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case_images: Post-operative radiograph of right shoulder.
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case_images: Surgery was uncomplicated, and post-operative radiographs are shown in Figure 1.
case_images: Coronal CT image of right shoulder.
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case_images: Shoulder radiographs (Figure 2), were negative for any complication. At 10 months post operatively decision was made to obtain a CT scan of her right shoulder shown in Figure 2.
case_images: Operative picture - The incision for exposure of supraspinatus fossa is approximately 7 cm in length and centered just superior to the scapular spine. This longitudinal incision allows for easy elevation of the supraspinatus muscle belly and visualization of suprascapular notch, suprascapular ligament, suprascapular nerve, and prominent hardware.
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case_images: An incision was carried down along the spine of the scapula (Figure 3).
case_images: Operative picture - deep exposure of the supraspinatus fossa. The scapular spine is used as the main landmark to begin elevating the supraspinatus muscle belly, starting at the most distal, superior aspect of the scapular spine and elevating deep and towards midline. Care should be taken not to lacerate the suprascapular artery as you approach the suprascapular notch.
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case_images: The retractor was used to lift and elevate the supraspinatus muscle belly (Figure 4).
case_images: Operative picture - deep exposure of the supraspinatus fossa with visualization of prominent hardware, blue arrow. The suprascapular ligament, pink arrow, has been released for decompression of the suprascapular nerve, white arrow. The scapular spine is marked with a green arrow.
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case_images: At this point, visualization of the prominent screw was obtained (Figure 5).
case_images: Operative picture - following hardware removal with a diamond tipped burr, the hardware is now below the cortical margin of the scapula, white arrow. The nerve was able to course around the lateral aspect of the scapular spine, black arrow, without continued bowstringing over the screw.
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case_images: Once the screw was burred down and flush with the bone, palpation confirmed a decompression of the nerve (Figure 6).
case_images: Post-operative radiographs of right shoulder.
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case_images: Post-operative radiographs can be seen in Figure 7 which noted decreased prominence of the superior screw.