Posterior Shoulder Pain and Arthroscopic Decompression of the Suprascapular Nerve at the Transverse Scapular Ligament

The etiology of posterior shoulder pain can be elusive for the treating physician. Compression of the suprascapular nerve at either the transverse scapular ligament or the spinoglenoid ligament can lead to resultant posterior shoulder pain, muscle weakness, and permanent muscle atrophy. Compression at the transverse scapular ligament, the more common finding than realized in the past in patients, can often result in weakness and atrophy of both the supraspinatus and infraspinatus muscles as compression occurs at the suprascapular notch prior to the nerve giving off motor branches to each of these muscles. Patients with this pathology often have a long-standing disease course of missed diagnoses and even wrong surgical procedures. This paper will discuss the anatomy, pathophysiology, and presentation of symptoms in patients. A thorough discussion of the physical examination as well as appropriate adjunct diagnostic procedures will follow to aid the clinician in making a correct diagnosis with detailed recommendations for appropriate arthroscopic decompression allowing the athlete and patient to return to activities of daily living with a short recuperation period.