Morphometry and Contents of the Suprascapular Notch with Potential Clinical Implications: Α Cadaveric Study

Abstract Background The suprascapular notch (SN) represents the point along the route of the suprascapular nerve (SSN) with the greatest potential risk for injury and compression. Thus, factors reducing the area of the notch have been postulated for suprascapular neuropathy development. Methods Thirty-one fresh-frozen shoulders were dissected. The contents of the SN were described according to four types as classified by Polguj et al and the middle-transverse diameter of the notch was measured. Also, the presence of an ossified superior transverse scapular ligament (STSL) was identified. Results The ligament was partially ossified in 8 specimens (25.8%), fully ossified in 6 (19.35%), and not ossified in the remaining 17 (54.85%). The mean middle-transverse diameter of the SN was 9.06 mm (standard deviation [SD] = 3.45). The corresponding for type-I notches was 8.64 mm (SD = 3.34), 8.86 mm (SD = 3.12) was for type-II, and 14.5 mm (SD = 1.02) was for type III. Middle-transverse diameter was shorter when an ossified ligament was present (mean = 5.10 mm, SD = 0.88 mm), comparing with a partially ossified ligament (mean =7.67 mm, SD = 2.24 mm) and a nonossified one (mean = 11.12 mm, SD = 2.92 mm). No statistically significant evidence was found that the middle-transverse diameter depends on the number of the elements, passing below the STSL. Conclusion Our results suggest that SSN compression could be more likely to occur when both suprascapular vessels pass through the notch. Compression of the nerve may also occur when an ossified transverse scapular ligament is present, resulting to significant reduction of the notch's area.

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The Influence of Suprascapular Notch Shape on the Visualization of Structures in the Suprascapular Notch Region: Studies Based on a New Four-Stage Ultrasonographic Protocol

BioMed Research International ◽

10.1155/2017/5323628 ◽

2017 ◽

Vol 2017 ◽

pp. 1-7 ◽

Cited By ~ 8

Author(s):

Hubert Jezierski ◽

Michał Podgórski ◽

Ludomir Stefańczyk ◽

David Kachlik ◽

Michał Polguj

Keyword(s):

Color Doppler ◽

Suprascapular Nerve ◽

Point Of View ◽

Transverse Diameter ◽

Type I ◽

Type Ii ◽

Suprascapular Notch ◽

Type Iii ◽

Type Iv ◽

Clinical Point

Evaluation of the morphology of the suprascapular notch region is important from a clinical point of view because it is the most common site of suprascapular nerve compression and injury. A group of 120 patients underwent ultrasound examination of the suprascapular notch region according to our original four-stage “step-by-step” protocol. The notches were classified based on their morphology and measurements like maximal depth (MD) and superior transverse diameter (STD) as follows: type I-MD is longer than STD, type II-MD and STD are equal, type III-STD is longer than MD, and in type IV/V-notches only the bony margin was visualized without depression. Both suprascapular notches were fully visualized in 115 of 120 patients. The type III suprascapular notch was the most prevalent (64.2%), followed by type IV/V (18.7%), type I (11.1%), and type II (6.0%). Color Doppler analysis allowed the suprascapular artery to be recognized in all visualized notches. The suprascapular vein was visible in 176 notches and the suprascapular nerve in 150. Notches containing both suprascapular nerve and vein were significantly wider and shallower than average. As the suprascapular artery is the most easily recognised structure in the area, it may serve as a useful landmark of the suprascapular notch.

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Correlations of Scapular Dimensions: A Tool to Identify Scapulae with Completely Ossified Superior Transverse Scapular Ligaments and Suprascapular Neuropathy

10.21203/rs.3.rs-55406/v1 ◽

2020 ◽

Author(s):

Adesanya Olamide Adewale ◽

Okeniran Olatayo Segun ◽

Ibe Michael Usman ◽

Ann Lemuel Monima ◽

Eric Simidi Kegoye ◽

...

Keyword(s):

Suprascapular Nerve ◽

Strong Negative Correlation ◽

Suprascapular Notch ◽

Correlation Studies ◽

Suprascapular Neuropathy ◽

Type Iv ◽

Different Types ◽

Superior Transverse Scapular Ligament ◽

Spearman’S Correlation ◽

One Way Anova

Abstract Background. A better understanding of the anatomy of the suprascapular notch and relationship with scapular dimensions are vital in the diagnosis, prevention, and assessment of the suprascapular nerve (SN) entrapment syndrome. Our purposes were to classify the suprascapular notches, determine the prevalence of completely ossified superior transverse scapular ligament, scapular dimensions, and their relationship among the different types of the suprascapular notch (SSN). Methods: An experimental study in which the SSN types and scapular dimensions were determined using previous methods. Statistical analyses were done using GraphPad Prism v.6 and MS Excel Version 2019, one-way ANOVA was used to compare and Spearman’s correlation coefficient was used to evaluate the correlation of scapular dimensions. Results: The superior transverse scapular ligament (STSL) was completely ossified in 8% of cases. There were no significant differences between the scapular dimensions for the different SSN types. For type VI SSN there is a strong negative correlation between A, B against D. There are strong (positive or negative) correlations between types I and III from type VI for A-axis; types I, III from VI for B; type IV and VI for C axis; and type III and VI for D axis.Conclusions: The prevalence of the completely ossified STSL in our study was moderately high; the correlation studies suggest that the scapular dimensions could be a valuable tool in the prediction, diagnosis, prevention, and assessment of the SN neuropathy due to the scapulae with the completely ossified superior transverse scapular ligaments (type VI SSN). Further studies on correlation analyses of scapular dimensions and characteristics of suprascapular notches are vital.

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Suprascapular Notch Asymmetry: A Study on 311 Patients

BioMed Research International ◽

10.1155/2014/196896 ◽

2014 ◽

Vol 2014 ◽

pp. 1-6

Author(s):

Michał Polguj ◽

Marcin Sibiński ◽

Andrzej Grzegorzewski ◽

Piotr Grzelak ◽

Ludomir Stefańczyk ◽

...

Keyword(s):

Computed Tomography ◽

Significant Degree ◽

Suprascapular Nerve ◽

Type I ◽

Type Ii ◽

Suprascapular Notch ◽

Type Iii ◽

Type Iv ◽

Computed Tomography Scans ◽

Symmetrical Type

The most important risk factor of suprascapular nerve entrapment is probably the shape of the suprascapular notch (SSN). The aim of the study was to perform a radiological study of the symmetry of SSN. Included in the study were 311 patients (137 women and 174 men) who underwent standard computed tomography investigation of the chest. A total of 622 computed tomography scans of scapulae were retrospectively analyzed to classify suprascapular notches into five types. Suprascapular notch was recognized as a symmetrical feature in 53.45% of the patients. Symmetry was more frequently seen in females (54.0% versus 52.9%), but not to any significant degree (P=0.8413). Type III was the most commonly noted symmetrical feature (66.9%) and type II was less common (0.6%). Type III was the most symmetrical type of suprascapular notch, occurring significantly more often as a symmetrical feature in comparison with type I (P<0.0001), type II (P=0.00137), or type IV (P=0.001). Our investigation did not show that the suprascapular notch is a symmetrical feature. However, symmetry was recognized more frequently in the case of type III SSN. No significant differences in symmetry were found with regard to sex.

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Morphological Aspects in Ultrasound Visualisation of the Suprascapular Notch Region: A Study Based on a New Four-Step Protocol

Journal of Clinical Medicine ◽

10.3390/jcm7120491 ◽

2018 ◽

Vol 7 (12) ◽

pp. 491 ◽

Cited By ~ 2

Author(s):

Hubert Jezierski ◽

Michał Podgórski ◽

Grzegorz Wysiadecki ◽

Łukasz Olewnik ◽

Raffaele De Caro ◽

...

Keyword(s):

Suprascapular Nerve ◽

Transverse Diameter ◽

Type I ◽

Suprascapular Notch ◽

Type Iv ◽

Morphological Aspects ◽

Common Location ◽

Suprascapular Nerve Block ◽

The Right ◽

Scapular Notch

Background: Sonographic evaluation of the suprascapular notch (SSN) region is clinically important, because it is the most common location for performing suprascapular nerve block. The aim of the study was to describe the morphology of the SSN region based on ultrasound examination and in accordance with the patients' body mass index (BMI). Material and Methods: The SSN region was sonographically examined in 120 healthy volunteers according to our new four-step protocol. The morphometry of the SSN and the neurovascular bundle was assessed, and patients' BMI were calculated. The shape of the suprascapular notch was classified based on its superior transverse diameter (STD) and maximal depth (MD). Result: The type III scapular notch was the most prevalent (64%). The BMI was higher in type IV/V (27.38 ± 3.76) than in type I (24.77 ± 3.49). However, no significant differences were observed in the distribution of SSN notch types with regard to BMI (p = 0.0536). The suprascapular artery was visualised in all of the recognised SSNs, while the suprascapular vein and nerve were visualised only in 74.9% and 48.1% of the SSNs, respectively. The suprascapular nerve was significantly thicker on the right side (3.5 +/- 1.1 mm) than on the left (1.3 +/- 0.4 mm) (p = 0.001). In contrast, the suprascapular vein (1.5 +/- 0.9 mm) was found to be a significantly wider on the left side than the right (1.2 +/- 0.7 mm) (p = 0.001). Conclusion: Our original four-step sonographic protocol enabled characterising the morphology of the SSN region, despite the SSN notch types. The suprascapular artery is the best sonographic landmark for the suprascapular notch region. No significant differences were found between sides regarding the thickness of the soft tissue above the suprascapular nerve and vessels. Recognition of the SSN morphology is not affected by the BMI.

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MRI-Evaluation of Suprascapular Notch Morphometry and Its Clinical Applications

10.52916/jmrs214036 ◽

2021 ◽

pp. 1-6

Author(s):

Thaer M. Farhan ◽

Huda Rashid Kamoona

Keyword(s):

Suprascapular Nerve ◽

Coracoid Process ◽

Lateral Part ◽

Type I ◽

Transverse Ligament ◽

Suprascapular Notch ◽

Constant Feature ◽

Mri Evaluation ◽

Superior Transverse Scapular Ligament ◽

Superior Border

The suprascapular notch, a depression on the lateral part of the superior border of the scapula, medial to the coracoid process, is covered by the superior transverse scapular ligament, which is converted into a foramen. Sometimes it might be ossified forming a complete osseous foramen. The Suprascapular Notch (SN) served as a passage for the Suprascapular Nerve (SSN). Study the morphology of the suprascapular notch and the suprascapular transverse ligament based on MRI, variations in shape and dimensions of the suprascapular notch. A group of 100 patients underwent MRI examination of the scapular region through the period from 10th July 2019 to 15th Feb 2020. Different morphological types of the suprascapular notch were encountered in the study, the most common type was type III, while type I was less common in the study. The symmetry of the morphological feature of SN bilaterally was seen in 51% of the cases. Conclusively, the symmetry of the suprascapular notch is not a constant feature bilaterally.

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An old friend is better than two new ones? Approaches to market research in the context of digital transformation for the antitrust laws enforcement

Voprosy Ekonomiki ◽

10.32609/0042-8736-2020-6-37-55 ◽

2020 ◽

pp. 37-55 ◽

Cited By ~ 1

Author(s):

A. E. Shastitko ◽

O. A. Markova

Keyword(s):

Business Models ◽

Rapid Development ◽

Digital Transformation ◽

Market Definition ◽

Type I ◽

Type Ii ◽

Digital Platforms ◽

Advantages And Disadvantages ◽

Pass Through ◽

Type Ii Errors

Digital transformation has led to changes in business models of traditional players in the existing markets. What is more, new entrants and new markets appeared, in particular platforms and multisided markets. The emergence and rapid development of platforms are caused primarily by the existence of so called indirect network externalities. Regarding to this, a question arises of whether the existing instruments of competition law enforcement and market analysis are still relevant when analyzing markets with digital platforms? This paper aims at discussing advantages and disadvantages of using various tools to define markets with platforms. In particular, we define the features of the SSNIP test when being applyed to markets with platforms. Furthermore, we analyze adjustment in tests for platform market definition in terms of possible type I and type II errors. All in all, it turns out that to reduce the likelihood of type I and type II errors while applying market definition technique to markets with platforms one should consider the type of platform analyzed: transaction platforms without pass-through and non-transaction matching platforms should be tackled as players in a multisided market, whereas non-transaction platforms should be analyzed as players in several interrelated markets. However, if the platform is allowed to adjust prices, there emerges additional challenge that the regulator and companies may manipulate the results of SSNIP test by applying different models of competition.

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Minimal Invasive Surgery for Gastroesophageal Reflux Disease and Hiatus Hernia—Our Experience: A Case Series with Review of Literature

International Journal of Recent Surgical and Medical Sciences ◽

10.1055/s-0041-1731115 ◽

2021 ◽

Author(s):

Rafique Umer Harvitkar ◽

Abhijit Joshi

Keyword(s):

Retrospective Study ◽

Gastroesophageal Reflux Disease ◽

Gastroesophageal Reflux ◽

Operating Time ◽

Type I ◽

Type Ii ◽

The Mean ◽

Gerd Symptoms

Abstract Introduction Laparoscopic fundoplication (LF) has almost completely replaced the open procedure performed for gastroesophageal reflux disease (GERD) and hiatus hernia (HH). Several studies have suggested that long-term results with surgery for GERD are better than a medical line of management. In this retrospective study, we outline our experience with LF over 10 years. Also, we analyze the factors that would help us in better patient selection, thereby positively affecting the outcomes of surgery. Patients and Methods In this retrospective study, we identified 27 patients (14 females and 13 males) operated upon by a single surgeon from 2010 to 2020 at our institution. Out of these, 25 patients (12 females and 13 males) had GERD with type I HH and 2 (both females) had type II HH without GERD. The age range was 24 to 75 years. All patients had undergone oesophago-gastro-duodenoscopy (OGD scopy). A total of 25 patients had various degrees of esophagitis. Two patients had no esophagitis. These patients were analyzed for age, sex, symptoms, preoperative evaluation, exact procedure performed (Nissen’s vs. Toupet’s vs. cruroplasty + gastropexy), morbidity/mortality, and functional outcomes. They were also reviewed to examine the length of stay, length of procedure, complications, and recurrent symptoms on follow-up. Symptoms were assessed objectively with a score for six classical GERD symptoms preoperatively and on follow-up at 1-, 4- and 6-weeks postsurgery. Further evaluation was performed after 6 months and then annually for 2 years. Results 14 females (53%) and 13 males (48%) with a diagnosis of GERD (with type I HH) and type II HH were operated upon. The mean age was 46 years (24–75 years) and the mean body mass index (BMI) was 27 (18–32). The range of duration of the preoperative symptoms was 6 months to 2 years. The average operating time dropped from 130 minutes for the first 12 cases to 90 minutes for the last 15 cases. The mean hospital stay was 3 days (range: 2–4 days). In the immediate postoperative period, 72% (n = 18) of the patients reported improvement in the GERD symptoms, while 2 (8%) patients described heartburn (grade I, mild, daily) and 1 (4%) patient described bloating (grade I, daily). A total of 5 patients (20%) reported mild dysphagia to solids in the first 2 postoperative weeks. These symptoms settled down after 2 to 5 weeks of postoperative proton-pump inhibitor (PPI) therapy and by adjusting consistency of oral feeds. There was no conversion to open, and we observed no perioperative mortality. There were no patients who underwent redo surgeries in the series. Conclusion LF is a safe and highly effective procedure for a patient with symptoms of GERD, and it gives long-term relief from the symptoms. Stringent selection criteria are necessary to optimize the results of surgery. Experience is associated with a significant reduction of operating time.

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Split spinal cord malformations in children

Journal of Neurosurgery ◽

10.3171/jns.1998.88.1.0057 ◽

1998 ◽

Vol 88 (1) ◽

pp. 57-65 ◽

Cited By ~ 72

Author(s):

Yusuf Ersşahin ◽

Saffet Mutluer ◽

Sevgül Kocaman ◽

Eren Demirtasş

Keyword(s):

Spinal Cord ◽

Neurological Deficits ◽

Single Type ◽

Type I ◽

Type Ii ◽

Content Type ◽

Spinal Lesion ◽

The Mean ◽

Fine Print

Object. The authors reviewed and analyzed information on 74 patients with split spinal cord malformations (SSCMs) treated between January 1, 1980 and December 31, 1996 at their institution with the aim of defining and classifying the malformations according to the method of Pang, et al. Methods. Computerized tomography myelography was superior to other radiological tools in defining the type of SSCM. There were 46 girls (62%) and 28 boys (38%) ranging in age from less than 1 day to 12 years (mean 33.08 months). The mean age (43.2 months) of the patients who exhibited neurological deficits and orthopedic deformities was significantly older than those (8.2 months) without deficits (p = 0.003). Fifty-two patients had a single Type I and 18 patients a single Type II SSCM; four patients had composite SSCMs. Sixty-two patients had at least one associated spinal lesion that could lead to spinal cord tethering. After surgery, the majority of the patients remained stable and clinical improvement was observed in 18 patients. Conclusions. The classification of SSCMs proposed by Pang, et al., will eliminate the current chaos in terminology. In all SSCMs, either a rigid or a fibrous septum was found to transfix the spinal cord. There was at least one unrelated lesion that caused tethering of the spinal cord in 85% of the patients. The risk of neurological deficits resulting from SSCMs increases with the age of the patient; therefore, all patients should be surgically treated when diagnosed, especially before the development of orthopedic and neurological manifestations.

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Automated immunoassays for the autoantibodies to carbamylated or citrullinated telopeptides of type I and II collagens

Clinical Chemistry and Laboratory Medicine (CCLM) ◽

10.1515/cclm-2014-0683 ◽

2015 ◽

Vol 53 (9) ◽

Cited By ~ 1

Author(s):

Jere Häyrynen ◽

Maija Kärkkäinen ◽

Aulikki Kononoff ◽

Leena Arstila ◽

Pia Elfving ◽

...

Keyword(s):

Early Arthritis ◽

Joint Disease ◽

Type I ◽

Type Ii ◽

Newly Diagnosed ◽

Seronegative Arthritis ◽

Inflammatory Joint Disease ◽

Undifferentiated Arthritis ◽

Serum Samples ◽

The Mean

AbstractThe aim of the study was to describe automated immunoassays for autoantibodies to homocitrulline or citrulline containing telopeptides of type I and II collagen in various disease categories in an early arthritis series.Serum samples were collected from 142 patients over 16 years of age with newly diagnosed inflammatory joint disease. All samples were analyzed with an automated inhibition chemiluminescence immunoassay (CLIA) using four different peptide pairs, each consisting of a biotinylated antigen and an inhibiting peptide. Assays were performed with an IDS-iSYS analyzer. Autoantibodies binding to homocitrulline and citrulline containing C-telopeptides of type I (HTELO-I, TELO-I) and type II collagens (HTELO-II, TELO-II) were analyzed.The mean ratio of HTELO-I inhibition in seropositive and seronegative rheumatoid arthritis (RA) was 3.07 (95% CI 1.41–11.60), p=0.003, and in seropositive and seronegative undifferentiated arthritis (UA) 4.90 (1.85–14.49), p<0.001. The respective mean ratios in seropositive and seronegative RA and UA were in TELO-I 8.72 (3.68–58.01), p<0.001 and 3.13 (1.49–6.16), p=0.008, in HTELO-II 7.57 (3.18–56.60), p<0.001 and 2.97 (1.23–6.69), p=0.037, and in TELO-II 3.01 (1.30–9.51), p=0.002 and 3.64 (1.86–7.65), p=0.008. In reactive arthritis, ankylosing spondylitis, psoriatic arthritis and unspecified spondyloarthritis the inhibition levels were similar to those observed in seronegative RA or UA.Autoantibodies binding to homocitrulline or citrulline containing telopeptides of type I and II collagen did not differ significantly. They were highest among patients with seropositive disease and they differentiated seropositive and seronegative arthritis.

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P006: Characterizing patients with newly-diagnosed diabetes mellitus in the emergency department: A one-year health records review

CJEM ◽

10.1017/cem.2017.208 ◽

2017 ◽

Vol 19 (S1) ◽

pp. S79

Author(s):

H. Ali Khan ◽

K. Gushulak ◽

M. Columbus ◽

I.G. Stiell ◽

J.W. Yan

Keyword(s):

Diabetic Ketoacidosis ◽

Type Ii Diabetes ◽

Type I ◽

Type Ii ◽

Newly Diagnosed ◽

Health Records ◽

The Mean ◽

One Year ◽

Diagnosed Diabetes ◽

Newly Diagnosed Diabetes

Introduction: Diabetes mellitus is an increasingly prevalent chronic condition that is usually managed in an outpatient setting. However, the emergency department (ED) plays a crucial role in the management of diabetic patients, particularly for those who are presenting with newly diagnosed diabetes. Little research has been done to characterize the population of patients presenting to the ED with hyperglycemia with no previous diagnosis of diabetes. The objective of this study was to describe the epidemiology, treatment, and outcomes of patients who were newly diagnosed with diabetes in the ED and to compare those with newly diagnosed type I versus type II diabetes. Methods: A one-year health records review of newly diagnosed diabetes patients ≥18 years presenting to one of four tertiary care EDs was conducted. All patients with a discharge diagnosis of hyperglycemia, diabetic ketoacidosis or hyperosmolar hyperglycemic syndrome were screened, but only those who did not have a previous history of diabetes were included. Trained research personnel collected data on patient characteristics, management, disposition, and outcome. Descriptive statistics were used to summarize the data where appropriate. Results: Of 645 patients presenting with hyperglycemia in the study period, 112 (17.4%) were newly diagnosed diabetes patients. Of these patients, 30 (26.8%) were later diagnosed with type I diabetes and 82 (73.2%) were diagnosed with type II diabetes. For the newly diagnosed type I patients the mean (SD) age was 27.6 (9.9) and the mean (SD) age for type II patients was 52.4 (14.1). Of all the new onset patients, 26.8% were diagnosed with diabetic ketoacidosis. The percentage of patients diagnosed with diabetic ketoacidosis was higher in type I than type II (63.3% vs 13.4%; P<0.01). A total of 49 (43.8%) patients were admitted to the hospital, and more patients with type I were admitted compared to those with type II (66.7% vs 35.4 %; P<0.01). Conclusion: Limited research has been done to describe patients newly diagnosed with diabetes in the ED. Patients with type I were found to be more likely to present to the ED with serious symptoms requiring admission to hospital. Our findings demonstrate that the ED may have a strong potential role for improving diabetic care, by providing future opportunities for education and follow-up in the ED to reduce complications, particularly in type I.

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