NERVE DECOMPRESSION SURGERY

The Goal

Dr. Kevin Wall provides specialized, fellowship-trained surgical treatment for Peripheral Nerve Entrapment around the shoulder in Richmond, VA, and the surrounding Central Virginia communities. Nerves are the electrical wiring of the upper extremity. When they become compressed by tight ligaments, cysts, or scar tissue, the result is severe pain and muscle weakness that often mimics a rotator cuff tear or other problems around the shoulder. The goal of decompression surgery is to physically release the pressure on the nerve, restoring its blood flow and allowing the muscle to "wake up" and recover function. Unlike tendon repairs that require long healing times, nerve decompressions often allow for a rapid return to motion.

This page is designed to educate you specifically about this procedure. Additional information that generally applies to most of Dr. Wall’s surgeries can be found on these pages:

• Pre-Operative Instructions

• Post-Operative Instructions

• Physical Therapy Protocols

The Procedures

Dr. Wall utilizes advanced arthroscopic and open techniques to address the specific site of compression.

Arthroscopic Suprascapular Nerve Decompression

• The Indication: Suprascapular neuropathy caused by entrapment at the suprascapular notch (by the transverse ligament) or the spinoglenoid notch (often by a paralabral cyst).

• The Technique: Performed entirely arthroscopically. Dr. Wall identifies the nerve and carefully cuts the tight transverse scapular ligament to "un-roof" the tunnel.

• Cyst Decompression: If a cyst (caused by a labral tear) is compressing the nerve, Dr. Wall drains the cyst and repairs the associated labral tear to prevent recurrence.

Arthroscopic Pectoralis Minor Release (for Brachial Plexus)

• The Indication: For patients with Functional STAM 1 or Neurogenic Thoracic Outlet Syndrome (TOS) where a tight pectoralis minor tendon compresses the brachial plexus against the chest wall.

• The Technique: A minimally invasive release of the pectoralis minor tendon from the coracoid process. This immediately relieves the "tether" on the scapula, freeing up the nerves and allowing the scapula to return to a normal position. There is rarely any functional consequence of releasing the pectoralis minor.

Axillary Nerve Decompression (Quadrilateral Space Release)

• The Indication: Quadrilateral Space Syndrome, often seen in overhead athletes or after trauma, where fibrous bands constrict the nerve supplying the deltoid.

• The Technique: Depending on the location of the scarring, this is performed either arthroscopically or through a small open incision in the armpit. The fibrous bands are released to free the nerve.

Long Thoracic Neurolysis

• The Indication: Rare cases where the nerve is intact but tethered by scar tissue from a previous surgery or injury, preventing the serratus anterior from firing or causing pain on the side of the chest wall.

• The Technique: A meticulous endoscopic release of scar tissue from around the nerve to restore signal conduction.

Dorsal Scapular Nerve Release

• The Indication: Chronic dorsal scapular nerve entrapment causing deep, aching pain straight down along the medial scapular border (often misdiagnosed as a “knot in the back”). This is typically caused by compression from fibrous bands next to the scapula. Because of how closely the dorsal scapular nerve travels with the scapula, when there is scapulothoracic abnormal motion, this nerve can very easily become irritated and symptomatic.

• The Technique: Dr. Wall performs an endoscopic, minimally invasive nerve release through small incisions on the back next to the scapula. The nerve is identified as it courses through this space, and the tight fibrous bands or small blood vessels compressing the nerve are released.

Post-Op Protocol

Recovery from isolated nerve decompression is faster than structural repairs because the only thing that really needs to heal is the skin.

• Immobilization (Phase 1):

  • Isolated Decompression: A sling is used for comfort only for 1–3 days. You are encouraged to move the arm immediately to prevent new scar tissue from forming around the nerve.

  • With Labral Repair: If a cyst was treated by repairing the labrum, you will remain in a sling for 4–6 weeks to protect the labral repair.

• Physical Therapy:

  • Begins within Week 1 for isolated releases.

  • Focuses on "nerve gliding" exercises and progressive strengthening of the re-innervated muscles.

• Recovery Timeline: Pain relief is often immediate. Muscle strength recovery is gradual and depends on how long the nerve was compressed; nerves typically recover slowly.

When to Seek Care

You should schedule a consultation if:

• You have deep, aching shoulder pain and weakness that has not improved with standard physical therapy or injections

• Your doctor ordered a shoulder MRI and it was normal but you’re still in pain.

• You have visible muscle wasting (atrophy) on the top or back of your shoulder blade.

• An EMG/NCS study has confirmed "denervation" or "slowing" of a specific nerve.

• You have a cyst visible on an MRI in the spinoglenoid or suprascapular notch.