MRI-Evaluation of Suprascapular Notch Morphometry and Its Clinical Applications

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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A Study on Morphology of Suprascapular Notch with Specific Emphasis on Completely Ossified Superior Transverse Scapular Ligament

National Journal of Clinical Anatomy ◽

10.1055/s-0040-1705291 ◽

2020 ◽

Author(s):

Tushar V. Nayak ◽

Subhash M. Gujar

Keyword(s):

Digital Camera ◽

Suprascapular Nerve ◽

Nerve Entrapment ◽

Suprascapular Notch ◽

Medical College ◽

Suprascapular Nerve Entrapment ◽

Risk Patients ◽

Type V ◽

Superior Transverse Scapular Ligament ◽

Superior Border

Abstract Background and Aim The superior border of scapula is marked by suprascapular notch which is bridged by suprascapular ligament. Beneath this ligament, passes the suprascapular nerve. Narrow notch and completely ossified superior transverse scapular ligament is one of the risk factors for suprascapular nerve entrapment. This study is done to study morphological variation of suprascapular notch. Knowledge of various types of suprascapular notch will help the clinician in early diagnosis and surgical treatment. Materials and Methods A total of 525 human scapulae of unknown age and sex were studied for morphology of suprascapular notch at the Department of Anatomy, GMERS medical college, Vadnagar and at B. J. Medical College, Ahmedabad. Photographs of various types of suprascapular notch were taken using digital camera and classified as per the Rengachary classification. Result In the present study, as per Rengachary classification, out of 525 scapulae, the most common is Type III (47.1%), least common is Type V (1.9%), and completely ossified superior transverse scapular ligament is Type VI (8.9%). Conclusion Knowledge of various types of suprascapular notch will help the physician in screening high-risk patients as well as diagnosis and treatment of suprascapular nerve entrapment disorder.

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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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Morphometric Study of Suprascapular Notch and Its Variations in Dried Human Scapulae

European Journal of Medical and Health Sciences ◽

10.24018/ejmed.2020.2.6.473 ◽

2020 ◽

Vol 2 (6) ◽

Author(s):

Kamal D. Pawar ◽

Sushama. K. Chavan ◽

Mohini M. Joshi

Keyword(s):

Statistical Tests ◽

Anatomical Study ◽

Suprascapular Nerve ◽

Coracoid Process ◽

Morphometric Study ◽

Transverse Ligament ◽

Suprascapular Notch ◽

Endoscopic Techniques ◽

Notch Edge ◽

Scapular Notch

The study was undertaken to see the variation of the suprascapular notch. The notch is present on the superior border of the scapula near the root of coracoid process. It is roofed by the superior transverse ligament and is converted into foramen for the passage of suprascapular nerve. The study was carried out on 121 scapulae in the department of Anatomy RMC Loni, Ahmednagar. The parameters included in the study were presence of notch, shape of notch, transvers length of notch, edge of notch, ossification of transverse ligament and other finding were also noted. The parameters were measured by Vernier calliper and appropriate statistical tests were applied. The supra-scapular notch was present in 82.64% of scapulae. U Deep shaped notch was most common shape followed by J shallow shaped notch. Round edge at the depth of the notch was more common. The knowledge of suprascapular notch variations is of great importance for surgeons performing suprascapular nerve decompression especially by means of endoscopic techniques. Our anatomical study helps the clinicians before planning a surgery.

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Ossification of the superior transverse ligament in a South African scapula: a factor to be considered in the diagnosis of suprascapular nerve entrapment

Journal of Morphological Sciences ◽

10.4322/jms.087415 ◽

2016 ◽

Vol 33 (03) ◽

pp. 155-156

Author(s):

O. Azu ◽

D. Ofusori ◽

E. Naidu ◽

J. Naidu

Keyword(s):

South African ◽

Critical Factor ◽

Suprascapular Nerve ◽

Nerve Entrapment ◽

Clinical Anatomy ◽

Shape Variation ◽

Suprascapular Notch ◽

Suprascapular Nerve Entrapment ◽

Shoulder Region ◽

Superior Transverse Scapular Ligament

Abstract Introduction: Ossification of the superior transverse scapular ligament is one of the factors considered in the classification of the suprascapular notch based on shape. Variation in morphology of the superior transverse scapular ligament is always considered a critical factor in the diagnosis of suprascapular nerve entrapment syndrome. Case Report: This study reports the complete ossification of the superior transverse scapular ligament in a South African scapula and a note on its clinical anatomy. Conclusion: This anatomical knowledge is of extreme clinical relevance to surgeons in relation to various syndromes associated with the shoulder region in the South African population.

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The Superior Transverse Scapular Ligament in Fetuses

Anatomy Research International ◽

10.1155/2013/323194 ◽

2013 ◽

Vol 2013 ◽

pp. 1-3

Author(s):

José Aderval Aragão ◽

Luiza Neves de Santana Teles ◽

Ana Bárbara de Jesus Chaves ◽

Jéssica Cândida Oliveira Prado ◽

Priscila Soares Pereira ◽

...

Keyword(s):

Suprascapular Nerve ◽

The Body ◽

Human Fetuses ◽

Suprascapular Notch ◽

Left Half ◽

Optical Instruments ◽

Significant Difference ◽

Length Measurements ◽

Thickness Measurements ◽

Superior Transverse Scapular Ligament

Introduction. The superior transverse scapular ligament (STSL) links the margins of the suprascapular notch and converts it into a foramen, through which, the suprascapular nerve and, on some rare occasions, the suprascapular vessels pass. This conversion often results from partial or complete ossification of the STSL and may produce compressive symptoms in the suprascapular nerve. Material and Method. Twenty shoulders from human fetuses were dissected without the aid of optical instruments and, using a digital pachymeter of precision 0.01 millimeters, length measurements and thickness measurements were made. The fetal age was from 21 to 33 weeks of gestation, with a mean of 27.6±4.14 weeks. Results. There was no statistically significant difference in STSL length or any difference in the thicknesses at the medial and lateral extremities between the halves of the body (P≥0.05). However, in the left half of the body, the medial extremity of the STSL was significantly thinner than the lateral extremity (P≤0.05). Conclusion. Anatomical and morphometric details about the STSL were described in human fetuses. These findings, in fetuses, may encourage the pursuit of further studies to understand the morphofunctional role and meaning of this small ligament.

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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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Morphometric study of suprascapular notch and scapular dimensions in Ugandan dry scapulae with specific reference to the incidence of completely ossified superior transverse scapular ligament

10.21203/rs.3.rs-55406/v2 ◽

2020 ◽

Author(s):

Adesanya Olamide Adewale ◽

Okeniran Olatayo Segun ◽

Ibe Michael Usman ◽

Ann Lemuel Monima ◽

Eric Simidi Kegoye ◽

...

Keyword(s):

Correlation Coefficient ◽

Suprascapular Nerve ◽

Nerve Entrapment ◽

Population Characteristics ◽

Specific Reference ◽

Suprascapular Notch ◽

Entrapment Syndrome ◽

Suprascapular Nerve Entrapment ◽

Superior Transverse Scapular Ligament ◽

Nerve Entrapment Syndrome

Abstract Background: Understanding of suprascapular notch (SSN) anatomy and relationship with scapular dimensions are vital in diagnosis, prevention, and assessment of suprascapular nerve entrapment syndrome. The study aimed to assess morphometry of suprascapular notch and scapular dimensions in Ugandan dry scapulae with specific reference to scapulae with completely ossified superior transverse scapular ligaments. Methods: This was a cross-sectional analytical study conducted on 50 Ugandan dry scapulae. SSN types and prevalence of completely ossified superior transverse scapular ligament among dry scapulae were quantified and compared with previous data. Scapular dimensions were assessed by measuring scapular length (A), scapular width (B), glenoid length (C), and glenoid width (D). One-way ANOVA was used to compare scapular dimensions of scapulae with different SSN types, and Spearman’s correlation coefficient was used to evaluate the correlation coefficient of scapular dimensions amongst groups. Results: Superior transverse scapular ligament (STSL) was completely ossified in 8% of cases. There was no significant (P > 0.05) difference between scapular dimensions of scapulae with completely ossified STSL compared to scapulae with other SSN types. Scapulae with completely ossified STSL showed strong negative (r = -0.89137, r = -0.877) correlations for its A, B respectively compared against D, this finding was not true to scapulae of other SSN types. Also, there were strong positive or negative (r > 0.7, r > -0.7) correlations: for A, types I and III compared to type VI; for B, types I, III compared to VI; for C, type IV and VI; and for D, type III and VI. Conclusions: The prevalence of completely ossified STSL is moderately high in the Ugandan population. Characteristics of the scapula (scapular dimensions) are not ‘vital’ but rather important or relevant for shoulder pathology with specific reference to suprascapular nerve entrapment syndrome due to completely ossified superior transverse scapular ligaments. Further correlation analyses of scapular dimensions of different SSN types in different populations are important.

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Ossification of superior transverse scapular ligament - a case report

National Journal of Clinical Anatomy ◽

10.1055/s-0039-3401562 ◽

2015 ◽

Vol 04 (03) ◽

pp. 155-157

Author(s):

Dibya Prabha Bara ◽

Swagatika Pradhan ◽

Rajashree Biswal ◽

Chinmayi Mohapatra

Keyword(s):

Case Report ◽

Suprascapular Nerve ◽

Nerve Entrapment ◽

Suprascapular Notch ◽

Orthopaedic Surgeons ◽

Suprascapular Nerve Entrapment ◽

Superior Transverse Scapular Ligament

AbstractSuperior transverse scapular ligament (STSL), a small ligament which bridges over the suprascapular notch bears enormous stress during shoulder movements. This causes the ligament to ossifY thereby compressing the suprascapular nerve which passes beneath it. The ossification can occur partially or cnmpletely. Different shape of ossified STSL also affects the rate of compression of the nerve. Knowledge of ossified STSL may be helpful for radiologists, neurosurgeons and orthopaedic surgeons in dealing with patients of suprascapular nerve entrapment.

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Protective and Predisposing Morphological Factors in Suprascapular Nerve Entrapment Syndrome: A Fundamental Review Based on Recent Observations

BioMed Research International ◽

10.1155/2017/4659761 ◽

2017 ◽

Vol 2017 ◽

pp. 1-9 ◽

Cited By ~ 10

Author(s):

Piotr Łabętowicz ◽

Marek Synder ◽

Mariusz Wojciechowski ◽

Krzysztof Orczyk ◽

Hubert Jezierski ◽

...

Keyword(s):

Suprascapular Nerve ◽

Nerve Entrapment ◽

Protective Function ◽

Suprascapular Notch ◽

Entrapment Syndrome ◽

Suprascapular Nerve Entrapment ◽

Superior Transverse Scapular Ligament ◽

Nerve Entrapment Syndrome ◽

Spinoglenoid Notch

Suprascapular nerve entrapment syndrome (SNES) is a neuropathy caused by compression of the nerve along its course. The most common compression sites include the suprascapular notch and the spinoglenoid notch. The aim of this article was to review the anatomical factors influencing the occurrence of SNES in the light of the newest reports. Potential predisposing morphological factors include a V-shaped, narrow, or “deep” suprascapular notch; a band-shaped, bifurcated, or completely ossified superior transverse scapular ligament (STSL); particular arrangements of the suprascapular nerve and vessels at the suprascapular notch. A very recent report indicates structures at the suprascapular notch region that may protect from SNES, such as the suprascapular notch veins (SNV). The role of the anterior coracoscapular ligament (ACSL) is still not clear. While some studies indicate that it may predispose for SNES, the newest study proposes a protective function. Knowledge of these variations is essential for arthroscopic and other surgical procedures of this area in order to avoid iatrogenic injury of the suprascapular nerve or unexpected bleeding from the suprascapular vessels running alongside the STSL.

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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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