Arthroscopic decompression at the suprascapular notch: A radiographic and anatomic roadmap

Academic Article

Abstract

  • © 2015 Journal of Shoulder and Elbow Surgery Board of Trustees. Background: Arthroscopic decompression of the suprascapular nerve (SSN) at the suprascapular notch is a technically demanding procedure. Additional preoperative and intraoperative information may assist surgeons. The purpose of this study was to (1) identify which imaging modality most accurately represents the anatomic distance to the notch and (2) quantify the mean intraoperative distances from routine arthroscopic portals to the notch. Methods: Ten matched pairs of fresh cadaveric shoulders were imaged by roentgenogram, computed tomography (CT), magnetic resonance imaging, and 3-dimensional (3D) CT, followed by arthroscopic SSN decompression at the notch and anatomic dissection. Measurements obtained included the distances from the anterolateral, posterior, and SSN portal sites to the notch in addition to the distance from the anterolateral acromion to the notch. Statistical analysis with Spearman correlation coefficients and Bland-Altman plots were used to determine the correlation and agreement between measurements. Results: The preoperative imaging modality with the highest correlation to anatomic distances from the anterolateral acromion to the notch was 3D CT (Rs=0.90, P<.0001). The mean intraoperative distances to the notch from the anterolateral, posterior, and SSN arthroscopic portals were 89mm, 88mm, and 49mm, respectively. The mean anatomic distance from the anterolateral acromion to the notch was 64mm. Conclusions: Preoperative imaging with 3D CT may assist surgeons in performing arthroscopic SSN decompression. Understanding of the mean distances from the portal sites to the suprascapular notch and being cautious of arthroscopic instruments placed beyond 9cm from laterally based portals may result in safer intraoperative medial dissection.
  • Digital Object Identifier (doi)

    Author List

  • Dietrich LN; Bentley A; Savage JA; Momaya AM; Larrison MC; McGwin G; Ponce BA
  • Start Page

  • 433
  • End Page

  • 438
  • Volume

  • 24
  • Issue

  • 3