Collin and colleagues measured how often suprascapular nerve neuropathy shows on preoperative EMG and nerve conduction studies in shoulders with massive retracted rotator cuff tears.
Prospective two‑center series of 49 patients aged 65 or younger, enrolled January 2008 to January 2009.
Suprascapular neuropathy with massive cuff tears is rare, and routine nerve release is not required.
Key Findings
Only 1 of 49 shoulders (2%) had suprascapular neuropathy on EMG/NCS. Recordings were normal in 43 of 49.
The other 5 abnormal studies had other sources: a C5 root lesion, a prior stroke and 3 partial axillary nerve palsies after shoulder dislocation.
Shoulders with fatty infiltration above stage 2 showed no reduction in latency or amplitude. The paper reports no statistical test for this comparison.
The two blinded rereads agreed completely with the original reports in every case.
The authors suggest selection bias may explain higher cited rates. In Costouros's series (38% isolated neuropathy), every affected patient had a traumatic tear after a fall.
The authors' EMG criteria are not validated, and they contend EMG has not been validated in massive tears. They cite animal work showing tenotomy can decrease EMG activity.
Board pearl
The authors argue that only medial muscle shortening can endanger the nerve, meaning shortening medial to the suprascapular notch. This study did not test that mechanism. Citing experimental work, they note that tendon retraction makes up more of total retraction than muscle shortening.
Authors' 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.
Collin and colleagues measured how often suprascapular nerve neuropathy shows on preoperative EMG and nerve conduction studies in shoulders with massive retracted rotator cuff tears.
Prospective two‑center series of 49 patients aged 65 or younger, enrolled January 2008 to January 2009.
Suprascapular neuropathy with massive cuff tears is rare, and routine nerve release is not required.
Key Findings
Only 1 of 49 shoulders (2%) had suprascapular neuropathy on EMG/NCS. Recordings were normal in 43 of 49.
The other 5 abnormal studies had other sources: a C5 root lesion, a prior stroke and 3 partial axillary nerve palsies after shoulder dislocation.
Shoulders with fatty infiltration above stage 2 showed no reduction in latency or amplitude. The paper reports no statistical test for this comparison.
The two blinded rereads agreed completely with the original reports in every case.
The authors suggest selection bias may explain higher cited rates. In Costouros's series (38% isolated neuropathy), every affected patient had a traumatic tear after a fall.
The authors' EMG criteria are not validated, and they contend EMG has not been validated in massive tears. They cite animal work showing tenotomy can decrease EMG activity.
Board pearl
The authors argue that only medial muscle shortening can endanger the nerve, meaning shortening medial to the suprascapular notch. This study did not test that mechanism. Citing experimental work, they note that tendon retraction makes up more of total retraction than muscle shortening.
Authors' 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.