The association of suprascapular neuropathy with massive rotator cuff tears: A preliminary report

doi:10.1016/j.jse.2005.10.019

Journal of Shoulder and Elbow Surgery

Volume 15, Issue 4, July–August 2006, Pages 395-398

https://doi.org/10.1016/j.jse.2005.10.019 Get rights and content

We studied a prospective, consecutive series of 8 patients presenting with massive rotator cuff tears (>5 cm. in maximum dimension), all associated with severe retraction and fatty infiltration of the supraspinatus muscle on magnetic resonance imaging studies. All 8 patients had suprascapular neuropathy shown by electromyography (EMG) findings of denervation in the supraspinatus and/or infraspinatus muscles. Clinically, all patients had severe limitation of active motion, with no patient able to elevate their affected arm actively >40°. Four patients elected débridement and partial surgical repair using margin convergence principles via a mini-open approach. Follow-up of these patients averaged 24 months. All 4 patients regained the ability to elevate their affected arm to >90°, and to place their hand actively behind their head without assistance. Two of the 4 surgical patients consented to follow-up EMG studies that demonstrated, in both cases, that the suprascapular nerve had significant renervation potentials, with almost complete recovery of the nerve in 1 case. We conclude that suprascapular neuropathy may be associated with massive rotator cuff tears, and that partial rotator cuff repair may allow recovery of the nerve and improvement of function.

Section snippets

Materials and methods

The cohort consists of a prospective, consecutive series of 8 patients presenting with massive rotator cuff tears (defined as >5 cm. in maximum dimension), as documented by severe retraction and fatty infiltration of the supraspinatus muscle on magnetic resonance imaging (MRI) studies. The average age was 68 (51-79). Clinically, all patients had severe limitation of active motion, with no patient able to elevate their affected arm actively >40°. Motor strength of elevation, in any plane, was

Results

Of the 4 patients who elected not to treat their rotator cuff tears surgically, their clinical status had not changed at their last follow-up. Four patients underwent surgery as described above. The 4 rotator cuff tears had a maximum dimension of >5 cm, with retraction to or beyond the glenoid rim. In no case could complete closure be performed. The defect remaining had a minimum dimension of 2 cm or greater in all 4 cases. The partial repair was performed via a mini-open approach and a deltoid

Discussion

The initial patient presented with significant rotator cuff deficiency on clinical exam. He was referred to one author (W.J.M.) by a qualified physiatrist after EMGs showed a suprascapular neuropathy. An MRI had been performed, but the initial reading (done at an outside hospital) was that no rotator cuff tear was present. Reading by the author, and a further evaluation by our radiologists, confirmed that, in fact, a very large rotator cuff tear was present on the MRI. This patient underwent

Summary

We have studied 8 patients with a known massive rotator cuff tear and found that a suprascapular neuropathy occurred concurrently in these patients. In the patients who underwent surgical partial repair, functional recovery of active elevation occurred in 4 of 4 patients. Two patients underwent repeat EMG studies that showed recovery or renervation of the suprascapular nerve.

We postulate that suprascapular neuropathy can occur in association with massive rotator cuff tears, and that it can

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Cited by (173)

Top 50 most impactful publications on massive rotator cuff tears
2024, JSES Reviews, Reports, and Techniques
Bibliometric analysis is a useful tool for measuring the scholarly impact of a topic and its more and less heavily studied aspects. The purpose of this study is to use bibliometric analysis to comprehensively analyze the 50 articles with the highest citation indices in studies evaluating the treatment and outcomes of massive rotator cuff tears (mRCTs).
This cross-sectional study identified articles within the Scopus database published through December 2022. Keywords used were “massive rotator cuff tear.” Articles were sorted in chronological order. The year published and number of citations were recorded. A citation index (CI) was calculated for each article by dividing the number of citations by number of years published [1 citation/1 year published (2021) = CI of 1]. Of these, the 50 articles with the highest CIs were carried forward for evaluation. Frequencies and distributions were assessed for data of each variable collected.
These search methods produced 625 articles regarding mRCT research (ranging from January 1986 to December 2022). Four of the top 10 most impactful articles were published in the 2010s. The level of evidence (LOE) published with the greatest frequency was level of evidence 4 (41%). The journal Arthroscopy published the highest number within the top 50 (26%) followed by the Journal of Bone and Joint Surgery and the American Journal of Sports Medicine (20% each). Clinical studies composed 88% of the top 50. Case series (38%) predominated, while systematic reviews (20%) and randomized control trials (8%) were less prevalent. The majority of studies concentrated on the clinical outcomes of certain interventions (62%), mainly comparing multiple interventions.
Despite the relatively high prevalence of mRCTs (40% of all tears), this topic comprises only a small proportion of all rotator cuff research. This analysis has identified gaps within and limitations of the findings concerning mRCTs for researchers to propose research questions targeting understudied topics and influence the future treatment and outcomes of this clinically difficult diagnosis.
Suprascapular nerve injury after reverse total shoulder arthroplasty: correlation with screw out of vault penetration and functional situation: prospective study
2023, Journal of Shoulder and Elbow Surgery
Baseplate screws have been suggested as a possible cause of suprascapular neuropathy after reverse total shoulder arthroplasty. This study aims to investigate the association between screw penetration out of the vault, electromyographic study, and the clinical outcomes.
A total of 31 patients who underwent reverse total shoulder arthroplasty for cuff tear arthropathy were prospectively enrolled. They were followed up for a minimum of 24 months. All patients underwent computed tomography 6 months postoperatively to determine the extraosseous position of the screws (perforation of the second bone cortex and protrusion into the supra- or infraspinatus fossa). Electrodiagnostic evaluation was performed preoperatively and postoperatively to stablish any relation between cortex perforation of the screw and suprascapular nerve (SSN) injury. Clinical outcomes pre- and postoperatively (Constant score, ranges of motion, and visual analog scale) of patients with and without documented injury were recorded.
A total of 14 patients (45.2%) had an abnormal preoperative SSN electrodiagnostic study (chronic or disuse injuries), and 6 patients (19.4%) had an abnormal postoperative study (acute injury). Of the 6 patients, 2 cases appeared over the pre-existing lesion and 4 appeared over an intact preoperative nerve, all of them affecting the infraspinatus branch of the SSN. Perforation of the second cortex was detected for 60% of superior screws and 40% of posterior screws. The mean lengths of the superior and posterior screws were 30 and 18.2 mm, respectively. Patients with screw perforation of the second cortex were assessed as having a high risk of nerve injury (40% vs. 9.5%).
Preoperative SSN injuries do not have a significant clinical impact and do not predispose to an acute postoperative SSN lesion. The Constant score and visual analog scale score for patients with acute SSN injuries were not statistically different from those without SSN injury. The extraosseous position of the screw increases the probability of an SSN injury to 31%. This risk is higher with the posterior screw, which leads us to question whether it is really necessary to use it.
Correlation of suprascapular notch morphology with suprascapular nerve palsy: a 3D-computed tomography study
2023, JSES International
The morphology of the suprascapular (SS) notch is a very important factor in treatment of suprascapular nerve (SSN) palsy. Several studies have reported SS notch morphology in cadavers or using a three-dimensional computed tomography (3D-CT); however, none has reported the distribution of SS notch morphology according to the age group. In addition, the correlation between SS notch morphology and SSN palsy remains unclear. The purposes of this study were to investigate the morphological distribution of the SS notch by age group in a large population and to assess the relationship between SS notch morphology and SSN palsy.
We studied the 3D-CT images of 1063 shoulders in 1009 patients (mean age, 60.8 years; age range, 14-96 years). There were 53 shoulders with SSN palsy and 1010 shoulders without SSN palsy. Morphology of the SS notch was classified by Rengachary’s classification (types I-VI). Shoulders with types I-IV were classified into the nonossified superior transverse scapular ligament (STSL) group (group N) and those with types V and VI into the ossified STSL group (group O).
The Rengachary’s classifications of the 1063 shoulders were as follows: type I: n = 113, 10.6%; type II: n = 313, 29.4%; type III: n = 383, 36.0%; type IV: n = 109, 10.3%; type V: n = 107, 10.0%; and type VI: n = 38, 3.6%. Mean age was significantly older in the ossified STSL group, and the age was <40 years for only two shoulders in this group. The Rengachary’s classifications of the SSN palsy cases were as follows: type I: 7.5%, II: 24.5%, III: 34.0%, IV: 15.1%, V: 13.2%, and VI: 5.7%. There was no statistical difference in age and sex, Rengachary type, or ossification between SSN palsy and non-SSN palsy cases.
Ossification of the STSL was significantly more common in older patients, which suggests age-related change. In addition, no relation was identified between narrow notch or ossification of the STSL with the onset of SSN palsy.
Massive Rotator Cuff Tears: Tips and Tricks for Surgical Management
2023, Operative Techniques in Sports Medicine
Massive rotator cuff tears provide a significant challenge to the orthopedic surgeon. A complete and anatomical tendon restoration without significant tension is the goal of treatment, but oftentimes the chronicity of the presentation makes it difficult. The treating surgeon must approach these cases in a methodical and organized manner. Visualization and recognition of the tear pattern, followed by appropriate soft tissue releases, and finally thoughtful suture management are the keys to optimizing surgical success and ultimately clinical outcomes. When the tendon cannot be anatomically restored to the native footprint, alternative options can be used with varying success. These alternatives include medialization of the footprint, partial repair, margin convergence, and patch augmentation, among others. We will provide some tips and tricks which we have found most useful to successfully complete these often-difficult cases. For tears that cannot be repaired or if a repair would be contraindicated or ill-advised, other options such as superior capsular reconstruction, tendon transfers, and reverse total shoulder arthroplasty are considerations that are beyond the scope of this manuscript.
Superior Capsular Reconstruction for Irreparable Rotator Cuff Tear
2023, Clinics in Sports Medicine
Patients with Dual Shoulder–Spine Disease: Does Operative Order Affect Clinical Outcomes?
2022, World Neurosurgery
1) To analyze the effect of operative sequence (anterior cervical discectomy and fusion [ACDF] first or rotator cuff repair [RCR] first) on surgical outcomes after both procedures for patients with dual shoulder–spine injuries and 2) to determine how operative sequence affects patient-reported outcome measures (PROMs) after surgery.
Patients >18 years of age who underwent primary ACDF and primary RCR at our institution were retrospectively identified. Only patients with overlapping symptoms before the first procedure were included. Patients were divided into 2 cohorts (ACDF first or RCR first). Patient demographics, surgical characteristics, surgical outcomes, and PROMs were compared between groups. Multivariate linear regression models were developed to determine if operative order was predictive of improvements in PROM scores at the 1-year postoperative point after the second procedure. Alpha was set at P < 0.05.
Of the 85 patients included, 44 patients (51.8%) underwent ACDF first, whereas 41 patients (48.2%) underwent RCR first. There were no significant differences in the rate of 90-day readmission, spine reoperations, and rotator cuff reoperations between groups (all, P > 0.05). Multivariate linear regression showed that undergoing an ACDF first was not a significant predictor of Δ Mental Component Score of the Short-Form 12 (β = –2.78; P = 0.626) and Δ Physical Component Score of the Short-Form 12 (β = 7.74; P = 0.077) at the 1-year postoperative point after the second procedure.
For patients with dual shoulder–spine injuries who are appropriate surgical candidates, undergoing ACDF first compared with RCR first does not result in significant differences in clinical surgical or patient-reported outcomes.

View all citing articles on Scopus

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Original articleThe association of suprascapular neuropathy with massive rotator cuff tears: A preliminary report

Section snippets

Materials and methods

Results

Discussion

Summary

J Shoulder Elbow Surg

J Shoulder Elbow Surg

Operative repair of massive rotator cuff tearslong-term results

J Shoulder Elbow Surg

Partial repair of irreparable rotator cuff tears

Arthroscopy

A unified biomechanical rationale for the treatment of rotator cuff tearsdebridement versus repair

Subscapular muscle transposition for repair of chronic rotator cuff tears

Surg Gynecol Obstet

Repair of the rotator cuff of the shoulder

J Bone Joint Surg [Br]

Suprascapular neuropathy in the differential diagnosis of rotator cuff injuries

Sports Med

The outcome and repair integrity of completely arthroscopically repaired large and massive rotator cuff tears

J Bone Joint Surg [Am]

Deltoid muscular flap transfer for massive defects of the rotator cuff

Latissimus dorsi transfer for the treatment of irreparable tears of the rotator cuff

Clin Orthop Rel Res

The results of repair of massive tears of the rotator cuff

J Bone Joint Surg [Am]

Original article
The association of suprascapular neuropathy with massive rotator cuff tears: A preliminary report