ARTHROSCOPIC ROTATOR CUFF REPAIR with Checkpoint

Intraoperative assessment of nerve function can be helpful during some shoulder arthroscopy procedures. In this case of a massive rotator cuff tear and super scapular neuropathy, the checkpoint is being used to confirm the anatomy, assess the function of the suprascapularnerve and the rotator cuff muscles and to identify the brachial plexus. The checkpoint is variously used at the 2 milliamp setting width near maximum pulse with, which is adjusted with the slider switch, or the 20 milliamp setting with a lower pulse width.

Here, the pectoralis minor muscle is seen on the right and the lateral cord of the brachial plexus is stimulated. The external view shows subtle but definite elbow flexion as a result of contraction of the biceps and brachialis muscles.

Next, the suprascapular nerve is stimulated at the transverse scapular notch prior to decompression by dividing the transverse scapular ligament. Stimulation also produces a good contraction of the rotator cuff muscles indicating that repair should be performed since the patient has functional rotator cuff muscles.

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Education

Tags:

• suprascapular nerve
• transverse scapular notch
• rotator cuff muscles
• shoulder arthroscopy
• Checkpoint
• brachial plexus
• nerve function