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Anatomic landmarks for arthroscopic suprascapular nerve decompression

  • Shoulder
  • Published:
Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

Arthroscopic suprascapular nerve (SSN) decompression has become a more frequently utilized procedure in the treatment of SSN entrapment and has gained popularity over recent years. Despite increasing technical notes and outcomes information regarding this technique, there remains a paucity of data with respect to clear anatomic guidelines for teaching this procedure. The purpose of this study was to provide guidelines that are visible arthroscopically and palpable externally to allow safer and more efficient surgery for arthroscopic decompression by analysing the superior scapular anatomy with respect to local landmarks.

Methods

A cadaveric study was used to examine neurovascular structural measurements obtained in twelve cadavera with 23 usable shoulders. Arthroscopic dissection of the pertinent anatomy as determined by previously described approaches was followed by meticulous open regional dissection and measurements of the local landmarks.

Results

Measurements of the pertinent arthroscopic anatomy with respect to local landmarks of the superior shoulder were recorded in 23 shoulders and are included herein. Measurements taken arthroscopically on 22 shoulders revealed that the lateral insertion of the transverse suprascapular ligament to the acromioclavicular joint was 3.6 cm (SD 0.5 cm). One of the anatomic measurements on open dissection had a significant correlation with our subject’s demographics and was found between cadaveric height and the linear distance from the lateral acromion to the suprascapular notch (mean distance = 66.53 ± 5.30 mm; Pearson’s correlation = 0.739; p = 0.006).

Conclusions

This cadaveric study describes meaningful landmarks and their measurements, which are identifiable arthroscopically and enable safer surgery in this area. Using these numbers, surgeons can know that it is safe to bluntly dissect to 2.5 cm medial to the acromioclavicular joint (and 5 cm medial to the palpable lateral acromion) before dissection is likely to encounter the SSN or artery. This knowledge will allow surgeons to learn this surgical technique, and for surgical educators to safely teach dissection and release in this uncommonly accessed anatomic region.

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Acknowledgments

The authors would like to thank the contributions made by Dr. Denis Clohisy and the Department of Orthopaedic Surgery at the University of Minnesota for the provision of funds and for the acquisition of materials and cadavera for this study. The authors would also like to thank Dr. Michal P. Zlowodzki for his contributions in the assistance of data collection for this study. The authors would also like to thank Dr. John Wechter for his line drawing contributions for this study.

Conflict of interest

The authors declare that they have no conflict of interest with regard to the present study.

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, University of Minnesota, 2450 Riverside Ave S #R200, Minneapolis, MN, 55454, USA

    Michael L. Knudsen & Jonathan P. Braman

  2. Minneapolis, MN, USA

    Jason C. Hibbard & David J. Nuckley

Authors
  1. Michael L. Knudsen
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  2. Jason C. Hibbard
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  3. David J. Nuckley
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  4. Jonathan P. Braman
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Corresponding author

Correspondence to Jonathan P. Braman.

Electronic supplementary material

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167_2014_3149_MOESM1_ESM.mp4

Video 1 Arthroscopically recorded video of a right shoulder demonstrating the course across the dissected superior shoulder from the acromioclavicular joint (localized by the spinal needle) to the transected transverse scapular ligament as viewed through a standard anterolateral viewing portal. The probe in the video identifies the base of the coracoclavicular ligaments, the location of the transverse scapular ligament, and the lateral deltoid undersurface (location of the lateral aspect of the acromion in line with the posterior aspect of the clavicle) (MP4 7,427 kb)

167_2014_3149_MOESM2_ESM.mp4

Video 2 Arthroscopically recorded video of a right shoulder demonstrating release of the transverse scapular ligament using an arthroscopic biter as seen through a standard anterolateral viewing portal (MP4 7,624 kb)

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Knudsen, M.L., Hibbard, J.C., Nuckley, D.J. et al. Anatomic landmarks for arthroscopic suprascapular nerve decompression. Knee Surg Sports Traumatol Arthrosc 24, 1900–1906 (2016). https://doi.org/10.1007/s00167-014-3149-4

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  • DOI: https://doi.org/10.1007/s00167-014-3149-4

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