Summary

Patient-reported outcomes and rates of return to sport are favorable after SSN decompression, with higher rates of return to sport and military duty than previously noted.

Abstract

Background

Suprascapular nerve (SSN) decompression has emerged as a controversial procedure. Momaya et al. published the first systematic review of SSN decompression in 2018 noting satisfactory outcomes with low rates of complications; however, numerous studies published since have contributed to existing contention regarding the procedure.

Purpose

The purpose of this study is to provide an updated assessment of outcomes after SSN decompression.

Methods

PubMed (MEDLINE) and Cochrane Library databases were searched for studies published prior to December 30th, 2021. Studies were eligible for inclusion if they reported outcomes following SSN decompression at either the suprascapular notch or spinoglenoid notch. Outcomes including patient-reported clinical outcomes, objective strength testing, return to sport, pre- and postoperative electrodiagnostic testing, and Goutallier classification distribution were collected and pooled for assessment.

Results

In total, 730 patients from 33 studies were eligible for inclusion. Most (89%) patients underwent arthroscopic rather than open SSN decompression. One prospective randomized trial reported early termination due to electromyographic complications caused by SSN in the setting of no observed clinical benefit. Preoperative electrodiagnostic testing was conducted in 25/33 studies (678 patients) and postoperative electrodiagnostic testing in 13/33 studies (361 patients).

Visual Analog Scale (VAS) pain scores, American Shoulder Elbow Surgeon (ASES) Standardized Shoulder Assessment scores, UCLA shoulder scores, Constant scores and Subjective Shoulder Value (SSV) scores improved significantly postoperatively (6.4 to 2.0; 46 to 69; 16 to 31; 53 to 79; 44 to 81, respectively) while disabilities of the arm, shoulder, and hand (DASH) scores did not change significantly (43 to 11). There was no statistical difference in scores between studies.

In total, 98% of patients returned to sport or military duty (n=90/92) and 96% returned to sport or military duty at their previous level of activity (n=48/50) with significantly different rates between studies. Volleyball was the most frequently implicated specified sport (n=52) followed by weightlifting (n=9). In more broadly assessing function in terms of return to activities and work as well as sports and military duty, 94% of patients were able to return to activity (n=123/131) with significantly different rates between studies.

Adverse events associated with SSN decompression or related surgeries were identified in 11% of patients (n=64/576). Continued symptoms were noted in 12% of patients (n=39/322) with three notable EMG-related symptomatic complications influencing cessation of the prospective randomized trial assessing SSN decompression. Rates of continued symptoms varied significantly between studies. A minority of patients underwent reoperation (3.3%, n=15/455) with significant differences in reoperation rates noted between studies.

Conclusion

Patient-reported outcomes and rates of return to sport are favorable after SSN decompression, with higher rates of return to sport and military duty than previously noted. Interestingly, rates of return to sport and military duty were higher than rates of return to activity overall, which may reflect superior outcomes among patients with high levels of activity preoperatively. However, rates of complications and persistent symptoms appear to be higher than previously reported. The heterogeneity of continued symptoms and reoperation rates observed between studies further demonstrates inconsistency in these outcomes that warrants further investigation.