Variation in Morphology of the Suprascapular Nerve and Vessels at the Suprascapular Notch: Clinical Implications for Suprascapular Nerve Release

Purpose This study aimed to classify variation in morphology of the suprascapular nerve (SSN), suprascapular artery (SSA), and suprascapular vein (SSV) in relation to the superior transverse scapular ligament (STSL) at the suprascapular notch (SN) to evaluate the risk of vascular injury during SSN release. Methods Dissections were performed on 104 shoulders to analyze the morphology of the SSN, SSA, and SSV at the SN. The superior transverse scapular ligament (STSL) was evaluated for dimensions, ossification, and impact on SN morphology Configurations of the nerve and vessels were categorized, and vascular injury risk was stratified as low, moderate, or high. Results The SSN passed beneath the STSL in 99% of shoulders, while the SSA and SSV configurations varied. Low vascular injury risk was identified in 82% of shoulders, moderate risk in 10.6%, and high risk in 7.4%, with female cadavers demonstrating higher risk anatomy (13.3%) compared to males (2.0%). Ossified STSLs were significantly associated with smaller SN dimensions, including reduced height and width (p < 0.001). Conclusion Anatomical variations at the SN play a critical role in determining the risk of vascular injury during SSN release. Surgeons should consider these morphological differences, particularly in cases involving ossified STSLs or higher-risk configurations, to optimize surgical planning. This study underscores the importance of precise anatomical knowledge for minimizing complications in suprascapular procedures at the SN.