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

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

Journal of Brachial Plexus and Peripheral Nerve Injury ◽

10.1055/s-0041-1731749 ◽

2021 ◽

Vol 16 (01) ◽

pp. e31-e36

Author(s):

George Tsikouris ◽

Ioannis Antonopoulos ◽

Dionysia Vasdeki ◽

Dimosthenis Chrysikos ◽

Athanasios Koukakis ◽

...

Keyword(s):

Suprascapular Nerve ◽

Transverse Diameter ◽

Type I ◽

Type Ii ◽

Suprascapular Notch ◽

Suprascapular Neuropathy ◽

Fresh Frozen ◽

The Mean ◽

Pass Through ◽

Superior Transverse Scapular Ligament

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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Ultrasound-guided Suprascapular Nerve Block Technique

January 2018 - Pain Physician ◽

10.36076/ppj.2007/10/743 ◽

2007 ◽

Vol 6;10 (6;11) ◽

pp. 746-746

Author(s):

Dominic Harmon

Keyword(s):

Case Report ◽

Real Time ◽

Nerve Block ◽

Ultrasound Guidance ◽

Adhesive Capsulitis ◽

Suprascapular Nerve ◽

Ultrasound Transducer ◽

Suprascapular Notch ◽

Suprascapular Nerve Block ◽

Scapular Notch

Background: In this article, we describe a case report of using real-time, high-resolution ultrasound guidance to facilitate blockade of the suprascapular nerve. We describe a case report and technique for using a portable ultrasound scanner (38 mm broadband (13-6 MHz) linear array transducer (SonoSite Micromaxx SonoSite, Inc. 21919 30th Drive SE Bothwell W. A..)) to guide suprascapular nerve block. Methods: A 44-year old male patient presented with severe, painful osteoarthritis with adhesive capsulitis of his right shoulder. The ultrasound transducer in a transverse orientation was placed over the scapular spine. Moving the transducer cephalad the suprascapular fossa was identified. While imaging the supraspinatus muscle and the bony fossa underneath, the ultrasound transducer was moved laterally (maintaining a transverse transducer orientation) to locate the suprascapular notch. The suprascapular nerve was seen as a round hyperechoic structure at 4 cm depth beneath the transverse scapular ligament in the scapular notch. The nerve had an approximate diameter of 200 mm. Real-time imaging was used to direct injection in the scapular notch. Ultrasound scanning confirmed local anesthetic spread. Results: The patient’s pain intensity decreased. Shoulder movement and function improved. These improvements were maintained at 12 weeks. Conclusion: Ultrasound guidance does not expose patients and personnel to radiation. It is also less expensive than other imaging modalities. This technique has applications in both acute and chronic pain management. Key words: Technique, visualization, real-time, Ultrasound,nerve, analgesia.

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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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Shoulder Numbness in a Patient with Suprascapular Nerve Entrapment Syndrome: Cutaneous Branch of the Suprascapular Nerve: Case Report

Neurosurgery ◽

10.1097/00006123-200012000-00041 ◽

2000 ◽

Vol 47 (6) ◽

pp. 1452-1452 ◽

Cited By ~ 21

Author(s):

Kimberly S. Harbaugh ◽

Rand Swenson ◽

Richard L. Saunders

Keyword(s):

Shoulder Pain ◽

Suprascapular Nerve ◽

Suprascapular Notch ◽

Study Results ◽

Cutaneous Branch ◽

Shoulder Region ◽

Motor Abnormalities ◽

The Right ◽

And Function ◽

Nerve Entrapment Syndrome

ABSTRACT OBJECTIVE AND IMPORTANCE The ability to diagnose peripheral nerve disorders is dependent on knowledge of the anatomic course and function of the nerves in question. The classic teaching regarding the suprascapular nerve (SScN) is that it has no cutaneous branches, despite the fact that a cutaneous branch was first reported in the anatomic literature 20 years ago. CLINICAL PRESENTATION We describe a case of a 35-year-old male patient who presented with right shoulder pain and atrophy and weakness of the right supra- and infraspinatus muscles. During the examination, he was also noted to have an area of numbness involving the right upper lateral shoulder region. Electrical study results were consistent with SScN entrapment at the suprascapular notch. INTERVENTION The patient underwent surgical decompression 7 months after the onset of his symptoms. The patient noted resolution of his shoulder pain immediately after the procedure, and his shoulder sensory disturbance had improved by 2 weeks. At 9 months after surgery, he remained pain-free, his shoulder sensation was normal, and his motor abnormalities had improved significantly. CONCLUSION This case provides clinical evidence for the presence of a cutaneous branch of the SScN, as described in cadaveric studies. Although shoulder numbness demands a search for alternative diagnoses, it does not necessarily exclude the diagnosis of SScN entrapment.

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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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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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Surgical Treatment of a Rare Presentation of Bertolotti's Syndrome from Castellvi Type IV Lumbosacral Transitional Vertebra: Case Report and Review of the Literature

Journal of Neurological Surgery Reports ◽

10.1055/s-0038-1667172 ◽

2018 ◽

Vol 79 (03) ◽

pp. e70-e74 ◽

Cited By ~ 3

Author(s):

Ryan Adams ◽

Sarah Herrera-Nicol ◽

Arthur Jenkins

Keyword(s):

Back Pain ◽

Surgical Treatment ◽

Leg Pain ◽

Lumbosacral Spine ◽

Complete Fusion ◽

Type I ◽

Type Iii ◽

Transitional Vertebra ◽

Type Iv ◽

The Right

Background Advancements in radiological imaging and diagnostic criteria enable doctors to more accurately identify lumbosacral transitional vertebrae (LSTV) and their association with back and L5 distribution leg pain. It is considered the most common congenital anomaly of the lumbosacral spine with an incidence between 4 and 35%,3 although many practitioners describe 10 to 12% overall incidence. LSTVs include sacralization of the L5 vertebral body and lumbarization of the S1 segment while demonstrating varying morphology, ranging from broadened transverse processes to complete fusion.5 The most common types of LSTV that present with symptomatic Bertolotti's syndrome are the Castellvi type I and type II; type III and type IV variants rarely present with symptoms referable with confirmatory and provocative testing to the transitional vertebra itself, and therefore there is limited experience and no case reports of treatment toward this particular entity. Case Description We illustrated a case of a 37 years old female in which a computed tomography scan demonstrated type III LSTV on the left and a type I anomaly on the right. The patient presented with right-sided leg pain and left-sided sacroiliac (SI) region low back pain, worse with rotation and standing, for several years, and had been on daily narcotic pain medications for more than 2 years. The patient had temporary relief of her leg pain with a transverse/ALA injection on the right, but no improvement in her back pain, whereas a left-sided injection into the region around the type III interface on the left did transiently alleviate her SI pain without improvement in her leg pain. We proposed that this particular anomaly induced mechanical back pain on the left side by flexion of the bone bridge (a form of stress-fracture, with associated sclerotic changes in the interface in the transverse/ALA junction) with associated irritation of the right L5 nerve from the type I anomaly on the right in conjunction with her typical radiating leg pain on the right. A patent, but somewhat hypoplastic L5/S1 disk space was also present. Nonsegmental pedicle screw instrumentation with low-profile screws was implanted on the right side with fusion induced using allograft and off label use of infuse rh-BMP2 bone graft substitute, and the patient was discharged the same day. The patient noted immediate improvement in her preoperative symptoms, and by 2 weeks after her surgery noted complete resolution of the preoperative symptoms, and required no narcotic medications to control her incisional pain. Conclusion Patients who present with symptoms consistent with Bertolotti's syndrome, even if they have a type III or type IV LSTV, should be considered for surgical treatment of their LSTV. These patients can respond well, even if symptoms have been present for years. Given the prevalence of these anatomic variants in the general population (10–12% in most series), Bertolotti's syndrome should be considered in the differential diagnosis of any patient with a presentation of L5 radiculopathy and/or back pain.

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Anatomical Evaluation of Mandibular Molars in a Saudi Population: An In Vivo Cone-Beam Computed Tomography Study

International Journal of Dentistry ◽

10.1155/2021/5594464 ◽

2021 ◽

Vol 2021 ◽

pp. 1-8

Author(s):

Mohammed Mashyakhy ◽

Ahmad Jabali ◽

Fatimah Saleem Alabsi ◽

Abdulaziz AbuMelha ◽

Mazen Alkahtany ◽

...

Keyword(s):

Computed Tomography ◽

Cone Beam Computed Tomography ◽

Cone Beam ◽

Type I ◽

Saudi Population ◽

Significance Level ◽

Mandibular Molars ◽

Type Iv ◽

The Right

Objective. This study assessed the canal configuration of mandibular molars according to Vertucci’s classification of a Saudi population using cone-beam computed tomography (CBCT). Methods. A total of 290 first and 367 second mandibular molars were analyzed. The CBCT images were evaluated in three sections to inspect the number of roots and canals and canal system. The data are presented as frequencies and percentages. The chi-squared test was used to assess differences between both sides. SPSS was used for analysis, with a significance level of α ≤ 0.05. Results. Among the first molars, 95.4% of the teeth had two roots, and 64.5% had three canals. Approximately 57.9% showed Vertucci type IV mesial roots. Between the second molars, 89.6% of teeth had two roots and 80.4% had three canals. The frequency of Vertucci type IV (39.4%) was the highest in mesial roots. The first molars showed a high prevalence of 3-rooted teeth (5.5%). Both the right and left sides showed teeth with similar external and internal anatomy p < 0.05 . Conclusion. Most of the mandibular first and second molars had two roots and three canals. In the first mandibular molars, similar to the second mandibular molars, the majority of the mesial canals had Vertucci type IV, while the distal canals had Vertucci type I.

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