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Suprascapular neuropathy has become increasingly recognized entity which is often overlooked and mistaken for other causes of shoulder pain and dysfunction like rotator cuff injury, shoulder impingement syndrome, cervical spondylosis and brachial plexopathy. It can be caused by a variety of anatomic and pathologic entities as the nerve courses from the brachial plexus through the suprascapular and spinoglenoid notches to innervate the supraspinatus and infraspinatus muscles. Because of the widespread availability of high-field MRI scanners now it is possible to detect the subtle perineural pathology, thereby excluding the other common causes of shoulder pain. There are scattered case reports and reviews describing suprascapular nerve (SSN) abnormalities using MRI. This article comprehensively reviews different pathologic abnormalities involving the SSN and illustrates their MR features, clinical presentation, correlation with electrophysiologic studies and surgical findings based on a review of 24 cases. We found the different clinical entities which includes trauma and a spectrum of nontraumatic etiology such as idiopathic, mass lesions compressing the nerve, intrinsic lesion like intraneural ganglion cysts of SSN, repetitive overuse, viral neuritis and chemotherapy induced neuropathy.

A new nerve transfer option of using viable fascicle of the ipsilateral middle trunk for suprascapular nerve reconstruction is presented. The procedure was used in two patients with upper brachial plexus injury involving loss of shoulder abduction and external rotation. Clinical evaluation and nerve conduction studies in both patients confirmed axonopathy of C5, C6 roots and C5 root, respectively. The proximal root stumps were unavailable for nerve grafting due to a very proximal root level scarring. The middle trunk fascicle was dissected on its superior surface and transferred to the non-functional suprascapular nerve. After 24 months follow up full abduction and external rotation could be achieved in both the patients. It is a simple and easy option for transfer to a suprascapular nerve in upper brachial plexus injuries. It lies next only to the upper trunk and does not require any additional dissection time. Donor deficit was not observed in our two patients.

Background: In brachial plexus surgery, a key focus is restoring shoulder abduction through spinal accessory nerve (SAN) to suprascapular nerve (SSN) transfer using either the anterior or posterior approach. However, no published randomised control trials have directly compared their outcomes to date. Therefore, our study aims to assess motor outcomes for both approaches.

Methods: This study comprises two groups of patients. Group A: anterior approach (29 patients), Group B: Posterior approach (29 patients). Patients were allocated to both groups using selective randomisation with the sealed envelope technique. Functional outcome was assessed by grading the muscle power of shoulder abductors using the British Medical Research Council (MRC) scale.

Results: Five patients who were operated on by posterior approach had ossified superior transverse suprascapular ligament. In these cases, the approach was changed from posterior to anterior to avoid injury to SSN. Due to this reason, the treatment analysis was done considering the distribution as: Group A: 34, Group B: 24. The mean duration of appearance of first clinical sign of shoulder abduction was 8.16 months in Group A, whereas in Group B, it was 6.85 months, which was significantly earlier (p < 0.05). At the 18-month follow-up, both intention-to-treat analysis and as-treated analysis were performed, and there was no statistical difference in the outcome of shoulder abduction between the approaches for SAN to SSN nerve transfer.

Conclusions: Our study found no significant difference in the restoration of shoulder abduction power between both approaches; therefore, either approach can be used for patients presenting early for surgery. Since the appearance of first clinical sign of recovery is earlier in posterior approach, therefore, it can be preferred for cases presenting at a later stage. Also, the choice of approach is guided on a case to case basis depending on clavicular fractures and surgeon preference to the approach.

Level of Evidence: Level II (Therapeutic)