dxand txof suprascapular nerve pathology · 7/19/2017 1 dxand txof suprascapular nerve pathology...
TRANSCRIPT
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Dx and Tx of Suprascapular Nerve Pathology
Matt Bahu, M.D.
Detroit Sports Symposium
July 13, 2017
Disclosures- None
Overview
• Scapular anatomy
• Presentation
• Imaging
• Treatment
• Post op rehab
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Anatomy of the Scapula
• Glenoid
• Coracoid
• Acromion
Anatomy of the Scapula
• Rotator cuff
Anatomy of the Scapula
• Suprascapular Notch
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Anatomy of the Scapula
• SpinoglenoidNotch
Anatomy of the Scapula
• SS Nerve
• SS Artery
• TSL
Suprascapular Nerve Entrapment
• 1-2% of shoulder pain
• Suprascapular
• Spinoglenoid
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Suprascapular Nerve Entrapment
• Non-op Tx for overuse
• Usually not successful for entrapment or space occupying lesions
Suprascapular Nerve Entrapment
• Operative intervention
• Pain relief
• Variable return of strength and function
Case Presentation #1
• HISTORY
• 57 y.o. F
• 6 weeks of pain
• Repetitive overhead activity
• PE
• 90/80/5 150/100/30
• +Neer, +Hawk
• 4/5 abd, and erwith pain
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Case Presentation
• Injection
• PT
• Patient called for MRI in 4 weeks
Imaging- X-ray
Imaging- MRI
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Case Presentation
• HISTORY
• Did 2 weeks of PT
• Feeling worse
• Shaking and dropping things
• PE
• 45/30/5 100/70/30
• +Neer, +Hawk
• 4/5 abd, and erwith pain
EMG
“Incomplete suprascapular neuropathy with EMG evidence of moderately severe acute denervation in supra and infra. Etiology uncertain”
Imaging- MRI
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Operative Intervention
Surgical Anatomy/ Technique
• CA ligament
• Conoid
• TSL
Operative Intervention
Arthoscopic Decompresion of the Suprascapular Nerve at the Spinoglenoid Notch and Suprascapular Notch Through the Subacromial Space. Arthroscopy April 2009 Vol. 25, Issue 4, Pg. 439-445. Ghodadra, Provencher, Romeo
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Operative Intervention
Operative Intervention
Operative Intervention
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Operative Intervention
6 Weeks Post Op
• HISTORY
• Done passive motion in PT
• “I feel I’m finally getting better”
• PE
• 45/80/0 110/110/30
Case Presentation #2
• HISTORY
• 54 y.o. M
• 4 mnths of pain
• Notices weakness
• PE
• 180/120/20 180/120/40
• +Neer, +Hawk
• 5/5 abd, 3/5 erwith pain
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Imaging- X-ray
Imaging- MRI
Imaging- MRI
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Operative Intervention
Decompress Cyst
Decompress Cyst?Treatment of Patients with SpinoglenoidCysts Associated With Superior Labral Tears Without Cyst Aspiration, Debridement, or Excision. May 2006 Volume 22,
Issue 5, Pages 548-552. Youm, El Attracheetal.
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Operative Intervention
With Rotator Cuff Repair
• Some authors suggest SSN role in pain with massive rotator cuff tears
With Rotator Cuff Repair
• 20 patients in each cohort
• 3B atrophy
• Pain and strength 2 grades in SSN release group vs. one grade in comparison group
A Comparison of Short Term Functional Outcomes in Patients Undergoing Revision Arthroscopic Repair of Massive Rotator Cuff Tears With and Without Arthroscopic Suprascapular Nerve Release. June 2010 Volume 26, Issue 6. Zunkiewicz, Savoie etal.
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Conclusion
• Rare cause of shoulder pain
• Suprascapular or spinoglenoid
• High index of suspicion
• Start non-operative, but usually unsuccessful
• Operative intervention for pain, not as consistent for strength/ function
Thank You!