July 1, 2013
The suprascapular nerve is extremely important to shoulder function. It comes off high in the brachial plexus and is felt to supply about 70% of the sensory input to the shoulder while innervating the majority of the rotator cuff. Thus, it is important both in pain perception as well as in providing the innervation to the muscle that stabilizes the shoulder. There is a tendency for it to be compressed in people performing vigorous frequent overhead sports such as weight lifters and volleyball players, but it also may affect the average individual. Most recently it has been noticed to be irritated in association with massive tears of the rotator cuff with retracted muscle. This was pointed out most poignantly by Costouros et al. of the Harvard Shoulder Service, Department of Orthopaedic Surgery, as published in Arthroscopy, Volume 23, No. 11, 2007, pages 152-1161. They noted that about 10% of their patients presenting with tears of the rotator cuff had massive tears. Patients had pain and marked weakness. Electrodiagnostic studies which are not normally performed on shoulder patients presenting with a rotator cuff tear were performed in their patients. Seven of these twenty-six patients, i.e. 38%, had suprascapular nerve dysfunction and interestingly, with repair of the rotator cuff, repeat electrodiagnostic studies performed after six months postoperatively revealed partial or full recovery of the suprascapular nerve palsy which correlated with complete pain relief and marked improvement in function. What needs to be determined thus is if simple decompression of the suprascapular nerve in these patients would suffice in giving the people pain relief particularly in those who are more intolerant of the prolonged immobilization of the shoulder and wherein it would be necessary to recuperate from the reconstruction of a massive rotator cuff tear. Certainly more research is needed in this repair.
Decompression of the suprascapular nerve when identified as the sole cause of a person’s shoulder pain is very rewarding, does not hurt much for the patient and, in the patients I have treated, allows them to return to work within a day or so of the operation.