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SUPERIOR APPROACH TO THE SUPRASCAPULAR NERVE
USES
This approach is used primarily to release the suprascapular notch in cases of suprascapular nerve entrapment. It also allows exposure of the lateral portion of the trapezius and the supraspinatus muscle belly.
ADVANTAGES
By approaching the nerve from the posterior side, we avoid all the vascular structures anteriorly and the brachial plexus. Also, this approach allows the branch of the nerve to the infraspinatus to be freed simply by taking the posterior deltoid off of the spine of the scapula and coming down onto the region of the nerve.
DISADVANTAGES
For the purposes for which it is intended, this approach does not have disadvantages.
STRUCTURES AT RISK
Posteriorly, there are no significant structures at risk. The trapezius is lifted off of the spine of the scapula subperiosteally to promote the ease of the repair. If the repair of the trapezius is not done carefully, the potential for its avulsion exists.
The suprascapular artery will not uncommonly pass superior to the suprascapular ligament while the nerve goes underneath it. You cannot indiscriminately release the ligaments until you are sure that there is no artery at risk. If there is, be sure to gently retract it out of the way before releasing the ligament.
TECHNIQUE
The incision is made just superior to the scapular spine and typically is 6 or 7 cm in length. You go through the subcutaneous tissue until you encounter the fascia overlying the trapezius muscle. Palpate the spine of the scapula and strip the trapezius muscle along with its periosteum off of the scapula. As you are moving anteriorly through the trapezius, be aware of the orientation of the fibers. When you come to the fibers running medially and laterally, you are looking at the supraspinatus muscle and you want to stay on top of that muscle. Strip as much trapezius as necessary to obtain adequate visualization.
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