Philippe Collin1, Tom Treseder2, Alexandre Lädermann3, Tewfik Benkalfate4, Reda Mourtada5, Olivier Courage6, Luc Favard7. 1. Saint-Grégoire Private Hospital Center, Saint-Grégoire, France. Electronic address: collin.ph@wanadoo.fr. 2. Royal Melbourne Hospital, Parkville, Melbourne, VIC, Australia. 3. Division of Orthopaedics and Trauma Surgery, Department of Surgery, Geneva University Hospitals, Geneva, Switzerland; Faculty of Medicine, University of Geneva, Geneva, Switzerland; Division of Orthopaedics and Trauma Surgery, La Tour Hospital, Meyrin, Switzerland. 4. Clinique mutualiste la Sagesse, Rennes, France. 5. Clinique Saint Laurent, Rennes, France. 6. Hôpital privé de l'Estuaire, Le Havre, France. 7. Hôpital Trousseau, Chambray-lès-Tours, France.
Abstract
BACKGROUND: An association between massive rotator cuff tear (RCT) and suprascapular nerve neuropathy has previously been suggested. The anatomic course of the suprascapular nerve is relatively fixed along its passage. Thus, injury to the nerve by trauma, compression, and iatrogenic reasons is well documented. However, the association between retraction of the RCT and development of neuropathy of the suprascapular nerve remains unclear. We aimed to prospectively evaluate the suprascapular nerve for preoperative neurodiagnostic abnormalities in shoulders with massive RCT. METHODS AND MATERIALS: A prospective study was performed in 2 centers. Fifty patients with retracted tears of both supraspinatus and infraspinatus were evaluated. This was confirmed with preoperative computed tomography arthrography, and the fatty infiltration of the affected muscles was graded. Forty-nine preoperative electromyograms were performed in a standardized fashion and the results analyzed twice. RESULTS: Of 49 shoulders, 6 (12%) had neurologic lesions noted on electromyography: 1 suprascapular nerve neuropathy, 1 radicular lesion of the C5 root, 1 affected electromyogram in the context of a previous stroke, and 3 cases of partial axillary nerve palsy with a history of shoulder dislocation. No difference or diminution of the latency or amplitude of the electromyographic curve was found in the cases that presented significant fatty infiltration. CONCLUSION: This study did not detect a suprascapular lesion in the majority of cases of massive RCT. With a low association of neuropathy with massive RCT, we find no evidence to support the routine practice of suprascapular nerve release when RCT repair is performed.
BACKGROUND: An association between massive rotator cuff tear (RCT) and suprascapular nerve neuropathy has previously been suggested. The anatomic course of the suprascapular nerve is relatively fixed along its passage. Thus, injury to the nerve by trauma, compression, and iatrogenic reasons is well documented. However, the association between retraction of the RCT and development of neuropathy of the suprascapular nerve remains unclear. We aimed to prospectively evaluate the suprascapular nerve for preoperative neurodiagnostic abnormalities in shoulders with massive RCT. METHODS AND MATERIALS: A prospective study was performed in 2 centers. Fifty patients with retracted tears of both supraspinatus and infraspinatus were evaluated. This was confirmed with preoperative computed tomography arthrography, and the fatty infiltration of the affected muscles was graded. Forty-nine preoperative electromyograms were performed in a standardized fashion and the results analyzed twice. RESULTS: Of 49 shoulders, 6 (12%) had neurologic lesions noted on electromyography: 1 suprascapular nerve neuropathy, 1 radicular lesion of the C5 root, 1 affected electromyogram in the context of a previous stroke, and 3 cases of partial axillary nerve palsy with a history of shoulder dislocation. No difference or diminution of the latency or amplitude of the electromyographic curve was found in the cases that presented significant fatty infiltration. CONCLUSION: This study did not detect a suprascapular lesion in the majority of cases of massive RCT. With a low association of neuropathy with massive RCT, we find no evidence to support the routine practice of suprascapular nerve release when RCT repair is performed.
Authors: Benjamin B Rothrauff; Thierry Pauyo; Richard E Debski; Mark W Rodosky; Rocky S Tuan; Volker Musahl Journal: Tissue Eng Part B Rev Date: 2017-02-09 Impact factor: 6.389
Authors: Alexandre Lädermann; Stephen S Burkhart; Pierre Hoffmeyer; Lionel Neyton; Philippe Collin; Evan Yates; Patrick J Denard Journal: EFORT Open Rev Date: 2017-03-13