Suprascapular nerve entrapment isolated to the spinoglenoid notch: surgical technique and results of open decompression.

BACKGROUND: Entrapment of the suprascapular nerve (SSN) at the spinoglenoid notch (SGN) specifically affects the infraspinatus, and isolated external rotation (ER) weakness can result. We describe the technique of open SSN decompression at the SGN for infraspinatus involvement and report the results of a consecutive series. MATERIALS AND METHODS: Twenty-nine shoulders underwent SSN decompression at the SGN. The mean age was 44 years (range, 15-69 years), and the mean follow-up was 4.3 years (range, 1-7 years). On manual muscle testing, ER strength was abnormal in all patients: 2/5 in 3, 3/5 in 21, and 4/5 in 5. The mean preoperative American Shoulder and Elbow Surgeons (ASES) score was 48 (range, 23-83). Atrophy of the infraspinatus was visible or palpable in 72% of shoulders. Magnetic resonance imaging showed ganglion cysts at the SGN in only 20.7% of shoulders. RESULTS: Of the patients, 19 (66%) regained full ER strength, 9 (31%) improved to 4/5, and 1 (3%) had ER strength of 3/5. The mean ASES score improved to 75 (range, 60-100) (P < .05). Of 29 shoulders, 23 (79%) showed improved ER strength within 1 week of surgery. All ganglion cyst cases regained full ER strength within a mean of 6 weeks. In all cases, ER strength improved by at least 1 full strength grade. DISCUSSION: A ganglion cyst is not necessary to produce SSN compression at the SGN. SSN compression at the SGN can present as an isolated entity or can occur in conjunction with rotator cuff pathology or a ganglion cyst. An index of suspicion, physical examination, magnetic resonance imaging, and electromyography confirm the diagnosis. The described operative approach detaches no muscle and allows rapid recovery, and in all cases, ER strength improved to normal or by 1 full grade.

Arthroscopic repair for posterior shoulder instability.

PURPOSE: The purpose of this study was to evaluate outcomes of a consistent arthroscopic stabilization technique for recurrent posterior instability. METHODS: Thirty-four consecutive shoulders with symptomatic recurrent posterior instability were treated with arthroscopic repair and evaluated at a mean follow-up of 36 months (range, 12 to 67 months). Two patients were excluded because of prior surgery, leaving 32 for further analysis. The mean age was 21.4 years (range, 15 to 33 years). There were 26 male and 6 female patients, and in 59% the dominant shoulder was affected. A known traumatic injury had occurred in 25 (78%), but only 2 (6%) had a documented dislocation. Arthroscopic repair was performed with the patient in the lateral decubitus position through an anterosuperior 12-o'clock viewing portal. Suture anchor repairs were performed in 30 cases and plication to the intact labrum in 4. A sling and derotation wedge were used for 4 weeks, followed by progressive active range of motion, with weight lifting at 3 months and return to contact sports at 6 months. Of the 34 cases, 22 met the inclusion and exclusion criteria and had complete preoperative and postoperative shoulder outcome scores. RESULTS: Significant improvement (P = .001) from preoperatively to final follow-up was seen for American Shoulder and Elbow Surgeons scores, from 68 to 93; Simple Shoulder Test scores, from 9.3 to 11.6; and visual analog scale scores, from 3.5 to 0.8. All patients returned to their previous level of athletic activity. Two patients reported postoperative instability; none required reoperation. There were no other postoperative complications. CONCLUSIONS: This study represents a consecutive series of patients with recurrent posterior instability who underwent arthroscopic posterior stabilization. In this population arthroscopic posterior labral repair and capsular plication provided significant clinical improvement and low rates of recurrent instability and revision surgery. LEVEL OF EVIDENCE: Level IV, therapeutic case series.

Lateral meniscus allograft biologic glenoid arthroplasty in total shoulder arthroplasty for young shoulders with degenerative joint disease.

To avoid potential polyethylene problems in younger shoulders with degenerative joint disease (DJD) requiring arthroplasty, lateral meniscus allograft (LMA) was used as a biologic resurfacing of the glenoid. We report preliminary, short-term results of this technique in a younger, higher-demand population. The shoulders of 20 men and 10 women, with an average age of 42 years (range, 18 to 52 years), underwent total shoulder arthroplasty with a LMA. A metallic prosthesis was used on the humerus. Etiology of the DJD was osteoarthritis in 16, postinstability surgery in 8, traumatic in 4, and failed open reduction with internal fixation in 2. Twenty-two (73%) had previous shoulder surgery. Preoperative average scores were American Shoulder and Elbow Surgeons (ASES), 38; Simple Shoulder Test (SST), 3.3; and Visual Analogue Scale (VAS), 6.4. The average active forward elevation was 96 degrees and external rotation was 26 degrees . Average follow-up was 18 months (range, 12 to 48 months). Postoperative average scores were ASES, 69; SST, 7.8; and VAS, 2.3. Active forward elevation was 139 degrees and external rotation was 53 degrees . All were significant improvements (P < .02). Most (94%) would have the surgery again. Radiologic evaluation at 1 year revealed an average joint space of 1.8 mm on anteroposterior views and 1.6 mm on axillary views. Five complications (17%) occurred within the first postoperative year, all of which required reoperation. Pain resulted in 2 conversions to a polyethylene glenoid. Polyethylene glenoids in young shoulders risk early failure. For young, high-demand shoulders with DJD requiring arthroplasty, the LMA shows promise. Most problems presented within the first year. Although not perfect, it provided significant pain relief, range-of-motion gains, and patient satisfaction without the risk of poly wear or loosening. Longer-term follow-up will be required to determine ultimate durability.