Suprascapular Nerve



C5, 6 from Upper trunk


Posterior triangle

- arises upper trunk and passes backward through posterior triangle

- under belly of omohyoid

- deep to trapezius to the suprascapular notch


Suprascapular Ganglion Coronal MRI


Runs through suprascapular notch

- under superior transverse scapular ligament

- suprascapular artery and vein run over this ligament

- supplies SS 1 cm after passing under ligament

- give articular branch to the shoulder


Suprascapular Nerve Sagittal MRI 1Suprascapular Nerve Sagittal MRI 2


Passes around lateral border spinous process / Spinoglenoid notch

- under spinoglenoid ligament

- inferior transverse scapular ligament

- supplies IS



-  supplies supraspinatus & infraspinatus




- CA and CH ligaments


Sites of Compression / Injury


Suprascapular notch

- weakness wasting SS & IS



- trauma most common / driect blow / clavicle or scapula fracture

- iatrogenic / excessive rotator cuff release

- athletes / repetitive overhead motion


Spinoglenoid notch

- weakness wasting IS



- spinoglenoid cyst associated with superior labral tear / horizontal cleavage / acts as one way valve

- posterior approach to shoulder - > 1 cm medial to glenoid neck

- posterior shoulder OA causing a cyst




Pain at back of shoulder







Atrophy SS/IS


Atrophy of IS alone




Rotator Cuff tear




1.  Spinoglenoid cyst / labral tear

- may be better seen with MRA


Spinoglenoid cyst Coronal MRISpinoglenoid Cyst Sagittal MRISpinoglenoid Cyst MRI Axial


2.  Atrophy of SS / IS


Spinoglenoid Cyst Infraspinatous Fatty Atrophy


3.  Exclude cuff tear




Demonstrate denervation SS/IS or IS alone




Inject SS nerve at suprascapular notch




Non Operative


Reasonable if no ganglion cyst

- a neuropraxia which usually resolves

- avoid overhead activities if possible

- 6 - 9 months




Spinoglenoid Cyst


1.  Secondary to superior labral tear


Majority of cases


A.  Cyst Decompression + Arthroscopic labral repair



- identify horizontal cleavage tear

- decompress throught tear

- repair labrum


Posterior Labral Tear Cyst 1Posterior Labral Tear Cyst 2Posterior Labral Tear Cyst 3


Posterior Labral Tear 1Posterior Labral Repair 2Posterior Labral Tear 3


Piatt et al J Should Elbow Surg 2002

- excellent results


B.  Arthroscopic Labral Repair without cyst decompression


Schroder et al JBJS Am 2008

- 42 patients

- posterior labral repair without cyst decompression

- cyst resolved in 88% on MRI and smaller in remainder

- all patients satisfied with outcome


2.  Spinoglenoid Cyst without labral tear


Options to decompress cyst

- ultrasound drainage / not always effective but may be worth a try intially

- posterior approach

- arthroscopic glenohumeral approach / posterior capsulotomy

- subacromial approach / between supraspinatous and infraspinatous




Werner et al Arthroscopy 2007

- posterior capsulotomy above IGHL with decompression of cyst with shaver


Posterior Shoulder Capsulotomy to decompress cyst


Ghodadra et al Arthroscopy 2009

- subacromial space

- identify spine of scapula

- dissect between infraspinatous and supraspinatous

- accessory posterior portal, retract IS and nerve

- decompress with shaver


Shoulder Subacromial Space Spinous ProcessSubacromial Spinous Process 1


Suprascapular Notch Impingement


Decompression / Division of Suprascapular ligament 



- weakness atrophy of SS and IS without cuff tear

- massive irreparable cuff tear with intractable pain



- open

- arthroscopic




Lafosse et al Arthroscopy 2007

- 10 patients with clinical and EMG evidence of suprascapular nerve compression

- no complications

- good clinical outcome in all patients


Open Technique

- incision along spine of scapular

- sharply elevate trapezius off spine off scapula

- SS reflected inferiorly to expose notch

- preserve superior NV bundle

- suprascapular artery lies above ligament, (branch of Subclavian Artery)

- divide ligament


Arthroscopic Technique


Standard posterior portal

- subacromial portal to debride cuff and identify base of coracoid as landmark

- find coracoid by following CAL to it

- feel hard bony prominence


Anterolateral working portal

- need to be able to work lateral to medial along anterior aspect of humeral head



- clear space medial to coracoid along subscapularis

- identify the conoid ligament attaching to the base of the coronoid

- medial to this is fatty area with THL


SSN Release CoracoidSSN Release Coracoid and CHL


Suprascapular portal / accessory Nevasier

- 7cm from posterior edge of acromion

- insert blunt instruments posteriorly from suprascapular portal

- pass under clavicle

- elevates supraspinous muscle

- use blunt trochar to dissect area



- will usually see the artery passing over the top of the THL 

- be careful as this runs from subclavian

- can get torrential bleeding


Conoid Ligament  SSA over THLSuprascapular artery and transverse scapula ligament


Identify transverse ligament

- identify SSN passing under

- divide TSL with scissors from posterior ACJ portal

- whilst retracting SS artery with probe from SSN portal


SSN release Divided THLSSN Release Divided TSL