Percutaneous arthroscopic release of the suprascapular nerve

Suprascapular nerve release is often performed for entrapment syndromes and to release pressure on the nerve associated with arthroscopic rotator cuff repair. Previous descriptions use basket forceps or scissors through a separate portal. This report describes an arthroscopic technique inserting a 14-gauge needle percutaneously in the superior suprascapular area while viewing through a standard posterior portal. A shaver through the lateral portal clears the acromion and distal clavicle of soft tissue and exposes the coracoclavicular ligaments. The medial border of the coracoclavicular ligaments (conoid ligament) is identified and then followed inferiorly to its coracoid attachment. The shaver removes the adipose tissue for better visualization and depresses and retracts the supraspinatus muscle. The transverse scapular ligament is located with the suprascapular artery coursing across its superior surface. A 14-gauge beveled needle is inserted in the "soft spot" medial to the junction of the scapular spine and clavicle. This insertion site is located approximately 7 cm medial to the lateral border of the acromion. The transverse scapular ligament is horizontal at this location and can be divided with the needle tip via an anterior-posterior sweeping motion, avoiding the suprascapular artery and decompressing the suprascapular nerve.