Double suprascapular foramen: a rare scapular notch variation

Abstract Background and aims : Supra-scapular notch is roofed by superior transverse scapular ligament and converted into a foramen which provides passage for suprascapular nerve. When it is completely ossified that time it manifest as supra-scapular foramen in dry scapulae. Variations of superior transverse scapular ligament include calcification, partial or complete ossification and multiple bands. Presence of this foramen in dry scapulae is considered to be rare. Aim of the study was to verify the prevalence of supra-scapular foramen in Indian dry scapulae. Materials and methods : A total of three fifty dry scapulae were analyzed (Right- 176, Left-174) to see the presence of supra-scapular foramen. Results : In the present study, suprascapular foramen was present in 25 right and in 12 left sided scapulae i.e., 10.57% incidence which is alarming. Conclusion : Present study demonstrates that suprascapular foramen which is the result of complete ossification of superior transverse scapular ligament, is common in Indian population. The anatomical knowledge of this foramen is of extreme importance for clinicians; it can be a risk factor during surgical explorations involving a suprascapular nerve decompression.

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Compression of the Suprascapular Nerve After Fracture of the Scapular Notch

Acta Orthopaedica Scandinavica ◽

10.3109/17453677809050085 ◽

1978 ◽

Vol 49 (4) ◽

pp. 338-340 ◽

Cited By ~ 63

Author(s):

Ludvig Fjeld Solheim ◽

Asbjørn Roaas

Keyword(s):

Suprascapular Nerve ◽

Scapular Notch

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Morphological and Radiological Study of Ossified Superior Transverse Scapular Ligament as Potential Risk Factor of Suprascapular Nerve Entrapment

BioMed Research International ◽

10.1155/2014/613601 ◽

2014 ◽

Vol 2014 ◽

pp. 1-7 ◽

Cited By ~ 13

Author(s):

Michał Polguj ◽

Marcin Sibiński ◽

Andrzej Grzegorzewski ◽

Michał Waszczykowski ◽

Agata Majos ◽

...

Keyword(s):

Risk Factor ◽

Potential Risk ◽

Suprascapular Nerve ◽

Nerve Entrapment ◽

Potential Risk Factor ◽

Suprascapular Notch ◽

Suprascapular Nerve Entrapment ◽

Suprascapular Foramen ◽

The Right ◽

Superior Transverse Scapular Ligament

The suprascapular notch is covered superiorly by the superior transverse scapular ligament. This region is the most common place of suprascapular nerve entrapment formation. The study was performed on 812 specimens: 86 dry scapulae, 104 formalin-fixed cadaveric shoulders, and 622 computer topography scans of scapulae. In the cases with completely ossified superior transverse scapular ligament, the following measurements were performed: proximal and distal width of the bony bridge, middle transverse and vertical diameter of the suprascapular foramen, and area of the suprascapular foramen. An ossified superior transverse scapular ligament was observed more often in men and in the right scapula. The mean age of the subjects with a completely ossified superior transverse scapular ligament was found to be similar than in those without ossification. The ossified band-shaped type of superior transverse scapular ligament was more common than the fan-shaped type and reduced the space below the ligament to a significantly greater degree. The ossified band-shaped type should be taken into consideration as a potential risk factor in the formation of suprascapular nerve entrapment. It could explain the comparable frequency of neuropathy in various populations throughout the world despite the significant differences between them in occurrence of ossified superior transverse scapular ligament.

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Landmarks for Identifying the Suprascapular Foramen Anteriorly: Application to Anterior Neurotization and Decompressive Procedures

Operative Neurosurgery ◽

10.1093/ons/opx096 ◽

2017 ◽

Vol 14 (2) ◽

pp. 166-170

Author(s):

Olga V Manouvakhova ◽

Veronica Macchi ◽

Fabian N Fries ◽

Marios Loukas ◽

Raffaele De Caro ◽

...

Keyword(s):

Anterior Approach ◽

Skin Surface ◽

Suprascapular Nerve ◽

Coracoid Process ◽

Average Depth ◽

Suprascapular Foramen ◽

The Mean

Abstract BACKGROUND Additional landmarks for identifying the suprascapular nerve at its entrance into the suprascapular foramen from an anterior approach would be useful to the surgeon. OBJECTIVE To identify landmarks for the identification of this hidden site within an anterior approach. METHODS In 8 adult cadavers (16 sides), lines were used to connect the superior angle of the scapula, the acromion, and the coracoid process tip thus creating an anatomic triangle. The suprascapular nerve's entrance into the suprascapular foramen was documented regarding its position within this anatomical triangle. Depths from the skin surface and specifically from the medial-most point of the clavicular attachment of the trapezius to the suprascapular nerve's entrance into the suprascapular foramen were measured using calipers and a ruler. The clavicle was then fractured and retracted superiorly to verify the position of the nerve's entrance into the suprascapular foramen. RESULTS From the trapezius, the nerve's entrance into the foramen was 3 to 4.2 cm deep (mean, 3.5 cm). The mean distance from the tip of the corocoid process to the suprascapular foramen was 3.8 cm. The angle best used to approach the suprascapular foramen from the surface was 15° to 20°. CONCLUSION Based on our study, an anterior suprascapular approach to the suprascapular nerve as it enters the suprascapular foramen can identify the most medial fibers of the trapezius attachment onto the clavicle and insert a finger at an angle of 15° to 20° laterally and advanced to an average depth of 3.5 cm.

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Suprascapular nerve release for treatment of shoulder and periscapular pain following intracranial spinal accessory nerve injury

Journal of Neurosurgery ◽

10.3171/jns/2008/109/11/0962 ◽

2008 ◽

Vol 109 (5) ◽

pp. 962-966 ◽

Cited By ~ 3

Author(s):

Leandro Pretto Flores

Keyword(s):

Nerve Injury ◽

Soft Tissues ◽

Suprascapular Nerve ◽

Spinal Accessory Nerve ◽

Accessory Nerve ◽

Promising Alternative ◽

Spinal Accessory ◽

Dorsal Branch ◽

Scapular Notch ◽

Surgical Release

Iatrogenic injury to the spinal accessory nerve is one of the most common causes of trapezius muscle palsy. Dysfunction of this muscle can be a painful and disabling condition because scapular winging may impose traction on the soft tissues of the shoulder region, including the suprascapular nerve. There are few reports regarding therapeutic options for an intracranial injury of the accessory nerve. However, the surgical release of the suprascapular nerve at the level of the scapular notch is a promising alternative approach for treatment of shoulder pain in these cases. The author reports on 3 patients presenting with signs and symptoms of unilateral accessory nerve injury following resection of posterior fossa tumors. A posterior approach was used to release the suprascapular nerve at the level of the scapular notch, transecting the superior transverse scapular ligament. All patients experienced relief of their shoulder and scapular pain following the decompressive surgery. In 1 patient the primary dorsal branch of the C-2 nerve root was transferred to the extracranial segment of the accessory nerve, and in the other 2 patients a tendon transfer (the Eden–Lange procedure) was used. Results from this report show that surgical release of the suprascapular nerve is an effective treatment for shoulder and periscapular pain in patients who have sustained an unrepairable injury to the accessory nerve.

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Motor Recovery of the Suprascapular Nerve after Arthroscopic Decompression in the Scapular Notch – a Systematic Review

Zeitschrift für Orthopädie und Unfallchirurgie ◽

10.1055/a-1128-0557 ◽

2020 ◽

Cited By ~ 2

Author(s):

Marius von Knoch ◽

Stephan Frosch ◽

Mike H. Baums ◽

Wolfgang Lehmann

Keyword(s):

Systematic Review ◽

Case Series ◽

Clinical Results ◽

Suprascapular Nerve ◽

Motor Recovery ◽

Cochrane Library ◽

Suprascapular Notch ◽

Compression Syndrome ◽

Pubmed Database ◽

Scapular Notch

Abstract Background The suprascapular nerve can be compromised as a result of a compression syndrome in different locations. A (proximal) compression within the scapular notch can lead to dorsal shoulder pain and simultaneous weakness of the infraspinatus and supraspinatus muscles. By transection of the lig. transversum this compression syndrome can be treated. By means of a systematic review, the present work analyzes the motor recovery potential after arthroscopic decompression. Material and Methods A systematic review of the U. S. National Library of Medicine/National Institutes of Health (PubMed) database and the Cochrane Library was performed using the PRISMA checklist. The search words used were “suprascapular” and “arthroscopic”; “suprascapular” and “arthroscopy”. Based on the evaluated literature, articles in English with at least a partial arthroscopic case series from 4 cases on and a compression syndrome of the suprascapular nerve treated with arthroscopic decompression in the scapular notch were identified. Motor recovery was described by means of EMG, clinical strength and MRI. Results Primarily 408 hits were generated. Six articles met the inclusion criteria and were further analyzed. The number of arthroscopic cases was between 4 and a maximum of 27. The level of evidence was between III and IV. The majority of the reported clinical results were good. Motor recovery as measured by EMG was observed, recovery of full strength was not achieved in the majority of reported cases (60%), neither was regression of structural (fatty) degeneration of the muscle bellies. Conclusion Arthroscopic decompression of the suprascapular nerve in the scapular notch provides good clinical results and considerable pain relief. However, in the majority of cases it does not lead to a complete recovery of the strength of the supra- and infraspinatus muscles. Patients should be informed about this. An early decompression after diagnosis in the event of proximal compression within the suprascapular notch combined with beginning EMG or MRI changes appears reasonable. These beginning changes should be further defined. Future studies should develop prognostic criteria for motor recovery. Awareness regarding the diagnosis needs to be improved due to the probably time-dependent irreversibility of resulting muscular weakness.

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