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Wild CJ, Heinze JD, Dorf ER. Intermuscular lipoma in the supraspinatus fossa: a case report. JSES REVIEWS, REPORTS, AND TECHNIQUES 2024; 4:91-95. [PMID: 38323197 PMCID: PMC10840575 DOI: 10.1016/j.xrrt.2023.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/08/2024]
Affiliation(s)
- Carrie J. Wild
- Department of Orthopaedic Surgery, Lincoln Memorial University- DeBusk College of Osteopathic Medicine, Harrogate, TN, USA
| | - Jared D. Heinze
- Vail-Summit Orthopaedics and Neurosurgery, Vail, CO, USA
- Vail-Summit Orthopaedics and Neurosurgery, Research and Education Foundation, Vail, CO, USA
| | - Erik R. Dorf
- Vail-Summit Orthopaedics and Neurosurgery, Vail, CO, USA
- Vail-Summit Orthopaedics and Neurosurgery, Research and Education Foundation, Vail, CO, USA
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Joo YB, Lee WY, Chung HJ. Suprascapular nerve entrapment caused by a large hematoma of the scapula: a case report. BMC Musculoskelet Disord 2023; 24:589. [PMID: 37468872 DOI: 10.1186/s12891-023-06723-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2022] [Accepted: 07/12/2023] [Indexed: 07/21/2023] Open
Abstract
BACKGROUND Suprascapular nerve entrapment is a rare disorder that is frequently misdiagnosed as another disease. The suprascapular nerve is commonly entrapped at the following two sites: the suprascapular and spinoglenoid notches. Nerve entrapment at the spinoglenoid notch causes infraspinatus muscle weakness and atrophy. Patients present with posterior shoulder pain and weakness. Magnetic resonance imaging is used to confirm the diagnosis of a spinoglenoid cyst and nerve compression. Open or arthroscopic aspiration or decompression is indicated for patients with cysts in whom conservative treatment has failed and those with cysts associated with suprascapular nerve compression. CASE PRESENTATION Herein, we describe the case of a 49-year-old man with suprascapular nerve entrapment caused by a large cyst, namely, a hematoma, in the superior scapular and spinoglenoid notches. Open surgical decompression of the suprascapular nerve was performed owing to an intact rotator cuff and glenoid labrum. CONCLUSION Posterior shoulder pain promptly resolved without complications.
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Affiliation(s)
- Yong Bum Joo
- Department of Orthopedic Surgery, Chungnam National University Hospital, Chungnam National University School of Medicine, Daejeon, South Korea
| | - Woo Yong Lee
- Department of Orthopedic Surgery, Chungnam National University Hospital, Chungnam National University School of Medicine, Daejeon, South Korea
| | - Hyung Jin Chung
- Department of Orthopedic Surgery, Chungnam National University Sejong Hospital, Chungnam National University School of Medicine, Daejeon, South Korea.
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Correlation of suprascapular notch morphology with suprascapular nerve palsy: a 3D-computed tomography study. JSES Int 2023; 7:316-323. [PMID: 36911777 PMCID: PMC9998890 DOI: 10.1016/j.jseint.2022.12.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
Background The morphology of the suprascapular (SS) notch is a very important factor in treatment of suprascapular nerve (SSN) palsy. Several studies have reported SS notch morphology in cadavers or using a three-dimensional computed tomography (3D-CT); however, none has reported the distribution of SS notch morphology according to the age group. In addition, the correlation between SS notch morphology and SSN palsy remains unclear. The purposes of this study were to investigate the morphological distribution of the SS notch by age group in a large population and to assess the relationship between SS notch morphology and SSN palsy. Methods We studied the 3D-CT images of 1063 shoulders in 1009 patients (mean age, 60.8 years; age range, 14-96 years). There were 53 shoulders with SSN palsy and 1010 shoulders without SSN palsy. Morphology of the SS notch was classified by Rengachary's classification (types I-VI). Shoulders with types I-IV were classified into the nonossified superior transverse scapular ligament (STSL) group (group N) and those with types V and VI into the ossified STSL group (group O). Results The Rengachary's classifications of the 1063 shoulders were as follows: type I: n = 113, 10.6%; type II: n = 313, 29.4%; type III: n = 383, 36.0%; type IV: n = 109, 10.3%; type V: n = 107, 10.0%; and type VI: n = 38, 3.6%. Mean age was significantly older in the ossified STSL group, and the age was <40 years for only two shoulders in this group. The Rengachary's classifications of the SSN palsy cases were as follows: type I: 7.5%, II: 24.5%, III: 34.0%, IV: 15.1%, V: 13.2%, and VI: 5.7%. There was no statistical difference in age and sex, Rengachary type, or ossification between SSN palsy and non-SSN palsy cases. Conclusions Ossification of the STSL was significantly more common in older patients, which suggests age-related change. In addition, no relation was identified between narrow notch or ossification of the STSL with the onset of SSN palsy.
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Saccheri P, Sabbadini G, Travan L. Two paleopathological cases suggestive of paralabral cysts of the shoulder. INTERNATIONAL JOURNAL OF PALEOPATHOLOGY 2022; 39:109-114. [PMID: 36347173 DOI: 10.1016/j.ijpp.2022.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 10/12/2022] [Accepted: 10/28/2022] [Indexed: 06/16/2023]
Abstract
OBJECTIVE To undertake differential diagnosis of scapular bone defects found in two medieval skeletons buried in different necropoles of Friuli Venezia Giulia (Italy) and to evaluate the clinical significance of paralabral cysts in the context of shoulder pathology. MATERIALS Individual JoT36 is an adult male exhumed from a necropolis belonging to a rural agricultural settlement dated to the 10th to 11th century A.D. Individual CIVT58 is an adult male from a Langobard necropolis dated to 630-670 A.D. METHODS Macroscopic examination of the skeletons was performed using standard osteological methods and review of pertinent clinical literature to assist differential diagnosis. RESULTS Between the glenoid cavity and the spinoglenoid notch of the right scapula of JoT36 there is a multilocular circular defect adjacent to the glenoid rim. On the neck of the left scapula of CIVT58, immediately above the spinoglenoid notch, there is a unilocular circular depression. In both cases, the cortical bone appears smooth without any evidence of erosion or sclerosis. CONCLUSIONS Skeletal findings and historical/archaeological contexts of both cases are compatible with the diagnosis of paralabral cysts. SIGNIFICANCE Paralabral cysts are relatively frequently observed in clinical settings but very few examples have been documented in paleopathological literature. This study seeks to improve recognition and interpretation of this pathology in historical/archaeological contexts. LIMITATIONS Findings from a case report can neither generate epidemiological information nor be generalized. SUGGESTIONS FOR FURTHER RESEARCH Identification of new cases may add valuable information about lifestyles and related shoulder pathologies in ancient times.
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Affiliation(s)
- Paola Saccheri
- Department of Medicine, Section of Anatomy and History of Medicine, University of Udine, P.le Kolbe 3, 33100 Udine, Italy.
| | - Gastone Sabbadini
- Department of Medicine, Surgery and Health Sciences, University of Trieste, Strada di Fiume 447, 34100 Trieste, Italy.
| | - Luciana Travan
- Department of Medicine, Section of Anatomy and History of Medicine, University of Udine, P.le Kolbe 3, 33100 Udine, Italy.
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Vij N, Fabian I, Hansen C, Kasabali AJ, Urits I, Viswanath O. Outcomes after minimally invasive and surgical management of suprascapular nerve entrapment: A systematic review. Orthop Rev (Pavia) 2022; 14:37157. [DOI: 10.52965/001c.37157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Accepted: 03/29/2022] [Indexed: 11/06/2022] Open
Abstract
Background The prevalence of suprascapular neuropathy is higher than previously estimated. Recent literature highlights a myriad of treatment options for patients ranging from conservative treatment and minimally invasive options to surgical management. However, there are no comprehensive review articles comparing these treatment modalities. Objective The purpose of this review article is to summarize the current state of knowledge on suprascapular nerve entrapment and to compare minimally invasive treatments to surgical treatments. Methods The literature search was performed in Mendeley. Search fields were varied redundant. All articles were screened by title and abstract and a preliminary decision to include an article was made. A full-text screening was performed on the selected articles. Any question regarding the inclusion of an article was discussed by 3 authors until an agreement was reached. Results Recent studies have further elucidated the pathoanatomy and described several risk factors for entrapment ranging. Four studies met our inclusion criteria regarding peripheral nerve stimulation with good pain and clinical outcomes. Two studies met our inclusion criteria regarding pulsed radiofrequency and showed promising pain and clinical outcomes. One study met our inclusion criteria regarding transcutaneous electrical nerve stimulation and showed good results that were equivalent to pulsed radiofrequency. Surgical treatment has shifted to become nearly all arthroscopic and surgical outcomes remain higher than minimally invasive treatments. Conclusions Many recently elucidated anatomical factors predispose to entrapment. A history of overhead sports or known rotator cuff disease can heighten a clinician’s suspicion. Entrapment at the suprascapular notch is more common overall, yet young athletes may be predisposed to isolated spinoglenoid notch entrapment. Pulsed radiofrequency, peripheral nerve stimulation, and transcutaneous electrical nerve stimulation may be effective in treating patients with suprascapular nerve entrapment. Arthroscopic treatment remains the gold-standard in patients with refractory entrapment symptoms.
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Affiliation(s)
- Neeraj Vij
- University of Arizona College of Medicine - Phoenix
| | - Isabella Fabian
- Louisiana State University Health Sciences Center Shreveport School of Medicine
| | - Colby Hansen
- Louisiana State University Health Sciences Center Shreveport School of Medicine
| | - Ahmad J Kasabali
- Louisiana State University Health Sciences Center Shreveport School of Medicine
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Review of the Evaluation of Acute Upper Extremity Neuropathy. CURRENT EMERGENCY AND HOSPITAL MEDICINE REPORTS 2022. [DOI: 10.1007/s40138-022-00244-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Liu Q, Tang Q, Liao L, Li D, Zhu W, Zhao C. Translational therapy from preclinical animal models for muscle degeneration after rotator cuff injury. J Orthop Translat 2022; 35:13-22. [PMID: 35846726 PMCID: PMC9260436 DOI: 10.1016/j.jot.2022.03.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2021] [Revised: 02/28/2022] [Accepted: 03/01/2022] [Indexed: 11/29/2022] Open
Abstract
Chronic rotator cuff tears are debilitating diseases which significantly affect patients’ quality of life and pose substantial financial burden to the society. The intraoperative reparability of injured tendon and postoperative probability of tendon retear are highly associated with the quality of torn muscles, specifically, the severity of muscle atrophy and fatty infiltration. Animal models that reproduce the characteristic muscle pathology after rotator cuff injury have been developed and used to provide insight into the underlying biology and pathophysiology. In this review, we briefly summarize the current information obtained from preclinical animal studies regarding the degenerative change of cuff muscle subsequent to tendon release and/or suprascapular nerve denervation. Importantly, we focus on the potential translational therapeutic targets or agents for the prevention or reversal of muscle atrophy and fatty infiltration. While further studies are warranted to assess the safety and efficacy of novel therapies derived from these preclinical animal research, we believe that their clinical translation for the treatment of rotator cuff disorders is on the horizon. The Translational potential of this article Novel therapeutic strategies described in this review from preclinical animal studies hold a great translational potential for preventing or reversing rotator cuff muscle pathology, while further assessments on their safety and efficacy are warranted.
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Effect of different postures of the scapular girdle and arm on the pressure pain threshold in the infraspinatus muscle. J Bodyw Mov Ther 2021; 28:276-282. [PMID: 34776153 DOI: 10.1016/j.jbmt.2021.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Revised: 07/18/2021] [Accepted: 08/01/2021] [Indexed: 11/23/2022]
Abstract
BACKGROUND Mechanosensitivity changes and trigger points in the infraspinatus muscle are associated with several painful conditions of the upper limb. The aim of this study was to assess the effect of different postures of the upper quadrant on the pressure pain threshold (PPT) of the infraspinatus muscle. METHODS This was an observational, cross-sectional study. Fifty-four subjects with and without shoulder pain (Asymptomatic subjects = 27, mean age 26.9 ± 4.92 years, BMI 23.73 ± 3.87), (symptomatic subjects = 27, mean age 27.6 ± 3.68 years, BMI 24.35 ± 3.86) were evaluated with a pressure algometer on the infraspinatus muscle belly, in four different positions of the upper quadrant: rest position (P1), passive scapular retraction position (P2), cervical contralateral inclination position (P3), and suprascapular nerve provocation position (P4). The assessed side was randomly chosen and all measurements were taken in sitting position. RESULTS No differences were observed between groups. The within-group analysis showed differences for both factors: "Positions" (F = 69.91; p = 0.001) and the interaction "Positions^Group" (F = 3.36; p = 0.02). The pairwise post-hoc analysis showed differences for the retracted position (P2) compared to others P1 (p = 0.001), P3 (p = 0.001), and P4 (p = 0.001), with higher PPT results achieved on the retracted position. Differences between P4 vs. P1 (p = 0.03) were also observed, with higher values for P4. CONCLUSION Placing the scapular girdle in a passive scapular retraction position significantly reduces the pressure sensitivity at the infraspinatus muscle. Physiotherapists can take into account these results when assessing and treating patients with upper quadrant pain syndromes.
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Abstract
Carpal tunnel syndrome, ulnar neuropathy at the elbow, and peroneal neuropathy are the most common mononeuropathies; however, other individual nerves may also be injured by various processes. These uncommon mononeuropathies may be less readily diagnosed owing to unfamiliarity with the presentations and vague symptoms. Electrodiagnostic studies are essential in the evaluation of uncommon mononeuropathies and can assist in localization and prognostication. However, they can also be challenging; stimulation at the proximal sites is difficult and well-validated reference values are not available. This article reviews the electrodiagnostic assessment of several uncommon upper and lower extremities mononeuropathies.
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Affiliation(s)
- Ghazala Hayat
- Saint Louis University School of Medicine, Saint Louis, MO, USA.
| | - Jeffrey S Calvin
- Department of Neurology, Saint Louis University School of Medicine, Saint Louis, MO, USA
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Prenaud C, Loubeyre J, Soubeyrand M. Decompression of the suprascapular nerve at the suprascapular notch under combined arthroscopic and ultrasound guidance. Sci Rep 2021; 11:18906. [PMID: 34556759 PMCID: PMC8460809 DOI: 10.1038/s41598-021-98463-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Accepted: 09/06/2021] [Indexed: 11/09/2022] Open
Abstract
Decompression of the suprascapular nerve (SSNe) at the suprascapular notch (SSNo) is usually performed with an arthroscopic procedure. This technique is well described but locating the nerve is complex because it is deeply buried and surrounded by soft tissue. We propose to combine ultrasound and arthroscopy (US-arthroscopy) to facilitate nerve localization, exposure and release. The main objective of this study was to assess the feasibility of this technique. This is an experimental, cadaveric study, carried out on ten shoulders. The first step of our technique is to locate the SSNo using an ultrasound scanner. Then an arthroscope is introduced under ultrasound control to the SSNo. A second portal is then created to dissect the pedicle and perform the ligament release. Ultrasound identification of the SSNo, endoscopic dissection and decompression of the nerve were achieved in 100% of cases. Ultrasound identification of the SSNo took an average of 3 min (± 4) while dissection and endoscopic release time took an average of 8 min (± 5). Ultrasound is an extremely powerful tool for non-invasive localization of nerves through soft tissues, but it is limited by the fact that tissue visualization is limited to the ultrasound slice plane, which is two-dimensional. On the other hand, arthroscopy (extra-articular) allows three-dimensional control of the surgical steps performed, but the locating of the nerve involves significant tissue detachment and a risk of damaging the nerve with the dissection. The combination of the two (US-arthroscopy) offers the possibility of combining the advantages of both techniques.
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Affiliation(s)
- Clément Prenaud
- Department of Orthopaedic Surgery, Public Assistance Hospital of Paris, 44 rue des Vinaigriers, 75010, Paris, France.
| | - Jeanne Loubeyre
- Department of Orthopaedic Surgery, Public Assistance Hospital of Paris, 44 rue des Vinaigriers, 75010, Paris, France
| | - Marc Soubeyrand
- Department of Orthopaedic Surgery, Clinique Saint Jean l'Ermitage, 272 Av Marc Jacquet, 77000, Melun, France
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Noh JS, Kim DH, Chun SM, Choi YH. Shoulder pain in a patient with renal cell carcinoma? Suprascapular neuropathy caused by bone metastasis of renal cell carcinoma: A case report. Palliat Med 2021; 35:1629-1633. [PMID: 34524045 DOI: 10.1177/02692163211024104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Pain management is crucial in palliative care for patients with advanced cancer. Here, we report a case of shoulder pain in a patient with renal cell carcinoma. CASE PRESENTATION A 36-year-old male diagnosed metastatic renal cell carcinoma presented with pain and weakness on left shoulder for more than 6 months. Physical examination showed limited range of motion and atrophic changes on supraspinatus and infraspinatus muscles. Weakness in shoulder abduction and external rotation was also noted. POSSIBLE COURSES OF ACTION In this case, suprascapular neuropathy, adhesive capsulitis of shoulder and metastatic lesions involving shoulder joint were suspected. FORMULATION OF A PLAN We planned imaging studies including X-ray, bone scan, magnetic resonance imaging, and electrodiagnostic studies. OUTCOME Imaging and electrodiagnostic studies showed suprascapular neuropathy by bone metastasis. Conservative treatment including injection and rehabilitation therapy reduced the patient's pain and improved the range of motion limitation. LESSONS FROM THE CASE Clinicians should be aware that bone metastasis in patients with advanced cancer can cause suprascapular neuropathy, shoulder pain and shoulder dysfunction. VIEW ON RESEARCH PROBLEMS, OBJECTIVES, OR QUESTIONS GENERATED BY THE CASE More research is expected on development of an early surveillance model, barriers to cancer pain management, communication from patients' perspectives.
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Affiliation(s)
- Jeong-Se Noh
- Department of Physical Medicine and Rehabilitation, Soonchunhyang University Seoul Hospital, Soonchunhyang University College of Medicine, Seoul, Korea
| | - Dong Hyun Kim
- Department of Radiology, Seoul Metropolitan Government - Seoul National University Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea
| | - Seong-Min Chun
- Department of Physical Medicine and Rehabilitation, Soonchunhyang University Seoul Hospital, Soonchunhyang University College of Medicine, Seoul, Korea
| | - Yoon-Hee Choi
- Department of Physical Medicine and Rehabilitation, Soonchunhyang University Seoul Hospital, Soonchunhyang University College of Medicine, Seoul, Korea
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Wieser K, Grubhofer F, Hasler A, Götschi T, Beeler S, Meyer D, von Rechenberg B, Gerber C. Muscle Degeneration Induced by Sequential Release and Denervation of the Rotator Cuff Tendon in Sheep. Orthop J Sports Med 2021; 9:23259671211025302. [PMID: 34423059 PMCID: PMC8371735 DOI: 10.1177/23259671211025302] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2021] [Accepted: 02/18/2021] [Indexed: 11/15/2022] Open
Abstract
Background In a sheep rotator cuff model, tenotomy predominantly induces fatty infiltration, and denervation induces mostly muscle atrophy. In clinical practice, myotendinous retraction after tendon tear or lateralization after tendon repair tear may lead to traction injury of the nerve. Purpose/Hypothesis To analyze whether an additional nerve lesion during rotator cuff repair leads to further degeneration of the rotator cuff muscle in the clinical setting. We hypothesized that neurectomy after tendon tear would increase atrophy as well as fatty infiltration and that muscle paralysis after neurectomy would prevent myotendinous retraction after secondary tendon release. Study Design Controlled laboratory study. Methods Twelve Swiss alpine sheep were used for this study. For the 6 sheep in the tenotomy/neurectomy (T/N) group, the infraspinatus tendon was released; 8 weeks later, the suprascapular nerve was transected. For the 6 sheep in the neurectomy/tenotomy (N/T) group, neurectomy was performed, and the infraspinatus was tenotomized 8 weeks later. All sheep were sacrificed after 16 weeks. Magnetic resonance imaging (MRI) was performed before the first surgery (baseline) and then after 8 and 16 weeks. The MRI data were used to assess muscle volume, fat fraction, musculotendinous retraction, pennation angle, and muscle fiber length of the infraspinatus muscle. Results Three sheep (2 in the T/N and 1 in the N/T group) had to be excluded because the neurectomy was incomplete. After 8 weeks, muscle volume decreased significantly less in the T/N group (73% ± 2% of initial volume vs 52% ± 7% in the N/T group; P < .001). After 16 weeks, the mean intramuscular fat increase was higher in the T/N group (36% ± 9%) than in the N/T group (23% ± 6%), without reaching significance (P = .060). After 16 weeks, the muscle volumes of the N/T (52% ± 8%) and T/N (49% ± 3%) groups were the same (P = .732). Conclusion Secondary neurectomy after tenotomy of a musculotendinous unit increases muscle atrophy. Tenotomy of a denervated muscle is associated with substantial myotendinous retraction but not with an increase of fatty infiltration to the level of the tenotomy first group. Clinical Relevance Substantial retraction, which is associated with hitherto irrecoverable fatty infiltration, should be prevented, and additional neurogenic injury during repair should be avoided to limit the development of further atrophy.
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Affiliation(s)
- Karl Wieser
- University Hospital Balgrist, Department of Orthopaedics, Zurich, Switzerland
| | - Florian Grubhofer
- University Hospital Balgrist, Department of Orthopaedics, Zurich, Switzerland
| | - Anita Hasler
- University Hospital Balgrist, Department of Orthopaedics, Zurich, Switzerland
| | - Tobias Götschi
- University Hospital Balgrist, Unit for Clinical and Applied Research, Zurich, Switzerland.,ETH Zurich, Institute for Biomechanics, Zurich, Switzerland
| | - Silvan Beeler
- University Hospital Balgrist, Department of Orthopaedics, Zurich, Switzerland
| | - Dominik Meyer
- University Hospital Balgrist, Department of Orthopaedics, Zurich, Switzerland
| | | | - Christian Gerber
- University Hospital Balgrist, Department of Orthopaedics, Zurich, Switzerland
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Bhandari PS. Suprascapular Nerve Entrapment by a Trifid Superior Transverse Scapular Ligament. INDIAN JOURNAL OF NEUROTRAUMA 2021. [DOI: 10.1055/s-0041-1734344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
AbstractAnatomical variations at the suprascapular notch may limit the available space for the suprascapular nerve (SSN), and cause its entrapment in the tight osseoligamentous tunnel. The author encountered the presence of a trifid superior transverse scapular ligament (STSL) while operating on a patient with SSN entrapment. Surgical division of the three bands resulted in complete regression of symptoms.
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Affiliation(s)
- Prem Singh Bhandari
- Department of Plastic and Reconstructive Microsurgery, Brij Lal Superspeciality Hospital, Nainital, Uttarakhand, India
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Lee JG, Peo H, Cho JH, Kim DH. Intraneural ganglion cyst of the lumbosacral plexus mimicking L5 radiculopathy: A case report. World J Clin Cases 2021; 9:4433-4440. [PMID: 34141811 PMCID: PMC8173415 DOI: 10.12998/wjcc.v9.i17.4433] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Revised: 03/16/2021] [Accepted: 03/24/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Intraneural ganglion cysts are benign gelatinous masses that form within the epineurium of a peripheral nerve. Only few cases of intraneural ganglion cyst arising from the hip joint have been reported.
CASE SUMMARY A previously healthy 65-year-old woman who had been experiencing left buttock pain radiating to the dorsum of the foot for 2 years visited our clinic. Prior to visiting the clinic, she underwent lumbar spine magnetic resonance imaging and received physiotherapy, pain killers, and epidural injections based on a presumptive diagnosis of spinal stenosis for 2 years in other hospitals. Repeat magnetic resonance imaging revealed joint connection of the articular branch of the hip joint and rostral extension of the cyst along the L5 spinal nerve near the L5-S1 neural foramen. The patient was diagnosed with intraneural ganglion cyst arising from the articular branch of the hip joint based on high-resolution magnetic resonance neurography. Using the arthroscopic approach, a cystic opening within the intra-articular space was detected, and cyst decompression was then performed. The pain in the left leg was significantly relieved during the 6-mo follow-up.
CONCLUSION Although intraneural ganglion cysts arising from the hip joint are rare, they can cause typical radicular pain and mimic common L5 radiculopathy. Typical cyst ascent phenomenon starting from the termination of the articular branch on magnetic resonance imaging is a crucial finding indicative of intraneural ganglion cysts arising from the hip joint.
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Affiliation(s)
- Jun Gyu Lee
- Department of Physical Medicine and Rehabilitation, College of Medicine, Chung-Ang University, Seoul 06973, South Korea
| | - Hyungsun Peo
- Department of Physical Medicine and Rehabilitation, College of Medicine, Chung-Ang University, Seoul 06973, South Korea
| | - Jang Hyuk Cho
- Department of Rehabilitation Medicine, Keimyung University School of Medicine, Daegu 42601, South Korea
| | - Du Hwan Kim
- Department of Physical Medicine and Rehabilitation, College of Medicine, Chung-Ang University, Seoul 06973, South Korea
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Kemp TD, Kaye TR, Scali F. Quadrangular Space Syndrome: A Narrative Overview. J Chiropr Med 2021; 20:16-22. [PMID: 34025301 PMCID: PMC8134859 DOI: 10.1016/j.jcm.2021.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Revised: 08/01/2020] [Accepted: 01/27/2021] [Indexed: 10/21/2022] Open
Abstract
OBJECTIVE The purpose of this narrative review of the literature is to provide an overview of quadrangular space syndrome with special attention to its clinical presentation, differential diagnosis, and treatment. METHODS A narrative review of the English-language, peer-reviewed literature was performed using the key words "axillary nerve," "quadrangular space," "quadrilateral space," and "posterior humeral circumflex artery." Databases searched were Medline Complete, Cumulative Index to Nursing and Allied Health Literatures, and Index to Chiropractic Literature. The search period was from 1983 through January 2020. RESULTS There were 85 articles selected for this review. A summary and overview are provided. CONCLUSION Quadrangular space syndrome is an uncommon cause of shoulder pain. Clinicians should consider it as a diagnosis after ruling out more common shoulder conditions and examining other concurrent diseases.
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Affiliation(s)
- Tyler D. Kemp
- College of Chiropractic, Logan University, Ballwin, Missouri
| | - Tyler R. Kaye
- College of Chiropractic, Logan University, Ballwin, Missouri
| | - Frank Scali
- School of Medicine, California University of Science and Medicine, School of Medicine, Colton, California
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Jerome TJ, Sabtharishi V, Sk T. Open Surgical Decompression for Large Multiloculated Spinoglenoid Notch Ganglion Cyst With Suprascapular Nerve Neuropathy. Cureus 2021; 13:e13300. [PMID: 33738151 PMCID: PMC7958802 DOI: 10.7759/cureus.13300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Suprascapular nerve entrapment at the spinoglenoid notch causes infraspinatus weakness and wasting. Patients present with shoulder pain and weakness. The spinoglenoid notch cyst is the reason for suprascapular nerve compression. Magnetic resonance imaging (MRI) confirms the diagnosis of spinoglenoid cyst and its nerve compression. Also, MRI rules out other differential diagnosis causing shoulder pain and weakness. One of the treatment modalities for small and asymptomatic cyst is conservative, which has produced acceptable results and functional outcome. Open or arthroscopic aspiration or decompression is indicated for patients with single small cysts where conservative treatment failed, and cyst associated with suprascapular nerve compression. We report a 32-year-old dancer with a large multiloculated multiple spinoglenoid cysts compressing the suprascapular nerve causing infraspinatus wasting and shoulder dysfunction. We performed an open surgical decompression of the suprascapular nerve and excised multiple ganglions. The patient improved significantly and regained his shoulder function and muscle wasting at two-year follow-up.
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Affiliation(s)
- Terrence Jose Jerome
- Orthopaedics, Hand and Reconstructive Microsurgery, Olympia Hospital and Research Centre, Trichy, IND
| | | | - Thirumagal Sk
- Trauma, Olympia Hospital and Research Centre, Trichy, IND
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Hasan SS, O'Loughlin JP, Sorger JI. A large intermuscular shoulder lipoma causing pain and weakness in an 87-year-old patient: a case report. JSES Int 2021; 5:154-157. [PMID: 33554181 PMCID: PMC7846676 DOI: 10.1016/j.jseint.2020.10.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Affiliation(s)
- Samer S Hasan
- Mercy Health-Cincinnati SportsMedicine and Orthopaedic Center, Cincinnati, OH, USA
| | - Jack P O'Loughlin
- Mercy Health-Cincinnati SportsMedicine and Orthopaedic Center, Cincinnati, OH, USA
| | - Joel I Sorger
- TriHealth Orthopedic and Sports Institute, Cincinnati, OH, USA
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Nolte PC, Woolson TE, Elrick BP, Tross AK, Horan MP, Godin JA, Millett PJ. Clinical Outcomes of Arthroscopic Suprascapular Nerve Decompression for Suprascapular Neuropathy. Arthroscopy 2021; 37:499-507. [PMID: 33091550 DOI: 10.1016/j.arthro.2020.10.020] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 10/06/2020] [Accepted: 10/11/2020] [Indexed: 02/02/2023]
Abstract
PURPOSE To report clinical outcomes following arthroscopic suprascapular nerve (SSN) decompression for suprascapular neuropathy at the suprascapular and/or spinoglenoid notch in the absence of major concomitant pathology. METHODS We retrospectively reviewed prospectively collected data of 19 patients who underwent SSN release at the suprascapular and/or spinoglenoid notch between April 2006 and August 2017 with ≥2 years of follow-up. Patients who underwent concomitant rotator cuff or labral repairs or had severe osteoarthritis were excluded. Pre- and postoperative strength and patient-reported outcomes were collected, including the American Shoulder and Elbow Surgeons (ASES), Single Assessment Numerical Evaluation (SANE), Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH), 12-item Short Form (SF-12), and satisfaction. Complications and revisions were recorded. RESULTS At a mean final follow-up of 4.8 years, pre- to postoperative ASES (64.9 ± 18.7 versus 83.5 ± 23.1; P = .018), QuickDASH (28.7 ± 17.2 versus 12.7 ± 17.1; P = .028), SANE (64.3 ± 16.4 versus 80.8 ± 22.3; P = .034), and SF-12 PCS (41.1 ± 10.8 versus 52.3 ± 5.8; P = .007) scores all significantly improved. Median strength for external rotation improved significantly (4 [range 2 to 5] versus 5 [range 3 to 5]; P = .014). There was no statistically significant improvement in median strength for abduction (4 [range 3 to 5] versus 5 [5]; P = .059). Median postoperative satisfaction was 9 (range 1 to 10), with 8 patients (50%) rating satisfaction ≥9. No complications were observed, and no patients went on to revision surgery. CONCLUSION Arthroscopic SSN decompression for suprascapular neuropathy at the suprascapular and/or spinoglenoid notch in the absence of major concomitant glenohumeral pathology results in good functional outcomes with significant improvements from before to after surgery. LEVEL OF EVIDENCE IV, therapeutic case series.
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Affiliation(s)
- Philip C Nolte
- Steadman Philippon Research Institute, Vail, Colorado, U.S.A.; BG Trauma Center Ludwigshafen at the University of Heidelberg, Clinic for Trauma and Orthopaedic Surgery, Ludwigshafen, Germany
| | | | - Bryant P Elrick
- Steadman Philippon Research Institute, Vail, Colorado, U.S.A
| | - Anna-Katharina Tross
- Steadman Philippon Research Institute, Vail, Colorado, U.S.A.; Heidelberg University Hospital, Clinic for Orthopedics and Trauma Surgery, Heidelberg, Germany
| | - Marilee P Horan
- Steadman Philippon Research Institute, Vail, Colorado, U.S.A
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Arce G, Calvo A, Golano P. Suprascapular Nerve Release: Technique Based on Anatomic Landmarks. Arthrosc Tech 2021; 10:e469-e473. [PMID: 33680780 PMCID: PMC7917141 DOI: 10.1016/j.eats.2020.10.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Accepted: 10/18/2020] [Indexed: 02/03/2023] Open
Abstract
Dysfunction of the suprascapular nerve (SSN) is closely related to rotator cuff pathology; nerve dysfunction can lead to cuff disease and vice versa. Owing to repetitive microtrauma during overhead sports or massive cuff tears with significant tendon retraction, the SSN may suffer compression or traction neuropathy at the suprascapular notch. The SSN release technique has already been described. However, on the basis of the many hands-on cadaveric laboratories in which we have participated in the past 20 years, only a few instructors and almost none of the attendants have shown the experience and skill set needed to release the SSN at the suprascapular notch. Therefore, a review of the surgical technique following the anatomic descriptions of an expert anatomist (P.G.) of the shoulder girdle is quite valuable.
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Affiliation(s)
- Guillermo Arce
- Instituto Argentino de Diagnóstico y Tratamiento, Buenos Aires, Argentina
| | - Angel Calvo
- Arthrosport, Clínica del Pilar, Zaragoza, Spain
| | - Pau Golano
- Departamento de Anatomía, Universidad de Barcelona, Barcelona, Spain
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Bagoji IB, Hadimani GA, Bulgoud RS, Desai V, Prakash KG, Bharatha A. Anatomical Variations of the Suprascapular Notch and its Importance in Suprascapular Entrapment Neuropathy. MÆDICA 2020; 15:298-304. [PMID: 33312243 DOI: 10.26574/maedica.2020.15.3.298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Background: Anatomical knowledge about the suprascapular notch is very important in understanding the risk of suprascapular nerve entrapment syndrome. Suprascapular nerve injuries have become commonly recognized as a cause of shoulder pain and dysfunction. This study aimed to describe the morphometrical influence of the suprascapular notch on the course of the suprascapular nerve. Method: A total of 138 dry human scapulae of both sides of the unknown sex were used. Four measurements were defined and collected for every suprascapular notch: maximum depth (MD), superior transverse diameter (STD), middle transverse diameter (MTD), and total circumferential diameter (TCD). Result: In the present study we found different shapes of suprascapular notches. Out of 138 scapulae, 67 (48.55%) had U-shaped notch, 29 (21.01%) V-shaped notch and 14 (10.14%) J-shaped notch. Nine (6.52%) scapulae had incomplete notch. Two (1.44%) scapulae had large double foramen. Six (4.34%) scapulae had complete suprascapular notch. In seven (5.07%) scapulae, the notch was absent. Interestingly, in two (1.44%) scapulae, we found a W-shaped notch. This observation was unique and not reported anywhere in the literature before. Conclusion: Anatomical knowledge about the morphology of the suprascapular notch is of extreme importance for clinicians, radiologists, neurosurgeons, and orthopedic surgeons in making a proper diagnosis and for planning the surgical procedures of the shoulder region.
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Affiliation(s)
- Ishwar B Bagoji
- Department of Anatomy, SRI B.M. Patil Medical College, BLDE (deemed to be University), Vijayapur, Karnataka, India
| | - Gavishiddappa A Hadimani
- Department of Anatomy, SRI B.M. Patil Medical College, BLDE (deemed to be University), Vijayapur, Karnataka, India
| | - R S Bulgoud
- Department of Anatomy, SRI B.M. Patil Medical College, BLDE (deemed to be University), Vijayapur, Karnataka, India
| | - Vikas Desai
- Department of Dentistry, SHRI B.M. Patil Medical College, Hospital and Research Centre, Vijayapura, Karnataka, India
| | - K G Prakash
- Department of Anatomy, Azeezia Institute of Medical Sciences and Research, Meeyyannoor, Kollam, Kerala, India
| | - Ambadasu Bharatha
- Faculty of Medical Sciences, University of The West Indies, Cave Hill Campus, Barbados, West Indies
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Buyukdogan K, Altintas B, Koyuncu Ö, Eren İ, Birsel O, Fox M, Demirhan M. Ultrasound-Guided Intralesional Methylene Blue Injection for the Arthroscopic Decompression of Spinoglenoid Notch Cyst Causing Suprascapular Neuropathy. Arthrosc Tech 2020; 9:e1785-e1789. [PMID: 33294341 PMCID: PMC7695623 DOI: 10.1016/j.eats.2020.07.025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Accepted: 07/24/2020] [Indexed: 02/03/2023] Open
Abstract
Symptomatic spinoglenoid ganglion cyst is a rare cause of shoulder pain and disability. Surgical treatment, which may be considered after failed nonoperative treatment, includes open or arthroscopic cyst debridement. Arthroscopic treatment is less invasive and has the advantage of addressing intraarticular pathologies; however, exposure of the cyst may be deemed difficult. Furthermore, the suprascapular nerve is susceptible to iatrogenic injury owing to its close proximity to the posterior glenoid rim. The purpose of this article is to present our technique for arthroscopic spinoglenoid cyst decompression after preoperative ultrasound-guided methylene blue injection.
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Affiliation(s)
- Kadir Buyukdogan
- Department of Orthopedics and Traumatology, Koç University Hospital, Istanbul, Turkey,Address correspondence to Kadir Buyukdogan, M.D., Department of Orthopaedic Surgery, Koc University Hospital, Davutpasa St, No. 4, 34010 Zeytinburnu/İstanbul, Turkey.
| | | | - Özgür Koyuncu
- Department of Orthopedics and Traumatology, VKV American Hospital, Istanbul, Turkey
| | - İlker Eren
- Department of Orthopedics and Traumatology, Koç University School of Medicine, Istanbul, Turkey
| | - Olgar Birsel
- Department of Orthopedics and Traumatology, Koç University Hospital, Istanbul, Turkey
| | - Michael Fox
- Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, PA, U.S.A
| | - Mehmet Demirhan
- Department of Orthopedics and Traumatology, Koç University School of Medicine, Istanbul, Turkey
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RESIDENTS CASE REPORT: MUSCULOCUTANEOUS NERVE INJURY IN A COLLEGIATE BASEBALL PITCHER. Int J Sports Phys Ther 2020; 15:804-813. [PMID: 33110700 DOI: 10.26603/ijspt20200804] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
Background Literature regarding musculocutaneous nerve injuries among the athletic population is scarce, with only several reported clinical cases among baseball and softball pitchers. Purpose To present a unique case of a musculocutaneous nerve injury to aid in clinician awareness and propose innovative rehabilitation practices that may facilitate improved patient outcomes during recovery. Case Description A 23-year-old Division 1 NCAA collegiate baseball pitcher presented with vague anterior arm pain following a pre-season game. The athlete described the pain as an "intense stretch" of his right arm that occurred during his last pitch. The initial evaluation identified tenderness over the right distal bicep. All shoulder and elbow orthopedic tests to assess shoulder impingement, labral pathologies, and glenohumeral instability were unremarkable. Increased neural tension was also noted with upper limb neurodynamic testing of the median and ulnar nerves on the right arm compared bilaterally. Electromyography (EMG) testing confirmed a right upper and mid-brachial plexus stretch injury with the primary involvement of the musculocutaneous nerve. Rehabilitation focused on restoring strength deficits and diminishing neural tension. Blood flow restriction (BFR) was introduced on the uninvolved limb to reduce deficits in bicep musculature strength. Once the athlete regained bicep strength and forearm sensation, he was progressed from flat-ground throwing activities to throwing off the mound. Outcomes A reduction in neural tension during neurodynamic testing of the right arm, improvement of bicep brachii deficits seen between the right and left limbs, and restoration of sensation in the right lateral forearm enabled a progressive return to sport. Discussion Due to vague reports and inconclusive findings, the initial presentation of musculocutaneous nerve injuries may be mistaken for other conditions such as a biceps brachii strain. Further -documentation of this injury and rehabilitation procedures are needed to enhance patient outcomes.
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Chung YH, Lee JH, Koo BS, Jung J, Lee SJ. Ultrasound-guided pulsed radiofrequency treatment for distal suprascapular neuropathy: A case report. Medicine (Baltimore) 2020; 99:e22469. [PMID: 32991484 PMCID: PMC7523776 DOI: 10.1097/md.0000000000022469] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
RATIONALE Suprascapular neuropathy is a rare cause of shoulder pain, and patients usually presents with posterosuperior shoulder pain and weakness on forward flexion and external rotation. Suprascapular neuropathy associated with rotator cuff pathology has received attention as an emerging cause of this condition. Suprascapular nerve (SSN) block can be used in these patients, and pulsed radio frequency (PRF) can be applied to achieve a long-term effect. Several studies have reported on PRF treatment of the SSN for shoulder pain, but most applied treatment to the nerve trunk under the transverse scapular ligament. This report describes a patient with suprascapular neuropathy treated with selective application of PRF to the distal SSN under ultrasound guidance. PATIENT CONCERNS A 68-year-old woman suffered from right posterior shoulder pain after traumatic full thickness rotator cuff tear. Her pain was not diminished despite of 2 surgeries. DIAGNOSES She was diagnosed with entrapment of the distal SSN in the spino-glenoid (SGN) notch and suprascapular neuropathy. INTERVENTIONS She underwent surgery to decompress the entrapped SSN in the SGN. After that, we applied PRF on the distal SSN under ultrasound guidance for persistent pain. This treatment was repeated 3 times. OUTCOMES PRF treatment resulted in a slight reduction in the visual analogue scale (VAS) pain score from 7-8/10 to 5-6/10 at the 2 weeks follow-up, and to 2-3/10 at the 1 month follow-up. The reduction in pain was maintained at the 1 year follow-up. LESSONS PRF treatment of the SSN is typically approached from the main branch in the suprascapular notch. We selectively applied PRF to the distal SSN close to the SGN. This technique was safe and effective.
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Meyer JS, Hessenauer FM, Reichel T, Pham M, Plumhoff P, Rueckl K. Isolated mononeuropathy of the suprascapular nerve: traumatic traction injury as an important differential diagnosis to the entrapment syndrome. JSES Int 2020; 4:499-502. [PMID: 32939475 PMCID: PMC7479038 DOI: 10.1016/j.jseint.2020.04.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
- Julian S Meyer
- Department of Orthopaedic Surgery, Koenig-Ludwig-Haus, University of Wuerzburg, Wuerzburg, Germany
| | - Florian M Hessenauer
- Department of Diagnostic and Interventional Neuroradiology, University of Wuerzburg, Wuerzburg, Germany
| | - Thomas Reichel
- Department of Orthopaedic Surgery, Koenig-Ludwig-Haus, University of Wuerzburg, Wuerzburg, Germany
| | - Mirko Pham
- Department of Diagnostic and Interventional Neuroradiology, University of Wuerzburg, Wuerzburg, Germany
| | - Piet Plumhoff
- Department of Orthopaedic Surgery, Koenig-Ludwig-Haus, University of Wuerzburg, Wuerzburg, Germany
| | - Kilian Rueckl
- Department of Orthopaedic Surgery, Koenig-Ludwig-Haus, University of Wuerzburg, Wuerzburg, Germany
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Bozzi F, Alabau-Rodriguez S, Barrera-Ochoa S, Ateschrang A, Schreiner AJ, Monllau JC, Perelli S. Suprascapular Neuropathy around the Shoulder: A Current Concept Review. J Clin Med 2020; 9:jcm9082331. [PMID: 32707860 PMCID: PMC7465639 DOI: 10.3390/jcm9082331] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2020] [Revised: 07/16/2020] [Accepted: 07/18/2020] [Indexed: 12/11/2022] Open
Abstract
Suprascapular neuropathy is an uncommon but increasingly recognized cause of shoulder pain and dysfunction due to nerve entrapment. The aim of this review is to summarize some important aspects of this shoulder pathology. An extensive research was performed on PubMed and Clinical Key. The goal was to collect all the anatomical, biomechanical and clinical studies to conduct an extensive overview of the issue. Attention was focused on researching the state of art of the diagnosis and treatment. A total of 59 studies were found suitable and included. This condition is more frequently diagnosed in over-head athletes or patients with massive rotator cuff tears. Diagnosis may be complex, whereas its treatment is safe, and it has a great success rate. Prompt diagnosis is crucial as chronic conditions have worse outcomes compared to acute lesions. Proper instrumental evaluation and imaging are essential. Dynamic compression must initially be treated non-operatively. If there is no improvement, surgical release should be considered. On the other hand, soft tissue lesions may first be treated non-operatively. However, surgical treatment by arthroscopic means is advisable when possible as it represents the gold standard therapy. Other concomitant shoulder lesions must be recognized and treated accordingly.
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Affiliation(s)
- Federico Bozzi
- Department of Orthopaedics and Traumatology, Fondazione Poliambulanza (Brescia)—Università Cattolica del Sacro Cuore, 00168 Rome, Italy
- Correspondence:
| | - Sergi Alabau-Rodriguez
- Institut Català de Traumatologia i Medicina de l’Esport (ICATME)—Hospital Universitari Quiròn-Dexeus. Universitat Autònoma de Barcelona, 08028 Barcelona, Spain; (S.A.-R.); (S.B.-O.); (J.C.M.); (S.P.)
| | - Sergi Barrera-Ochoa
- Institut Català de Traumatologia i Medicina de l’Esport (ICATME)—Hospital Universitari Quiròn-Dexeus. Universitat Autònoma de Barcelona, 08028 Barcelona, Spain; (S.A.-R.); (S.B.-O.); (J.C.M.); (S.P.)
| | - Atesch Ateschrang
- Orthopedic department, Gemeinschaftsklinikum Mittelrhein, 56073 Koblenz, Germany;
| | - Anna J. Schreiner
- Department of Traumatology and Reconstructive Surgery, BG Trauma Center Tübingen, Eberhard-Karls University of Tübingen, 72076 Tübingen, Germany;
| | - Juan Carlos Monllau
- Institut Català de Traumatologia i Medicina de l’Esport (ICATME)—Hospital Universitari Quiròn-Dexeus. Universitat Autònoma de Barcelona, 08028 Barcelona, Spain; (S.A.-R.); (S.B.-O.); (J.C.M.); (S.P.)
- Department of Orthopaedic Surgery, Hospital del Mar. Universitat Autònoma de Barcelona (UAB), 08028 Barcelona, Spain
| | - Simone Perelli
- Institut Català de Traumatologia i Medicina de l’Esport (ICATME)—Hospital Universitari Quiròn-Dexeus. Universitat Autònoma de Barcelona, 08028 Barcelona, Spain; (S.A.-R.); (S.B.-O.); (J.C.M.); (S.P.)
- Department of Orthopaedic Surgery, Hospital del Mar. Universitat Autònoma de Barcelona (UAB), 08028 Barcelona, Spain
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Katsuura Y, Yao K, Chang E, Kadrie TA, Dorizas JA. Shoulder Double Crush Syndrome: A Retrospective Study of Patients With Concomitant Suprascapular Neuropathy and Cervical Radiculopathy. CLINICAL MEDICINE INSIGHTS-ARTHRITIS AND MUSCULOSKELETAL DISORDERS 2020; 13:1179544120921854. [PMID: 32612405 PMCID: PMC7309339 DOI: 10.1177/1179544120921854] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Accepted: 04/03/2020] [Indexed: 11/16/2022]
Abstract
Purpose While the double crush phenomena (compression along two points on a nerve) has been established between median neuropathy and cervical radiculopathy, combined suprascapular neuropathy (SSN) and cervical C5/C6 radiculopathy-so-called shoulder double crush syndrome-has not been well examined. We aim to identify the incidence of shoulder double crush syndrome in patients undergoing arthroscopic suprascapular nerve release for SSN. Methods One hundred consecutive patients >18 years of age who were positive for SSN on electromyography and motor nerve conduction studies (EMG/NCS) and underwent a suprascapular nerve release were included. Patients with evidence of shoulder double crush syndrome were identified based on x ray, cervical spine magnetic resonance imaging (MRI) and examination findings. Demographics, electrodiagnostics results, treatment courses, and clinical outcomes (visual analog scores and rotator cuff strength) following arthroscopic suprascapular nerve release were compared between patients with double crush syndrome versus isolated SSN. Results Thirty one percent of patients had evidence of shoulder crush syndrome. Two significant electrophysiologic differences were noted in shoulder double crush patients compared to isolated SSN patients. Patients with double crush had an increased incidence of median neuropathy (51% vs 30%, P = .04). Double crush patients had less supraspinatus motor amplitude difference between the affected side and non-affected side compared to isolated SSN patients (2.62 mV vs 3.44 mV, P = .03). In general, most double crush patients were treated conservatively with regard to their cervical spine pathology. Conclusion A significant percentage of patients with SSN have evidence of shoulder double crush syndrome. Patients with SSN and concomitant median neuropathy should have a detailed neck examination performed.
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Affiliation(s)
- Yoshihiro Katsuura
- Department of Orthopaedic Surgery, The University of Tennessee College of Medicine Chattanooga, Chattanooga, TN, USA
| | | | - Eric Chang
- School of Medicine, Tulane University, New Orleans, LA, USA
| | - Tareck A Kadrie
- The Chattanooga Heart Institute Memorial Hospital, Chattanooga, TN, USA
| | - John A Dorizas
- Erlanger Sports and Health Institute, Chattanooga, TN, USA
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Helfenstein Júnior M. Uncommon compressive neuropathies of upper limbs. Best Pract Res Clin Rheumatol 2020; 34:101516. [DOI: 10.1016/j.berh.2020.101516] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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John TS, Fishman F, Sharkey MS, Carter CW. Current concepts review: peripheral neuropathies of the shoulder in the young athlete. PHYSICIAN SPORTSMED 2020; 48:131-141. [PMID: 31596162 DOI: 10.1080/00913847.2019.1676136] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Peripheral neuropathies of the shoulder and upper extremity are uncommon injuries that may affect the young athletic population. When present, they can result in significant pain and functional impairment. The cause of peripheral neuropathy in young athletes may be an acute, traumatic injury such as a shoulder dislocation or a direct blow to the shoulder girdle. Alternatively, repetitive overuse with resultant compression or traction of a nerve over time may also result in neuropathy; overhead athletes and throwers may be particularly susceptible to this mechanism of nerve injury. Regardless of etiology, young athletes typically present with activity-related pain, paresthesias, and dysfunction of the affected upper extremity. In addition to physical examination, diagnostic studies such as radiographs and magnetic resonance imaging (MRI) are commonly performed as part of an initial evaluation and electrodiagnostic studies may be used to confirm the diagnosis of peripheral neuropathy. Electrodiagnostic studies may consist of electromyography, which evaluates the electrical activity produced by skeletal muscles, and/or a nerve conduction study, which evaluates a nerve's ability to transmit an electrical signal. Although data are not robust, clinical outcomes for young patients with activity-related peripheral neuropathies of the shoulder are generally good, with most young athletes reporting both symptomatic and functional improvement after treatment.
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Affiliation(s)
- Tamara S John
- Orthopaedic Surgeon, Kaiser Permanente - Emory Healthcare, Atlanta, GA, USA
| | - Felicity Fishman
- Orthopaedic Surgery, Stritch School of Medicine at Loyola University, Chicago, IL, USA
| | - Melinda S Sharkey
- Orthopaedic Surgery, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Cordelia W Carter
- Orthopaedic Surgery, New York University School of Medicine, New York, NY, USA
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A retrospective review of 112 patients undergoing arthroscopic suprascapular nerve decompression. J Orthop 2020; 19:31-35. [PMID: 32021032 DOI: 10.1016/j.jor.2019.11.048] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Accepted: 11/24/2019] [Indexed: 11/21/2022] Open
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30
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LiBrizzi CL, Rojas JL, Bontrager NC, Srikumaran U, McFarland EG. Suprascapular nerve entrapment in young kayaker: a case report. PHYSICIAN SPORTSMED 2020; 48:236-240. [PMID: 31469970 DOI: 10.1080/00913847.2019.1662273] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Kayaking has become one of the most popular paddle sports throughout the world. The shoulder is the most commonly injured area of the body among kayaking participants as a result of acute traumatic events and chronic overuse injuries. Therefore, kayaking participants may often seek advice for shoulder problems and there is a scarcity of studies regarding shoulder injuries in this population. In this case report, we present a young male recreational whitewater kayaker with a severe suprascapular nerve (SSN) entrapment who presented with shoulder pain and inability to perform his sport. He was initially evaluated elsewhere and was treated with nonsteroidal anti-inflammatory medications and physical therapy for presumptive diagnosis of subacromial impingement. After 5 months of failed non-operative treatment, the patient sought a second opinion with our group. SSN entrapment diagnosis was confirmed by a thorough careful physical examination, magnetic resonance imaging and electrodiagnostic study. Given the failure of non-operative treatment, the patient was treated with arthroscopic SSN decompression and successfully returned to kayaking without symptoms. While SSN entrapment has been reported in a variety of sports, especially those involving overhead movements, this is the first case report of SSN entrapment reported which impaired participation in kayaking. This case report supports the consideration of SSN entrapment in the differential diagnosis of painful shoulder among kayaking participants and highlights the importance of undressing the patient and examining the posterior shoulder for atrophy, winging or deformity.
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Affiliation(s)
- Christa L LiBrizzi
- The Division of Shoulder Surgery, Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, MD, USA
| | - Jorge L Rojas
- The Division of Shoulder Surgery, Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, MD, USA
| | - Nicholas C Bontrager
- The Division of Shoulder Surgery, Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, MD, USA
| | - Uma Srikumaran
- The Division of Shoulder Surgery, Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, MD, USA
| | - Edward G McFarland
- The Division of Shoulder Surgery, Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, MD, USA
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Monroe EJ, Flores SE, Zhang AL, Feeley BT, Lansdown DA, Ma CB. Do Outcomes of Arthroscopic Subscapularis Tendon Repairs Depend on Rotator Cuff Fatty Infiltration? Orthop J Sports Med 2020; 8:2325967120913036. [PMID: 32284947 PMCID: PMC7139190 DOI: 10.1177/2325967120913036] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Background: Rotator cuff fatty infiltration has been correlated with poorer radiographic
and clinical outcomes in supraspinatus and infraspinatus tendon repairs, but
this has not been well-studied in subscapularis tendon repairs. Purpose: To evaluate the influence of preoperative rotator cuff fatty infiltration on
postoperative outcomes for patients undergoing arthroscopic subscapularis
tendon repair. Study Design: Cohort study; Level of evidence, 3. Methods: Patients who underwent arthroscopic subscapularis repair between 2010 and
2016 were retrospectively identified, and demographic data and surgical
findings were recorded. The extent of fatty infiltration was determined on
preoperative magnetic resonance imaging by the Fuchs modification of the
Goutallier classification. At the most recent follow-up, patients completed
the Patient-Reported Outcomes Measurement Information System for Upper
Extremity (PROMIS-UE) computer adaptive test and a postoperative visual
analog scale for pain. The distribution of fatty infiltration was compared
between patients undergoing subscapularis tendon repair versus subscapularis
tendon repair combined with a posterior cuff repair. Outcomes were compared
for patients using Goutallier grade 0-1 versus grade ≥2 changes in each
rotator cuff muscle. Multivariate linear regression analysis was performed
to evaluate the influence of muscle quality, as well as demographic factors,
on PROMIS-UE scores. Significance was defined as P <
.05. Results: There were 140 shoulders included (mean age, 61.8 years; 42.1% female; mean
follow-up, 51.7 months). The prevalence of Goutallier grade 2 changes or
higher was significantly greater in patients with multitendon repair
relative to isolated subscapularis tendon repair. For the overall group of
all patients undergoing subscapularis tendon repair, whether in isolation or
as part of a multitendon repair, PROMIS-UE scores were significantly lower
for patients with infraspinatus muscle grade 2 or higher Goutallier changes
relative to grade 0 or 1. After adjustment for age, body mass index, patient
sex, and fatty infiltration in other rotator cuff muscles, poor
infraspinatus muscle quality remained the only significant predictor for
lower PROMIS-UE scores. Conclusion: Patients undergoing arthroscopic subscapularis tendon repair with poor
infraspinatus muscle quality had worse patient-reported outcomes. This was
true whether subscapularis tendon repair was isolated or was performed in
conjunction with supraspinatus and infraspinatus tendon repairs.
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Affiliation(s)
- Emily J Monroe
- Heartland Orthopedic Specialists, Alexandria, Minnesota, USA
| | - Sergio E Flores
- Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California, USA
| | - Alan L Zhang
- Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California, USA
| | - Brian T Feeley
- Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California, USA
| | - Drew A Lansdown
- Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California, USA
| | - C Benjamin Ma
- Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California, USA
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Sun Y, Kwak JM, Zhou Y, Fu Y, Wang Z, Chen Q, Jeon IH. Suprascapular nerve injury affects rotator cuff healing: A paired controlled study in a rat model. J Orthop Translat 2020; 27:153-160. [PMID: 33981574 PMCID: PMC8071639 DOI: 10.1016/j.jot.2020.02.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2019] [Revised: 12/26/2019] [Accepted: 02/10/2020] [Indexed: 11/08/2022] Open
Abstract
Purpose We designed a paired controlled study to investigate the role of the suprascapular nerve (SSN) in rotator cuff healing using a rat tear model, and we hypothesised that rotator cuff healing is impaired in the absence of a healthy SSN. Methods Bilateral supraspinatus tenotomy from the great tuberosity was performed for 36 Wistar rats, which was then repaired immediately. A defect on the SSN was made on the right side, and a sham surgery was performed on the SSN at the left side. Twelve rats were sacrificed for biomechanical (six rats) and histological (six rats) testing, evaluated at 3, 6, and 9 weeks after surgery. Results The bone–tendon junction on the nerve-intact side showed significantly better biomechanical characteristics than the nerve-injured side in terms of maximum load, maximum stress over time, stiffness at 9 weeks, and Young's modulus at 3 and 9 weeks. On the nerve-injured side, significantly smaller fibrocartilage layers and muscle fibres could be obtained over time. In addition, on the nerve-injured side, inferior bone–tendon interface formation was obtained in terms of cell maturity, cell alignment, collagen orientation, and the occurrence of tidemark and Sharpey's fibres through 9 weeks. In addition, neuropeptide Y was secreted in the nerve-intact group at 6 and 9 weeks. Conclusion This study showed the inferior healing of the bone–tendon junction on the nerve-injured side compared with the nerve-intact side, which indicates that the SSN plays an important role in rotator cuff healing. Surgeons should pay more attention to SSN injury when treating patients with rotator cuff tear.
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Affiliation(s)
- Yucheng Sun
- Department of Hand Surgery, Affiliated Hospital of Nantong University, College of Medicine, University of Nantong, Nantong, China.,Department of Orthopedic Surgery, ASAN Medical Center, College of Medicine, University of Ulsan, Seoul, South Korea
| | - Jae-Man Kwak
- Department of Orthopedic Surgery, ASAN Medical Center, College of Medicine, University of Ulsan, Seoul, South Korea
| | - Youlang Zhou
- Department of Hand Surgery, Affiliated Hospital of Nantong University, College of Medicine, University of Nantong, Nantong, China
| | - Yan Fu
- Department of Interventional Therapy, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Zhe Wang
- Department of Radiology, Tianjin Medical University General Hospital, Tianjin, China
| | - Qingzhong Chen
- Department of Hand Surgery, Affiliated Hospital of Nantong University, College of Medicine, University of Nantong, Nantong, China
| | - In-Ho Jeon
- Department of Orthopedic Surgery, ASAN Medical Center, College of Medicine, University of Ulsan, Seoul, South Korea
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Abstract
Muscle atrophy in shoulders with rotator cuff tendon tears is a negative prognosticator, associated with decreased function, decreased reparability, increased retears after repair, and poorer outcomes after surgery. Muscle edema or atrophy within a neurologic distribution characterizes denervation. Because most nerve entrapments around the shoulder are not caused by mass lesions and show no nerve findings on routine MR imaging sequences, pattern of muscle denervation is often the best clue to predicting location of nerve dysfunction, which narrows the differential diagnosis and guides clinical management. The exception is suprascapular nerve compression in the spinoglenoid notch caused by a compressing cyst.
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Affiliation(s)
- David A Rubin
- All Pro Orthopedic Imaging Consultants, LLC, St Louis, MO, USA; Radsource, Brentwood, TN, USA; NYU Langone Medical Center, New York, NY, USA.
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Le Hanneur M, Maldonado AA, Howe BM, Mauermann ML, Spinner RJ. "Isolated" Suprascapular Neuropathy: Compression, Traction, or Inflammation? Neurosurgery 2019. [PMID: 29529303 DOI: 10.1093/neuros/nyy050] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Several hypotheses have been proposed for the pathophysiology of suprascapular nerve (SSN) palsy, including compression, traction, and nerve inflammation. OBJECTIVE To provide insight into the pathophysiology of isolated nontraumatic SSN palsy by performing critical reinterpretations of electrodiagnostic (EDX) studies and magnetic resonance (MR) images of patients with such diagnosis. METHODS We retrospectively reviewed all patients referred to our institution for the past 20 yr with a diagnosis of nontraumatic isolated suprascapular neuropathy who had an upper extremity EDX study and a shoulder or brachial plexus MR scan. Patient charts were reviewed to analyze their initial clinical examination, and their original EDX study and MR images were reinterpreted by an experienced neurologist and a musculoskeletal radiologist, respectively, both blinded from the authors' hypothesis and from each other's findings. RESULTS Fifty-nine patients were included. Fifty of them (85%) presented with at least 1 finding that was inconsistent with an isolated SSN palsy. Forty patients (68%) had signs on physical examination beyond the SSN distribution. Thirty-one patients (53%) had abnormalities on their EDX studies not related to the SSN. Twenty-two patients (37%) had denervation atrophy in other muscles than the spinati, or neural hyperintensity in other nerves than the SSN on their MR scans, without any evidence of SSN extrinsic compression. CONCLUSION The great majority of patients with presumed isolated SSN palsy had clinical, electrophysiological, and/or imaging evidence of a more diffuse pattern of neuromuscular involvement. These data strongly support an inflammatory pathophysiology in many cases of "isolated" SSN palsy.
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Affiliation(s)
- Malo Le Hanneur
- Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota.,De-partment of Orthopedics and Trauma-tology - Service of Hand, Upper Limb, and Peripheral Nerve Surgery, Georges-Pompidou European Hospital (HEGP), Assistance Publique - Hôpitaux de Paris (APHP), Paris, France
| | - Andres A Maldonado
- Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota.,Department of Plastic, Hand, and Reconstructive Sur-gery, BG Unfallklinik Frankfurt, Frankfurt, Germany
| | | | | | - Robert J Spinner
- Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota
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Surya P, Pankhania R, Ul Islam S. Suprascapular Neuropathy in Overhead Athletes: A Systematic Review of Aetiology and Treatment Options. Open Orthop J 2019. [DOI: 10.2174/1874325001913010177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/22/2023] Open
Abstract
Suprascapular neuropathy is often overlooked as a cause for shoulder pain in overhead athletes and can be misdiagnosed for many months, even years. With recent advancements in the understanding of the condition as well as its treatment methods, suprascapular neuropathy is now being diagnosed more frequently. However with a multitude of treatment options, it can be difficult to choose the optimal management. In this systematic review, we have carried out a detailed literature search about suprascapular neuropathy looking into evidence-based diagnostic workup and treatment modalities available. Repetitive overhead activities, rotator cuff tear and direct compression of the nerve by space-occupying lesion are important etiologies for suprascapular neuropathy. Whilst MRI is widely used for the identification of space-occupying lesions and rotator cuff injury; Electromyography (EMG) and Nerve Conduction Studies (NCS) remain gold standards for confirming injury to the nerve. Conservative treatment modalities including physiotherapy and activity modification, nerve blocks, arthroscopic and open surgical interventions are the main treatment options for suprascapular neuropathy.
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36
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Memon AB, Dymm B, Ahmad BK, Sripathi N, Schultz L, Chandok A. Suprascapular neuropathy: A review of 87 cases. Muscle Nerve 2019; 60:250-253. [DOI: 10.1002/mus.26630] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Revised: 07/04/2019] [Accepted: 07/05/2019] [Indexed: 12/17/2022]
Affiliation(s)
- Anza B. Memon
- Department of NeurologyHenry Ford Hospital Detroit Michigan
- School of MedicineWayne State University Detroit Michigan
| | - Braydon Dymm
- Department of NeurologyUniversity of Michigan Ann Arbor Michigan
| | | | - Naganand Sripathi
- Department of NeurologyHenry Ford Hospital Detroit Michigan
- School of MedicineWayne State University Detroit Michigan
| | - Lonni Schultz
- Department of NeurologyHenry Ford Hospital Detroit Michigan
| | - Arun Chandok
- Department of NeurologyHenry Ford Hospital Detroit Michigan
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37
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Spinner RJ, Hanna AS, Maldonado AA, Wilson TJ. Peripheral Nerve. Oper Neurosurg (Hagerstown) 2019; 17:S229-S255. [DOI: 10.1093/ons/opz072] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Accepted: 02/13/2019] [Indexed: 11/13/2022] Open
Affiliation(s)
- Robert J Spinner
- Department of Neurologic Surgery, Mayo Clinic, Rochester Minnesota
| | - Amgad S Hanna
- Department of Neurosurgery, University of Wisconsin, Madison, Wisconsin
| | - Andrés A Maldonado
- Department of Plastic, Hand, and Reconstructive Surgery, BG Unfallklinik, Frankfurt, Germany
| | - Thomas J Wilson
- Department of Neurosurgery, Stanford University, Stanford, California
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Small KM, Adler RS, Shah SH, Roberts CC, Bencardino JT, Appel M, Gyftopoulos S, Metter DF, Mintz DN, Morrison WB, Subhas N, Thiele R, Towers JD, Tynus KM, Weissman BN, Yu JS, Kransdorf MJ. ACR Appropriateness Criteria ® Shoulder Pain-Atraumatic. J Am Coll Radiol 2019; 15:S388-S402. [PMID: 30392607 DOI: 10.1016/j.jacr.2018.09.032] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Accepted: 09/07/2018] [Indexed: 01/25/2023]
Abstract
Shoulder pain is one of the most common reasons for musculoskeletal-related physician visits. Imaging plays an important role in identifying the specific cause of atraumatic shoulder pain. This review is divided into two parts. The first part provides a general discussion of various imaging modalities (radiographs, arthrography, nuclear medicine, ultrasound, CT, and MRI) and their usefulness in evaluating atraumatic shoulder pain. The second part focuses on the most appropriate imaging algorithms for specific shoulder conditions including: rotator cuff disorders, labral tear/instability, bursitis, adhesive capsulitis, biceps tendon abnormalities, postoperative rotator cuff tears, and neurogenic pain. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.
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Affiliation(s)
| | | | | | - Shaan H Shah
- Research Author, Brigham & Women's Hospital, Boston, Massachusetts
| | | | - Jenny T Bencardino
- Panel Vice-Chair, New York University School of Medicine, New York, New York
| | - Marc Appel
- James J. Peters VA Medical Center, Bronx, New York; American Academy of Orthopaedic Surgeons
| | | | - Darlene F Metter
- University of Texas Health Science Center at San Antonio, San Antonio, Texas
| | | | | | | | - Ralf Thiele
- University of Rochester School of Medicine and Dentistry, Rochester, New York; American College of Rheumatology
| | - Jeffrey D Towers
- University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Katherine M Tynus
- Northwestern Memorial Hospital, Chicago, Illinois; American College of Physicians
| | | | - Joseph S Yu
- The Ohio State University Wexner Medical Center, Columbus, Ohio
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Ohanisian L, Brown N, White SD, Rubay D, Schwartz PM. Persistent Shoulder Pain Due to a Suprascapular Nerve Injury in the Setting of Trauma. Cureus 2019; 11:e4224. [PMID: 31123646 PMCID: PMC6510660 DOI: 10.7759/cureus.4224] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Suprascapular neuropathy is a rare cause of shoulder pain with an injury to the nerve intrinsically related to the anatomy and course of the suprascapular nerve. The common etiologies of a suprascapular nerve injury include repetitive overhead activity, rotator cuff pathology, and compression of the nerve at either the suprascapular or the spinoglenoid notch secondary to space-occupying lesions. Although uncommon, suprascapular nerve damage has been associated with scapular fractures previously. However, there is a scarcity of literature describing a suprascapular nerve injury as the etiology of persistent shoulder pain after trauma. We present the case of a 52-year-old male who was struck by a motor vehicle, suffered a scapular fracture, and developed persistent shoulder pain secondary to a suprascapular nerve injury diagnosed 15 months post trauma.
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Affiliation(s)
- Levonti Ohanisian
- Internal Medicine, Florida Atlantic University Charles E. Schmidt College of Medicine, Boca Raton, USA
| | - Nicholas Brown
- Physical Medicine and Rehabilitation, Florida Atlantic University Charles E. Schmidt College of Medicine, Boca Raton, USA
| | | | - David Rubay
- Surgery, Florida Atlantic University Charles E. Schmidt College of Medicine, Boca Raton, USA
| | - Paul M Schwartz
- Internal Medicine, Florida Atlantic University Charles E. Schmidt College of Medicine, Boca Raton, USA
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Katsuura Y, Hill AJ, Colón LF, Dorizas JA. MRI diagnosis of suprascapular neuropathy using spinoglenoid notch distension. Radiol Med 2019; 124:643-652. [PMID: 30835024 DOI: 10.1007/s11547-019-01005-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Accepted: 02/11/2019] [Indexed: 11/30/2022]
Abstract
PURPOSE To assess the use of a spinoglenoid notch distension measurement as a radiographic marker on MRI to aid the diagnosis of suprascapular neuropathy. METHODS Spinoglenoid notch distension was compared on MRI by blinded independent observers for two patient cohorts: one group with an electromyography/nerve conduction study confirmed diagnosis of suprascapular neuropathy who underwent arthroscopic suprascapular nerve decompression, and a control group of patients aged 18-30 years with a normal shoulder MRI. RESULTS Sixty suprascapular nerve patients (average age 52 years) were compared to 47 control patients (average age 24 years). Intra-rater and inter-rater reliability showed excellent agreement between reviewers for all measurements. There was a significant difference in the mean spinoglenoid notch distension for the SSN group (m = 8.36, SD = 2.42) compared to the control group (m = 5.7, SD = 1.56); [t(212) = 9.40, p < 0.0001]. CONCLUSION The spinoglenoid notch distension is significantly increased in patients with suprascapular neuropathy. We hypothesize that hypertrophy of the transverse scapular ligament creates a venous obstruction resulting in varicosities of the suprascapular vein which runs with the nerve under the ligament. This distends the spinoglenoid notch and can be enlarged in cases of suprascapular neuropathy which is evident on MRI.
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Affiliation(s)
- Yoshihiro Katsuura
- Department of Orthopaedic Surgery, University of Tennessee College of Medicine, Chattanooga, 975 East Third St., Hospital Box 260, Chattanooga, TN, 37403, USA.
| | - Andrew J Hill
- Department of Radiology, Erlanger University Hospital, Chattanooga, USA
| | | | - John A Dorizas
- Department of Orthopaedic Surgery, University of Tennessee College of Medicine, Chattanooga, 975 East Third St., Hospital Box 260, Chattanooga, TN, 37403, USA
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Isolated Infraspinatus Atrophy Secondary to Suprascapular Nerve Neuropathy Results in Altered Shoulder Muscles Activity. J Sport Rehabil 2019; 28:219-228. [DOI: 10.1123/jsr.2017-0232] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Context: Isolated infraspinatus atrophy (IIA) is a common condition among overhead activity athletes, which affects the hitting shoulder and is caused by suprascapular nerve injury. The loss of infraspinatus function could lead to altered activity of the glenohumeral and scapulothoracic (ST) muscles and compromise the optimal shoulder function. Objective: To assess the surface electromyographic (sEMG) activity patterns, relationships, and response latencies of relevant shoulder girdle muscles in professional volleyball players with IIA and in healthy control players. Design: Cross-sectional study. Setting: Research laboratory. Patients or Other Participants: Twenty-four male professional volleyball players (12 players with diagnosed IIA and 12 healthy players) recruited from local volleyball teams. Intervention(s): sEMG activity of anterior, middle, and posterior deltoid; upper, middle, and lower trapezius; and serratus anterior (SA) was recorded and evaluated during a movement of shoulder abduction in the scapular plane, monitored with an optoelectronic motion capture system. Main Outcome Measure(s): sEMG activity, relationships, and response latencies of the selected muscles were analyzed with analysis of variance models to highlight statistical differences within and between groups. Results: Athletes with IIA demonstrated significant higher deltoid and trapezius muscles activity and lower SA activity compared with the contralateral shoulder and healthy athletes. The shoulder with IIA also showed a higher activity ratio between the upper trapezius and other ST muscles in addition to anticipated activation of the upper trapezius and delayed activation of the SA, with regard to the onset of shoulder movement. Conclusions: This study highlighted altered shoulder muscle activity levels, ST muscles imbalances, and abnormal ST recruitment patterns in the hitting shoulder of professional volleyball players with IIA, secondary to suprascapular nerve neuropathy. Such shoulder girdle muscles’ impairments may compromise the optimal scapulohumeral rhythm and function, increasing the risk of acute and overuse shoulder injuries.
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42
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Coory JA, Parr AF, Wilkinson MP, Gupta A. Efficacy of suprascapular nerve block compared with subacromial injection: a randomized controlled trial in patients with rotator cuff tears. J Shoulder Elbow Surg 2019; 28:430-436. [PMID: 30651194 DOI: 10.1016/j.jse.2018.11.051] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2018] [Revised: 11/04/2018] [Accepted: 11/09/2018] [Indexed: 02/01/2023]
Abstract
HYPOTHESIS We aimed to compare the clinical efficacy of a suprascapular nerve block (SSNB) versus subacromial injection (SA) for outpatient treatment of patients with symptomatic rotator cuff tears in a double-blinded, randomized controlled trial using sealed-envelope randomization. METHODS A total of 42 participants with symptomatic partial- and full-thickness rotator cuff tears quantified by ultrasound or magnetic resonance imaging received either an ultrasound-guided SSNB or SA. The primary outcome measure was shoulder function measured by the modified Constant-Murley (CM) score and the secondary outcome was the pain score measured by a visual analog scale at 2, 6, and 12 weeks after injection. RESULTS We analyzed 43 shoulders (27 in male patients, 62.2%). The mean age was 65.2 years (standard deviation [SD], 11.9 years). Of the shoulders, 22 (51.2%) underwent SAs and 21 (48.8%) underwent SSNBs. Continuous variables were analyzed by an independent t test (2 tailed), and nominal data were analyzed by the Fisher exact test (1 sided). At 6 weeks, the mean change from the baseline CM score was significantly higher in the SSNB group than in the SA group (14.3 [SD, 18.1] vs 3.0 [SD, 12.8]; P = .048). At 12 weeks' follow-up, the SSNB group had a significantly higher CM score than the SA group (57.6 [SD, 10] vs 44.6 [SD, 16]; P = .023) and greater improvement from the baseline CM score (23.4 [SD, 17.5] vs 7.8 [SD, 16.5]; P = .014). At 12 weeks, the visual analog scale score was significantly better in the SSNB group than in the SA cohort (9.9 [SD, 3.3] vs 7.3 [SD, 4.3]; P = .03). CONCLUSIONS This study demonstrates that an SSNB resulted in better pain and functional results than an SA at 6 and 12 weeks for symptomatic rotator cuff tears.
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Affiliation(s)
| | - Adam F Parr
- Townsville Hospital, Douglas, QLD, Australia
| | | | - Ashish Gupta
- Townsville Hospital, Douglas, QLD, Australia; Greenslopes Private Hospital, Brisbane, QLD, Australia
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Phillips CJ, Field AC, Field LD. Transcapsular Decompression of Shoulder Ganglion Cysts. Arthrosc Tech 2018; 7:e1263-e1267. [PMID: 30591872 PMCID: PMC6305895 DOI: 10.1016/j.eats.2018.08.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Accepted: 08/03/2018] [Indexed: 02/03/2023] Open
Abstract
Paralabral cysts are an increasingly recognized cause of suprascapular nerve (SSN) impingement, often causing insidious weakness in the rotator cuff. Compression at the suprascapular notch is often due to the presence of a SLAP tear and leads to pain, weakness, and atrophy of both the supraspinatus and infraspinatus muscles. Compression of the SSN at the spinoglenoid notch leads to weakness and atrophy of the infraspinatus only. Arthroscopic decompression of cysts with repair of labral pathology is typically performed in a sublabral fashion, which may make visualization of the extent of the cyst difficult and places the SSN at increased risk. With any approach, an intimate knowledge of the anatomy of the SSN is vital to safe decompression. We present a surgical technique for decompression of paralabral cysts using an intra-articular transcapsular approach. This approach maximizes visualization and efficiency and reduces possible damage to the SSN.
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Affiliation(s)
| | | | - Larry D. Field
- Address correspondence to Larry D. Field, M.D., Mississippi Sports Medicine and Orthopaedic Center, 1325 E Fortification St, Jackson, MS 39202, U.S.A.
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Sensorimotor Control of the Shoulder in Professional Volleyball Players With Isolated Infraspinatus Muscle Atrophy. J Sport Rehabil 2018; 27:371-379. [PMID: 28605232 DOI: 10.1123/jsr.2016-0183] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
CONTEXT Isolated infraspinatus muscle atrophy (IIMA) affects only the hitting shoulder of overhead-activity athletes and is caused by suprascapular nerve neuropathy. No study has assessed the static and dynamic stability of the shoulder in overhead professional athletes with IIMA to reveal possible shoulder sensorimotor alterations. OBJECTIVE To assess the shoulder static stability, dynamic stability, and strength in professional volleyball players with IIMA and in healthy control players. DESIGN Cross-sectional study. SETTING Research lab. PATIENTS OR OTHER PARTICIPANTS A total of 24 male professional volleyball players (12 players with diagnosed IIMA and 12 healthy players) recruited from local volleyball teams. INTERVENTION(S) Static stability was evaluated with 2 independent force platforms, and dynamic stability was assessed with the "Upper Quarter Y Balance Test." MAIN OUTCOME MEASURE(S) The static stability assessment was conducted in different support (single hand and both hands) and vision (open and closed eyes) conditions. Data from each test were analyzed with analysis of variance and paired t-test models to highlight statistical differences within and between groups. RESULTS In addition to reduced abduction and external rotation strength, athletes with IIMA consistently demonstrated significant less static (P < .001) and dynamic stability (P < .001), compared with the contralateral shoulder and with healthy athletes. Closed eyes condition significantly enhanced the static stability deficit of the shoulder with IIMA (P = .04 and P = .03 for both hand and single hand support, respectively) but had no effect on healthy contralateral and healthy players' shoulders. CONCLUSIONS This study highlights an impairment of the sensorimotor control system of the shoulder with IIMA, which likely results from both proprioceptive and strength deficits. This condition could yield subtle alteration in the functional use of the shoulder and predispose it to acute or overuse injuries. The results of this study may help athletic trainers and physical/physiotherapists to prevent shoulder injuries and create to specific proprioceptive and neuromuscular training programs.
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Kim JY, Rhee YG. The prevalence and morphometric analysis of ossified superior transverse scapular ligaments in patients with rotator cuff tears. J Shoulder Elbow Surg 2018; 27:1044-1050. [PMID: 29325703 DOI: 10.1016/j.jse.2017.11.027] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2017] [Revised: 11/08/2017] [Accepted: 11/14/2017] [Indexed: 02/01/2023]
Abstract
BACKGROUND The prevalence of ossified superior transverse scapular ligaments (OSTSLs) in rotator cuff tears (RCTs) has not yet been determined. The purposes of this study were to evaluate the prevalence of OSTSLs in RCTs and to investigate the correlation between OSTSL morphology and supraspinatus muscle atrophy. METHODS We analyzed a total of 213 patients with RCTs for whom 3-dimensional (3D) computed tomography (CT) and magnetic resonance imaging were performed prior to arthroscopic procedures. The mean age of the patients was 59.73 ± 8.43 years, and 103 patients were men. OSTSLs were identified based on 3D CT findings. The correlations between OSTSLs and age, sex, and RCT size were analyzed. The horizontal and vertical diameters, area, and circumference of the suprascapular foramen were measured. By use of the occupation ratio calculated from magnetic resonance imaging results, supraspinatus muscle atrophy was evaluated. RESULTS Of 213 patients with RCTs, 22 (10.3%) had OSTSLs. OSTSLs were found at a rate of 15.5% (16 of 103) in men, higher than that in women (P = .016). The rate of OSTSLs increased with age (P = .003). RCT size was not correlated with the prevalence of OSTSLs. As the horizontal diameter and circumference of the suprascapular foramen increased, muscle atrophy progressed (P = .001 and P = .046, respectively). CONCLUSION One of ten patients with RCTs had OSTSLs; the rate of OSTSLs was higher among men and increased with age. For patients with RCTs preparing to undergo arthroscopic superior transverse ligament resection, preoperatively identifying OSTSLs through 3D CT would be useful for the resection.
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Affiliation(s)
- Jung Youn Kim
- Department of Orthopaedic Surgery, Hangang Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Republic of Korea
| | - Yong Girl Rhee
- Shoulder & Elbow Clinic, Department of Orthopaedic Surgery, College of Medicine, Kyung Hee University, Seoul, Republic of Korea.
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Abstract
In the past 30 years, the use of ultrasonography in the field of orthopaedics has evolved. As ultrasonography has been refined, smaller machines with higher fidelity and better transducers have become available at a lower cost. Diagnostic and therapeutic applications of ultrasonography in the shoulder and elbow have expanded imaging options and provided alternatives to surgical management. Ultrasonography is a dynamic tool that affords immediate diagnostic assessment for clinical correlation and can be used for serial examinations and image guidance during therapeutic procedures. This imaging modality is highly reliable and accurate and may limit the need for costly imaging referrals, particularly in geographic areas where advanced imaging is not readily available. However, clinical expertise is paramount for ultrasonography, which is an operator-dependent modality. Ultrasonography is an effective educational resource; therefore, the curriculum in orthopaedic residency training programs should include education on this modality as the use of ultrasonography increases among orthopaedic surgeons.
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Kowalczuk M, Lin A. Isolated suprascapular mononeuropathy following nondisplaced scapular fracture. J Shoulder Elbow Surg 2018; 27:e50-e53. [PMID: 29217421 DOI: 10.1016/j.jse.2017.09.038] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2017] [Accepted: 09/24/2017] [Indexed: 02/01/2023]
Affiliation(s)
- Marcin Kowalczuk
- Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, PA, USA
| | - Albert Lin
- Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, PA, USA.
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Hourglass-like constriction of the suprascapular nerve: a contraindication for minimally invasive surgery. J Shoulder Elbow Surg 2018; 27:e29-e37. [PMID: 29102255 DOI: 10.1016/j.jse.2017.08.021] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2017] [Revised: 08/17/2017] [Accepted: 08/28/2017] [Indexed: 02/01/2023]
Abstract
BACKGROUND Suprascapular nerve (SSN) entrapment is usually ascribed to static or dynamic compression. When no cause of compression is found, SSN entrapment is defined as idiopathic. Focal hourglass-like constriction (H-LC) of the SSN that results in muscle paralysis represents an unusual condition that may be misinterpreted and erroneously diagnosed as SSN entrapment or as neuralgic amyotrophy. METHODS With the aim of finding clinical and surgical clues that could differentiate the traditional form of idiopathic SSN entrapment from the rare H-LC, a series of 6 cases of SSN palsy caused by H-LC is presented. RESULTS All but 1 supraspinatus muscle recovered M5 muscle strength. The Constant shoulder score was excellent in 3 patients, good in 1, fair in 1, and poor in 1. DISCUSSION If a diagnosis is not made in time, H-LC may evolve from mild to severe nerve torsion that may require a shift in surgical procedure from epineurotomy and external neurolysis to focal resection and suture. If an incorrect therapy is chosen, the chance of recovery might be definitively compromised with the persistence of muscle palsy. Conversely, when SSN palsy persists despite notch decompression, especially when it is performed with a limited open approach or arthroscopically, concerns about the real etiology and location of nerve compression responsible for the nerve palsy may arise. CONCLUSION When approaching SSN pathology, H-LC should be considered as a potential cause of nerve palsy, as it may represent a contraindication for a limited open approach or arthroscopic decompression.
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Memon M, Kay J, Ginsberg L, Simunovic N, Bak K, Lapner P, Ayeni OR. Arthroscopic management of suprascapular neuropathy of the shoulder improves pain and functional outcomes with minimal complication rates. Knee Surg Sports Traumatol Arthrosc 2018; 26:240-266. [PMID: 28879607 DOI: 10.1007/s00167-017-4694-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2017] [Accepted: 08/21/2017] [Indexed: 01/02/2023]
Abstract
PURPOSE The purpose of this study was to systematically assess the arthroscopic management of suprascapular neuropathy, including the aetiology, surgical decision-making, clinical outcomes, and complications associated with the procedure. METHODS Three databases [PubMed, Ovid (Medline), and Embase] were searched. Systematic literature screening and data abstraction was performed in duplicate to present a review of studies reporting on arthroscopic management of suprascapular neuropathy. The quality of the included studies was assessed using level of evidence and the MINORS (Methodological Index for Nonrandomized Studies) checklist. RESULTS In total, 40 studies (17 case reports, 20 case series, 2 retrospective comparative studies, and 1 prospective comparative study) were identified, including 259 patients (261 shoulders) treated arthroscopically for suprascapular neuropathy. The most common aetiology of suprascapular neuropathy was suprascapular nerve compression by a cyst at the spinoglenoid notch (42%), and the decision to pursue arthroscopic surgery was most commonly based on the results of clinical findings and investigations (47%). Overall, 97% of patients reported significant improvement in or complete resolution of their pre-operative symptoms (including pain, strength, and subjective function of the shoulder) over a mean follow-up period of 23.7 months. Further, there was a low overall complication rate (4%) associated with the arthroscopic procedures. CONCLUSION While most studies evaluating arthroscopic management of suprascapular neuropathy are uncontrolled studies with lower levels of evidence, results indicate that such management provides patients with significant improvements in pain, strength, and subjective function of the shoulder, and has a low incidence of complications. Patients managed arthroscopically for suprascapular neuropathy may expect significant improvements in pain, strength, and subjective function of the shoulder. LEVEL OF EVIDENCE Level IV, systematic review of level II to IV studies.
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Affiliation(s)
- M Memon
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada
| | - J Kay
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada
| | - L Ginsberg
- Department of Life Sciences, McMaster University, Hamilton, ON, Canada
| | - N Simunovic
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada
| | - K Bak
- Sports Clinic, Aleris-Hamlet Parken, Oester Alle 42, 2nd Floor, Copenhagen, Denmark
| | - P Lapner
- Division of Orthopaedic Surgery, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON, Canada
| | - O R Ayeni
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University Medical Centre, McMaster University, 1200 Main St West, 4E15, Hamilton, ON, L8N 3Z5, Canada.
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Sirlyn Q. Compression neuropathy as a cause for painful shoulder. SONOGRAPHY 2017. [DOI: 10.1002/sono.12121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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