to have no benefit for cuff healing or FD reversal in cuff muscles. The possibility of suprascapular nerve entrapment remains in patients with more FD in the infraspinatus than the supraspinatus, and this potential nerve problem is not properly addressed by TSL release alone.

Does suprascapular nerve release provide additional benefits for rotator cuff repair: a systematic review and meta-analysis

BACKGROUND

There is still a lack of consensus regarding whether suprascapular nerve decompression should be routinely performed with rotator cuff repair. Therefore, this meta-analysis aimed to evaluate whether additional suprascapular nerve release (SSNR) could improve shoulder functional outcomes and pain relief more than rotator cuff repair alone.

MATERIALS AND METHODS

We performed a literature review of electronic databases for noncomparative and comparative studies investigating the effect of SSNR in patients undergoing rotator cuff repair. The primary outcome was the change in shoulder function scores from the preoperative status, and the secondary outcome was the change in the visual analog scale (VAS) score of pain after surgery. A subgroup analysis was conducted based on the study design (noncomparative studies vs. comparative studies).

RESULTS

Nine studies comprising 279 participants were included. Our analysis demonstrated that the group that underwent SSNR had a better shoulder functional score after surgery than at preoperative assessment (standardized mean difference [SMD], 1.333, 95% confidence interval [CI], 0.708-1.959). No significant differences were identified in shoulder function improvement between those with and without SSNR, with an SMD of 0.163 (95% CI, -0.091 to 0.418). Likewise, the group with SSNR showed a decreased VAS score after surgery compared to their preoperative status (SMD, 0.910; 95% CI, 0.560-1.260). However, there was no significant difference in VAS change between those with and without SSNR, with an SMD of 0.431 (95% CI, -0.095 to 0.956).

CONCLUSION

The present meta-analysis revealed that SSNR might not be routinely needed in rotator cuff tendon repair as no additional benefits in functional improvement or pain relief were identified compared to rotator cuff tendon repair alone.

Suprascapular nerve release does not provide additional benefits in arthroscopic rotator cuff repair surgery: a systematic review and meta-analysis

PURPOSE

To investigate the effect of suprascapular nerve release in arthroscopic rotator cuff repair surgery.

METHODS

This systematic review was performed to include randomized controlled trials (RCTs) and non-RCTs that compared the outcomes of patients who did and did not receive suprascapular nerve release (SSNR) during arthroscopic rotator cuff repair surgery. MEDLINE, Embase, and the Cochrane Central Register of Controlled Trials were searched for relevant studies. Methodological Index for Non-randomized Studies (MINORS) was used for cohort study assessment. The Cochrane risk of bias assessment tool (version 1.0) was used to assess the risk of bias in randomized trials. The primary outcomes were pain and shoulder function. The secondary outcome was the re-tear rate.

RESULTS

Two RCTs and three non-RCTs with a total of 187 patients (90 patients received SSNR and 97 patients did not receive SSNR) were included in this systematic review. The meta-analysis revealed that the SSNR group did not had a more pain reduction, assessed by visual analogue scale, compared to the non-SSNR group. Also, the SSNR group did not have a significantly more improvement in the UCLA score, compared to the non-SSNR group. In addition, there was no significant difference between the two groups in terms of Constant score and re-tear rate.

CONCLUSIONS

The result of this study showed that additional suprascapular nerve release did not provide additional benefit in arthroscopic rotator cuff repair surgery. Routine arthroscopic SSNR is not recommended when treating patients with rotator cuff tear.

LEVEL OF EVIDENCE

Level III.

Variations in the Course and Diameter of the Suprascapular Nerve: Anatomical Study

(1) Background: Suprascapular neuropathy is an important factor contributing to shoulder pain. Given the prevalence of nerve injury and nerve block in the suprascapular notch region, as well as the frequency of arthroscopic procedures on the suprascapular notch, which are recommended in shoulder pain management, its morphology is relevant from a clinical perspective. (2) Methods: Suprascapular nerve course was studied in twelve shoulders by dissection. Its diameter was measured at omohyoid level, proximal to the suprascapular notch and distal to the spinoglenoid notch. A multi-vari chart was used in order to descriptively visualize the results. The variations found were analyzed with a mixed linear model. (3) Results: In two of the six subjects, the suprascapular nerve was divided into two motor branches proximal to the superior transverse scapular ligament. An increase in diameter around the suprascapular notch was detected, with an estimated difference between diameter means of 2.008 mm at the suprascapular notch level and 2.047 mm at the spinoglenoid notch level. (4) Conclusions: A difference in the estimated diameter detected and the fact that the motor branches, which innervate supraspinatus and infraspinatus muscle, were divided proximal to the suprascapular notch may be relevant in the diagnosis and treatment of suprascapular neuropathy and arthroscopic procedures.