Suprascapular neuropathy combined with massive rotator cuff tears: clinical signs, diagnostics, treatment

Suprascapular neuropathy is a type of disease, which up until recently was considered quite rare and observed mainly among the athletes. On the contrary, this problem is observed quite often, especially as a professional disease among the individuals involved in heavy manual labour. The syndrome of suprascapular nerve compression is a complex problem, combining a multitude of reasons and resulting in the atrophy of the supraspinal and infraspinous muscles. The compression of the suprascapular nerve is developing due to its complex anatomy, the presence of additional bony and other types of structures in the area of the scapular notch, as well as due to the traumatic lesions of the rotator cuff and of the scapular spine. There is an opinion that the contraction of the damaged supraspinal and infraspinous muscles may cause contusion- related changes in the suprascapular nerve, which may persist after the reconstruction of the rotator cuff. The provided research summarizes the data available on the suprascapular neuropathy, especially combined with massive rotator cuff tears, as well as on the reasons of its development, the clinical manifestations, the diagnostics and the comparative results for various treatment methods. An analysis was conducted of the main research results obtained using the surgical treatment for suprascapular neuropathy, in particular, the arthroscopic decompression combined with the treatment of rotator cuff abnormalities. The analysis of literature data has shown that, in case of the presence of space-occupying masses or bone deformities in the area of the scapular notch, surgical correction shows significant positive results. In case of damaged rotator cuff, the combination of arthroscopic release of the suprascapular nerve with its reconstruction provides good clinical results, promoting to the decrease of the pain syndrome during the postoperative period, however, no significant differences were reported when restoring the rotator cuff both with the release procedure and without it. Most part of the patients with chronic pain syndrome and degenerative changes can be successfully treated conservatively. Despite the fact that the relation of rotator cuff tears and suprascapular neuropathy is undoubtful, many researchers describe the absence of statistically significant difference in the clinical results of reconstructing the rotator cuff together with arranging the procedure of arthroscopic release and without it. Thus, probably, the indications to arthroscopic release of the suprascapular nerve should be clearly limited to cases of its neuropathy based on the data obtained during the research including larger samples of patients.