The presence of suprascapular neuropathy in rotator cuff tears

The suprascapular nerve has three distinctive anatomical locations where it is most vulnerable to injury: at the suprascapular and spinoglenoid notch and along the supraspinatus fossa, where it is relatively fixed to the periosteum. The supraspinatus muscle has closest relation to all three and is also the most studied muscle of rotator cuff in conjunction with the mechanism of nerve neuropathy. Several anatomical studies try to mimic rotator cuff rupture and surgical reconstruction and thus describe effect on nerve when medial retraction or lateral advancement of the supraspinatus is present. Clinical series do not correlate with anatomical studies concerning safe amount of lateral traction of supraspinatus tendon. It is recommended to do a neurological evaluation of the suprascapular nerve in patients who are being considered for surgical repair of the rotator cuff tears and have a significant degree of muscle atrophy, as the accompanying neuropathy may prolong post-surgical recovery or result in a poor outcome. Recently new arthroscopic techniques have been described to release the suprascapular nerve at the suprascapular notch, and it is believed that this will have a beneficial effect on nerve recovery and resolution of pain in case of nerve entrapment.