Suprascapular neuropathy can have multiple potential etiologies, though it is typically secondary to traction or compression. It has usually been considered to be a rare cause of shoulder pain and dysfunction, and it was viewed as a diagnosis of exclusion. However, reports have emerged that have demonstrated a predilection for this condition in athletes who engage in high-level overhead activity and in those with a retracted posterior or superior rotator cuff tear, because traction can be applied to the nerve around the suprascapular notch or base of the scapular spine when the rotator cuff tendon moves medially. Vad et al. observed an 8% incidence of suprascapular neuropathy in 25 patients with a massive rotator cuff tear and associated atrophy, whereas Mallon et al. found that 8 patients with a tear >5 cm developed fatty infiltration. Costouros reported that 7 of 26 (38%) patients with a massive rotator cuff tear had an isolated suprascapular nerve injury. Interestingly, all of their patients in whom the rotator cuff was either partially or completely arthroscopically repaired demonstrated partial or full recovery of the nerve palsy, and this correlated with reduced pain and improved function. This was further explored in a proof-of-concept report by the same group. On the basis of this reported experience, some surgeons routinely release the nerve while performing an arthroscopic rotator cuff repair.

Both arthroscopic and open techniques of suprascapular nerve decompression have been reported with successful results. The main portals used as well as approaches vary depending on surgeon preference, though the primary aim is always to release the transverse scapular ligament. In the setting of nerve decompression with a concomitant rotator cuff repair, the nerve can be released prior to the repair to minimize swelling and bleeding during the repair that could make the dissection more challenging. A percentage of transverse scapular ligaments will be ossified, so a Stryker (Kalamazoo, MI) notch view or computed tomographic (CT) scan can be helpful in advance of surgery to identify these. In such cases, a small osteotome or Kerrison rongeur may be needed.