Thank you, sir. Thank you for the opportunity to present our work on the two distinct presentations and outcomes of decompression for suprascapular neuropathy. Green button is go, yeah? Thank you. We have no relevant disclosures. Green button is there. Yes, in slides. Green, great. Doesn't seem to be working. Suprascapular neuropathy is a rare and potentially underappreciated pathology in part because of a challenging diagnosis. It lacks a reliable examination maneuver and existing data on EMG demonstrates limited diagnostic capability. Next slide, please. It's recognized to stem from nerve compression or tension at the suprascapular notch causing posterior superior shoulder pain or weakness and has had some recently increased recognition. However, it does remain a nebulous diagnosis without consistent identified patterns of clinical symptoms or methods for diagnostic evaluation. Next slide. While suprascapular neuropathy can occur secondary to rotator cuff tear or space-occupying lesion, this series focused on patients with neither. Next slide. Next slide, please. Our goal is to review the outcomes of arthroscopic suprascapular nerve decompression at the suprascapular notch in a predominantly young and active military population. Next slide. We retrospectively reviewed two surgeons' databases for all surgically treated suprascapular neuropathy from 2013 to 2021 and collected all patient demographics and outcome data from the EMR. Next slide. We identified 25 patients with a mean age of 27 of which 68% were male. Just over half the cases involved the dominant shoulder. There were 13 athletes of which 12 played overhead sports and 6 at a Division I level. Next slide. The mean mark shoulder activity score was 80th percentile at 14.8. Median preoperative symptom duration was 12 months and was longer in patients presenting with pain. And our median follow-up was nearly 6 years. Next slide. Primary finding of the study was a clear division in patient chief complaint which was nearly equally distributed between predominantly pain and predominantly weakness. Regardless of chief complaint, each patient received a thorough evaluation with potential for physical exam, MRI, EMG, and diagnostic injection. And the reliability of these diagnostic tests aligned with these divergent patient presentation patterns. Next slide. Due to a lack of reliable exam maneuvers, our primary diagnostic methods differed based on patient presentation. MRI was obtained in all patients and was notable for supra or infraspinatus atrophy or edema in 11 of 12 patients in the weakness cohort, while it was not present in any patients in the pain cohort. Next slide. The second diagnostic tool in the setting of weakness was EMG, in which 9 of 10 patients had denervation changes specific to the suprascapular nerve. When EMG was obtained in 5 patients with pain, all were normal. Next slide. In the pain cohort, ultrasound-guided suprascapular nerve injection was utilized as a diagnostic modality and provided a period of greater than 90 percent symptom relief. Next slide. When looking at the combined outcomes of all patients, both motor grade and patient reported measures significantly improved after decompression. Next slide. Next slide. In the predominantly pain group, there was no change in pre- to post-op strength, while VAS pain scores significantly dropped. Two clicks here. Next slide. And when looking specifically at the weakness cohort, there was no significant change in pain, but there was significant improvement in shoulder strength post-operatively. Another couple clicks. Next slide. Time to plateau in motor grade occurred at 11 weeks for abduction and 16 for external rotation. Strength in abduction more reliably returned to near normal, while external rotation tended to have some persistent weakness. Next slide. Return to full military duty occurred in 88 percent of service members at a mean of 15 weeks, while two non-military patients successfully returned to play. Next slide. In conclusion, we found in this series of patients that suprascapular neuropathy presented as either pain or weakness in nearly equal proportions. This is relevant to the diagnostic process as we would expect that those with pain would respond to suprascapular nerve injection, while those with weakness are likely to have EMG denervation changes. In contrary to previous reports of limited EMG utility, we found that when applied to patients with weakness, it did have excellent utility in our series. Next slide. As for outcomes, we found significant improvements in pain and shoulder strength in the respective presentation groups with a high rate of return to military duty. Next slide. Next slide, please. Limitations of this study are its small size and reflection of the outcomes of two surgeons, retrospective design, and relatively homogenous cohort. Next slide. And in summary, in our clinical series, we found equal distribution presentation types of pain and weakness for suprascapular neuropathy. For diagnosis, EMG is useful for those with weakness and injection for those with pain. And good to excellent outcomes were obtained for both groups. Next slide. Thank you.

decompression

suprascapular neuropathy

shoulder pain

nerve compression

arthroscopic suprascapular nerve decompression