Abstract
Surgical Technique
Preoperative Preparation and Patient Positioning
Arthroscopic Portals
Procedure


Step | Description | Pitfalls |
---|---|---|
Patient positioning | Beach chair position | Drapes should be placed to allow medial exposure of the shoulder up to the root of the neck, to allow the placement of 2 portals medial to the acromion by 3.5 cm. |
Lateral portal | Placed about 2 cm lateral to the acromion in line with the posterior border of the lateral end of the clavicle. | Too much anterior placement of the portal will not allow clear visualization of the targeted structures in the surgical field. |
Medial and far medial portals | Placed 1.5 and 3.5 cm medial to the acromion and 1.5 cm posterior to the clavicle | Placing these portals too close to each other or too close to the clavicle will not allow easy manipulation of the instruments |
Obtaining a good arthroscopic view | A switching stick is placed through the far medial portal to feel the coracoclavicular (CC) ligaments, and then the scope is introduced through the lateral portal and triangulated on the switching stick. The switching stick is used to clear the view by displacing the fat medially using a windshield wiper-like movement. | Using the shaver to remove the fat will cause a lot of bleeding and increase the risk of injury to the suprascapular (SS) artery. |
Decompression of the SS nerve | The stick is moved downward along the medial border of the CC ligaments to feel the base of the coracoid process and the top of the SS ligament. Once there, an arthroscopic scissors or low-profile basket forceps is used to cut the SS ligament through the medial portal. | Starting the decompression before obtaining a good view or without protecting the SS artery. |
Discussion
Surgical Technique | Classic Technique for Arthroscopic Suprascapular Nerve Decompression 5 | Shortcut Technique for Arthroscopic Suprascapular Nerve Decompression |
---|---|---|
Principle | Resecting the fat medial to the subacromial space under vision until reaching the suprascapular notch. | Palpating the coracoclavicular ligaments before starting the arthroscopic visualization, which is used as a landmark to guide the scope directly to the suprascapular notch. |
Advantages | • Every step of the surgery is done under vision. | • Minimizes fat resection. • Reduces the risk of injury of the suprascapular artery. • Shortens the operative time. |
Disadvantages | • Longer operative time. • Bleeding caused by fat resection reduces the visualization. • Relatively higher risk of injury of suprascapular artery | • Technically demanding. |
Supplementary Data
- Video 1
This video describes a shortcut to arthroscopic suprascapular nerve decompression at the suprascapular notch. The depicted surgery is carried out on a left shoulder. The patient is placed in the beach chair position. The concept depends upon palpating the coracoclavicular (CC) ligaments from the far medial portal and triangulating the scope to the area of arthroscopic work through the lateral portal, which allows direct visualization of the CC ligament and the suprascapular (SS) ligament with minimal resection of fat. Once the suprascapular artery is identified and protected, the punch is used through the medial portal to cut the SS ligament.
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References
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- Der Karpaltunnel der Schulter/the carpal tunnel of the shoulder: Die arthroskopische Dekompression des N. suprascapularis.Sports Orthopaed Traumatol. 2014; 30: 215-219
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- Anatomic variance of the coracoclavicular ligaments.J Shoulder Elbow Surg. 2001; 10: 585-588
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The authors report the following potential conflicts of interest or sources of funding: H.G.S. receives support from AO Trauma and SICOT. Full ICMJE author disclosure forms are available for this article online, as supplementary material.
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