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Published 10/1/2010
Peter Pollack

Release the nerve, improve the outcome

Study finds better revision outcomes with subscapular nerve release

Massive, chronic rotator cuff tears can shift the position of the suprascapular nerve, potentially leaving the patient with less function after the rotator cuff is repaired. With that in mind, Mark R. Zunkiewicz, MD, and his coauthors conducted a retrospective study of patients who had undergone revision arthroscopic repair of massive rotator cuff tears with Goutallier Grade 3 atrophy (equal amounts of fat and muscle) that were retracted medial to the glenoid.

“We wanted to answer some questions about the indications for suprascapular nerve release for patients with massive rotator cuff tears,” explained Dr. Zunkiewicz at the 2010 annual meeting of the Arthroscopy Association of North America. “They just aren’t very well defined right now.”

The research team looked at 44 patients who had undergone revision arthroscopic repair of massive rotator cuff tears with either concomitant release of the suprascapular nerve (n = 22, ages 42 to 74 years, 14 male) or a similar group with no nerve release (n = 22, ages 45 to 88 years, 15 male). All of the procedures were performed by the senior attending surgeon, Felix H. Savoie III, MD.

Across the board improvement
Overall, the authors found that scores on the Modified UCLA Shoulder Rating Scale (a measure of pain, strength, function, flexion, and patient satisfaction) improved across both groups of patients, but those who underwent nerve release had significantly better outcomes. At an average follow-up of 21.89 months (range 9.9 to 32.1 months), 19 of the 22 patients in the nerve release group were satisfied and had recovered at least two grades of strength. In addition, patients in this group saw their pain scores improve an average of 4 points according to the Modified UCLA Shoulder Rating Scale.

Of the patients in the control group, 19 of 22 were satisfied with their outcomes, but only recovered an average 1.32 grades of strength. Pain scores also improved in all but one of the patients in this group.

Dr. Zunkiewicz admitted that the results of this study are preliminary and stated that more research is needed to determine indications for nerve release, which is a technically demanding procedure.

“This is a retrospective study,” he said. “Areas for future research could include a prospective trial, with electromyography and nerve conduction studies performed both pre- and postoperatively to objectively confirm the diagnosis of suprascapular neuropathy prior to surgery and the effects of release postoperatively.

“One other issue is the nonrandomized nature of this study. The preoperative decision to perform a nerve release was made by the surgeon and was not based on any predetermined criteria. In theory, there could have been a selection bias. However, I think we were able to establish that, within our patient population, patients who had the nerve release had greater functional recovery than patients who did not have a nerve release,” he said. “We plan to follow these patients to see if they continue to improve in comparison to those who did not receive the nerve release.”

In addition to Dr. Savoie, Dr. Zunkiewicz’s coauthors for “A comparison of short term functional outcomes in patients undergoing revision arthroscopic repair of massive rotator cuff tears with and without arthroscopic suprascapular nerve release” included Larry D. Field, MD, and Michael J. O’Brien, MD.

Disclosure information: Dr. Zunkiewicz—Smith & Nephew, Pfizer, Johnson & Johnson, GlaxoSmithKline, Merck, Roche, Bristol-Myers Squibb, Zimmer, Siemens, Arthrex, Mitek; Dr. Savoie—Mitek, Smith & Nephew, Cayenne Medical; Dr. Field—Arthrex, Mitek, Smith & Nephew; Dr. O’Brien—Arthrex, DePuy, Mitek, Smith & Nephew.

Peter Pollack is a staff writer for AAOS Now. He can be reached at ppollack@aaos.org