Decompression of the suprascapular nerve at the suprascapular notch under combined arthroscopic and ultrasound guidance

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.

A Study on Suprascapular Foramen and Its Clinical Importance: A Cadaveric Study in Western Part of Tamilnadu, India

Background: Suprascapular notch is present along the superior border of the scapula close to the lateral angle, which is converted into a Suprascapular foramen by the transverse Suprascapular ligament. Normally the Suprascapular nerve and vein pass through the foramen below the ligament, while the Suprascapular artery runs above the ligament. Suprascapular nerve entrapment is an interesting clinical condition which is widely involved in this area. Aim of the study: To find out the presence of Suprascapular artery passing along with the Suprascapular nerve and vein within the foramen and any pathology associated with it. Materials and Methods: The proposed study is carried out in the Department of Anatomy, Karpagam Faculty of Medical Sciences and Research, Coimbatore, where 51 well embalmed cadavers of both the sexes and various age groups was utilised. Results: Out of 51 cadavers dissected, we found Suprascapular artery was found passing along with the Suprascapular nerve and vein in 2 of the cadavers, of which one each is found in a male and a female cadaver with an incidence of 3.92%. Conclusion: Studies done earlier pointed out the importance of Suprascapular nerve entrapment, the various causes and predisposing factors responsible for it ,and a knowledge of safe zone around the shoulder region should be known well to the operating surgeon and the available imaging techniques should be utilised by the radiologists in order to avoid the complications while dealing with the Suprascapular nerve entrapment. KEY WORDS: Cadaver, Suprascapular foramen, Suprascapular artery, Nerve entrapment, Transverse Suprascapular ligament.

Pathological findings identified during the posterior approach to the spinal accessory nerve after high-energy trauma

The spinal accessory to suprascapular nerve transfer is a key procedure for restoring shoulder function in upper brachial plexus injuries and is typically undertaken via an anterior approach. The anterior approach may miss injury to the suprascapular nerve about the suprascapular notch, which may explain why functional outcomes are often limited. In 2014 we adopted a posterior approach to enable better visualization of the suprascapular nerve at the notch. Over the next 6 years we have used this approach for 20 explorations after high-energy trauma. In 7/20 we identified abnormalities at the level of the suprascapular ligament, which we would not have identified with an anterior approach: there were two ruptures, two neuromas-in-continuity and three cases of scar encasement, necessitating neurolysis. Nerve transfer could be undertaken distal to the suprascapular notch, bypassing the site of injury. These pathological findings support the wider adoption of the posterior approach in cases of high-energy trauma. Level of evidence: IV

Suprascapular Nerve Entrapment by a Trifid Superior Transverse Scapular Ligament

Anatomical 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.

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.

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

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.

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

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.