Arthroscopic suprascapular nerve decompression at the suprascapular notch

The suprascapular notch is a common location for entrapment of the suprascapular nerve. Open surgical procedures for excision of the transverse scapular ligament are associated with pain relief and functional improvement. Arthroscopic procedures have been described for decompressing ganglion cysts, which compress the nerve at the spinoglenoid notch. However, there is no description of an arthroscopic procedure for decompression of the nerve at the suprascapular notch, and this is probably related to unfamiliarity with the complex anatomy of the region. The technique described herein is based on standard anatomic landmarks and utilization of these as reference points for arthroscopic orientation and reproducibility. The acromioclavicular joint, conoid ligament, and coracoid process are stepwise reference landmarks leading to the suprascapular notch. Arthroscopic identification of structures around the notch is necessary before ligament resection. A new suprascapular portal, in combination with an accessory portal, is described for retraction, blunt dissection, nerve stimulation, and ligament resection. Key instruments include a 4-mm arthroscope of standard length (160 mm), with a 70 degree angled lens for adequate visualization and a calibrated probe to guide and limit dissection.