DOCSLIB.ORG

An Unusual Cause of Shoulder Pain

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
An Unusual Cause of Shoulder Pain 264 Ann Rheum Dis 1999;58:264–265 LESSON OF THE MONTH Ann Rheum Dis: first published as 10.1136/ard.58.5.264 on 1 May 1999. Downloaded from An unusual cause of shoulder pain P Wong, J V Bertouch, G A C Murrell, M Hersch, P P Youssef A 20 year old man with no significant past active denervation. The left supraspinatus, medical problems presented with a six week biceps, triceps and deltoid were normal. Mag- history of gradual onset diVuse left shoulder netic resonance imaging (MRI) of the left and scapula pain. Two weeks before the onset shoulder region confirmeda2cmby1cm of pain he had started work as a builder, multi-loculated fluid collection at the spinogle- performing heavy lifting. There was no history noid notch causing compression of the inferior of injury or other precipitant. In the week branch of the suprascapular nerve that supplies before presenting, the severity of the pain pre- infraspinatus (figs 2 and 3). There was no evi- vented him from working despite regular anal- dence of more proximal compression of the gesia. He did not complain of upper limb suprascapular nerve. A small tear of the weakness. No constitutional symptoms were posterosuperior glenoid labrum was also iden- present. There was no preceding viral-like tified. illness or vaccination. A provisional diagnosis of a ganglion was On examination, there was left infraspinatus made and the patient was referred to an ortho- tenderness and wasting (see fig 1) with weakness of external rotation of the shoulder. Prince of Wales Power in other muscle groups around the left Hospital, Sydney, New shoulder was normal. All upper limb reflexes South Wales, Australia were present and sensation was normal. P Wong J V Bertouch Examination of the left axilla revealed five P P Youssef small mobile lymph nodes. There was no other lymphadenopathy or splenomegaly. St George Hospital, Computed tomography (CT) of the left http://ard.bmj.com/ Sydney, New South scapula and axilla was performed to determine Wales, Australia if significant lymphadenopathy was present, for G A C Murrell M Hersch example, because of lymphomatous involve- ment. It showed wasting of the muscles Correspondence to: surrounding the scapula but no mass lesions in Dr P Youssef, Royal Prince the region of the brachial plexus. There were Alfred Medical Centre, Suite 408, 100 Carillon Avenue, non-enlarged lymph nodes in the axilla. on September 27, 2021 by guest. Protected copyright. Newtown, Sydney, New Electromyographic (EMG) assessment re- South Wales, Australia 2042. vealed profuse fibrillations and positive sharp Accepted for publication waves in the left infraspinatus muscle but no Figure 2 Axial (T2 weighted) MRI showing the ganglion 18 January 1999 units under voluntary control, consistent with cyst in the spinoglenoid notch adjacent to the glenoid labrum. Ganglion cyst Suprascapular nerve Figure 3 Diagram showing a ganglion in the spinoglenoid Figure 1 Left infraspinatus wasting. (View from behind the patient). notch causing compression of the nerve to infraspinatus. An unusual cause of shoulder pain 265 paedic surgeon for an arthroscopic ganglion along the path of least resistance, thus resulting drainage and repair of the glenoid labrum. This in a ganglion cyst.1 Tirman et al6 have shown an was successfully performed. Ten weeks after association between ganglion cysts and glenoid the operation, there was significant reduction labrocapsular tears on MRI—as seen in this Ann Rheum Dis: first published as 10.1136/ard.58.5.264 on 1 May 1999. Downloaded from in both shoulder pain and infraspinatus wasting patient. They suggest that detection of a shoul- with only a mild reduction in global range of der ganglion cyst should prompt both a clinical movement. Unfortunately, the patient failed to and MRI evaluation of the glenoid labrum and present for a follow up MRI three months later joint capsule. to assess if there had been a recurrence of the The treatment of this condition is dependent ganglion. upon the extent of pain and the loss of function. In the absence of pain, shoulder Discussion rehabilitation to maximise function is usually With the advent of MRI, suprascapular nerve the only intervention necessary, as the func- compression is becoming increasingly recog- tional deficit is usually mild.1 However, in the nised as a cause of shoulder pain in the presence of persistent or severe pain, as in this orthopaedic,1–4 radiological,56 and sports case, surgery is required. Arthroscopic evalua- medicine8 literature. However, we are unaware tion is often necessary with simultaneous repair of any such reports in the rheumatological of intra-articular pathology to prevent a recur- literature. rence of the ganglion. Traditionally, open gan- The suprascapular nerve arises from the glion excision is performed. However, Iannotti upper trunk of the brachial plexus. It then and Ramsey2 report a series of three cases in traverses the suprascapular notch underneath which suprascapular nerve compression by a the transverse scapular ligament. On entering ganglion cyst was treated by arthroscopic the supraspinatus fossa, it innervates the decompression of the cyst into the shoulder supraspinatus muscle. It then enters the infra- joint. In each of their three cases, the patient’s spinatus fossa via the spinoglenoid notch to symptoms resolved and a postoperative MRI innervate the infraspinatus muscle (fig 3).1 In showed no reaccumulaton of the fluid in the this patient, the ganglion was located at the ganglion. The procedure was well tolerated. spinoglenoid notch, causing only compression Successful ultrasound or CT guided aspiration of the nerve to infraspinatus resulting in weak- of ganglia causing suprascapular nerve com- ness of the infraspinatus muscle. pression has also been reported.4 This patient is noteworthy because of his Overall, in patients with previously normal relatively acute presentation. The usual pre- shoulder anatomy, a successful surgical proce- senting symptom is that of longstanding, deep dure involving decompression of the ganglion and diVuse posterolateral shoulder pain. How- with repair of any underlying labral pathology ever, this man presented with pain of only sev- results in a good long term prognosis. eral weeks’ duration that had worsened over the preceding week, raising the possibility of http://ard.bmj.com/ brachial neuritis. The lessons This case demonstrates that EMG and nerve x Suprascapular nerve entrapment must be conduction studies are useful in localising the considered in the diVerential diagnosis of a site of nerve compression. They distinguish painful shoulder, particularly in the presence nerve entrapment at the suprascapular notch, of supraspinatus or infraspinatus weakness. which produces denervation of both suprasp- x The most appropriate investigation is MRI inatus and infraspinatus, from that at the of the shoulder girdle. However, EMG and on September 27, 2021 by guest. Protected copyright. spinoglenoid notch, which results in infrasp- nerve conduction studies can be useful in inatus weakness only. In addition, they exclude determining the site of nerve compression more widespread pathology, for example bra- and the degree of nerve dysfunction. chial neuritis. Nevertheless, MRI is the imaging modality 1 Fehrman DA, Orwin JF, Jennings RM. Suprascapular nerve of choice for defining the lesion because of its entrapment by ganglion cysts: A report of six cases with arthroscopic findings and review of the literature. Arthros- excellent resolution of soft tissue. In this case, it copy 1995;11:727–34. would have been preferable to perform MRI as 2 Iannotti JP, Ramsey ML. Arthroscopic decompression of a ganglion cyst causing suprascapular nerve compression. the initial investigation, thereby negating the Arthroscopy 1996;12:739–45. need for EMG and nerve conduction studies. 3 Ogino T, Minami A, Kato H, Hara R, Suzuki K. Entrapment neuropathy of the suprascapular nerve by a However, MRI is not readily available in our ganglion. J Bone Joint Surg Am 1991;73:141–7. unit. Hence, this patient had initial EMG and 4 Ganzhorn RW, Hocker JT, Horowitz M, Switzer HE. Suprascapular nerve entrapment. J Bone Joint Surg Am nerve conduction studies to delineate the neu- 1981;63:492–4. rological abnormality. 5 Fritz RC, Helms CA, Steinbach LS, Genant HK. Supras- capular nerve entrapment: Evaluation with MR imaging. This case also demonstrates many of the Radiology 1992;182:437–44. typical features of this condition. It is mostly 6 Tirman PFJ, Feller JF, Janzen DL, Peterfry CG, Bergman AG. Association of glenoid labral cysts with labral tears and seen in men for two reasons. Firstly, there is an gleno-humeral instability: Radiologic findings and clinical association with weight lifting.47Secondly, the significance. Radiology 1994;190:653–8. 7 Neviaser TJ, Ain BR, Neviaser RJ. Suprascapular nerve spinoglenoid ligament is absent in 50% of denervation secondary to attenuation by a ganglion cyst. J women compared with 13% of men.9 Bone Joint Surg Am 1986;68:627–8. 8 Ferrick MR, Marzo JM. Ganglion cyst of the shoulder asso- The pathogenesis of this condition is uncer- ciated with a glenoid labral tear and symptomatic tain. It is believed that trauma results in tearing glenohumeral instability. Am J Sports Med 1997;25:717– 19. of the posterior capsulo-labral complex. This 9 Kaspi A, Yanai J, Pick CG, Mann G. Entrapment of the dis- allows synovial fluid to leak out of the joint tal suprascapular nerve. Int Orthop 1988;12:273–5..
Load more

Recommended publications
  • Suprascapular Nerve Lesions at the Spinoglenoid Notch: Report of Three Cases and Review of the Literature 243
    Journal ofNeurology, Neurosurgery, and Psychiatry 1991;54:241-243 241 Suprascapular nerve lesions at the spinoglenoid J Neurol Neurosurg Psychiatry: first published as 10.1136/jnnp.54.3.241 on 1 March 1991. Downloaded from notch: report of three cases and review of the literature Jay A Liveson, Michael J Bronson, Michael A Pollack Abstract of root involvement (cervical pain, and change Lesions of the suprascapular nerve can from Valsalva's manoeuvre). His past medical occur at the supraspinatus notch (SSN) history was negative. On physical examination or at the spinoglenoid notch (SGN). Elec- cranial nerves were normal. No weakness was tromyographic (EMG), evaluation of the detected on careful manual muscle examin- infraspinatus, and especially the supra- ation. Sensation was intact. Deep tendon spinatus muscles distinguishes SGN reflexes were active and symmetrical with no from SSN lesions. Three cases of SGN pathological reflexes. There was no Homer's lesions, which are more common than sign. SSN lesions, are presented. The patient gave up weight lifting and started a programme of physiotherapy. His shoulder ache resolved rapidly, but his muscle Entrapment of the suprascapular nerve at the bulk did not return to normal for another 12 suprascapular notch (SSN) was first described months. He reported completely normal func- in 1963 by Kopell and Thompson.' No alter- tion. native entrapment site was recognised until 1981 when the first case of spinoglenoid notch Case 2 (SGN) entrapmnt was described by Ganzhorn A 22 year old right handed male was skeet et al.2 Since then nine additional cases of SGN shooting, a month before his examination.
    [Show full text]
  • Arthroscopic Decompression of the Suprascapular Nerve at the Spinoglenoid Notch and Suprascapular Notch Through the Subacromial Space
    Technical Note Arthroscopic Decompression of the Suprascapular Nerve at the Spinoglenoid Notch and Suprascapular Notch Through the Subacromial Space Neil Ghodadra, M.D., Shane J. Nho, M.D., M.S., Nikhil N. Verma, M.D., Stefanie Reiff, B.A., Dana P. Piasecki, M.D., Matthew T. Provencher, M.D., and Anthony A. Romeo, M.D. Abstract: Suprascapular nerve entrapment can cause disabling shoulder pain. Suprascapular nerve release is often performed for compression neuropathy and to release pressure on the nerve associated with arthroscopic labral repair. This report describes a novel all-arthroscopic technique for decom- pression of the suprascapular nerve at the suprascapular notch or spinoglenoid notch through a subacromial approach. Through the subacromial space, spinoglenoid notch cysts can be visualized between the supraspinatus and infraspinatus at the base of the scapular spine. While viewing the subacromial space through the lateral portal, the surgeon can use a shaver through the posterior portal to decompress a spinoglenoid notch cyst at the base of the scapular spine. To decompress the suprascapular nerve at the suprascapular notch, a shaver through the posterior portal removes the soft tissue on the acromion and distal clavicle to expose the coracoclavicular ligaments. The medial border of the conoid ligament is identified and followed to its coracoid attachment. The supraspinatus muscle is retracted with a blunt trocar placed through an accessory Neviaser portal. The transverse scapular ligament, which courses inferior to the suprascapular artery, is sectioned with arthroscopic scissors, and the suprascapular nerve is decompressed. Key Words: Arthroscopy—Suprascapular nerve—Transverse scapular ligament—Suprascapular notch—Rotator cuff—Shoulder.
    [Show full text]
  • Suprascapular Nerve Entrapment: Technique for Arthroscopic Release
    Techniques in Shoulder and Elbow Surgery 7(2):000–000, 2006 Ó 2006 Lippincott Williams & Wilkins, Philadephia | REVIEW | Suprascapular Nerve Entrapment: Technique for Arthroscopic Release Peter J. Millett, MD, MSc Steadman Hawkins Clinic, Vail, CO Harvard Medical School Boston, MA R. Shane Barton, MD, Iva´n H. Pacheco, MD, and Reuben Gobezie, MD Harvard Shoulder Service Harvard Medical School Brigham and Women’s Hospital Massachusetts General Hospital Boston, MA | ABSTRACT with suprascapular nerve palsy may present with an often vague range of symptoms or even be asympto- Suprascapular neuropathy can be caused by a variety of matic.3 Pain over the posterolateral shoulder or easy anatomic and pathologic entities as the nerve courses fatigability with overhead activities may be reported, or from the brachial plexus through the suprascapular and painless weakness of external rotation with or without spinoglenoid notches to innervate the supraspinatus and spinatus muscle atrophy may be noted. Compression of infraspinatus muscles. We describe techniques for arthro- the nerve at both the suprascapular and spinoglenoid scopically accessing the nerve at both the suprascapular notches are commonly reported mechanisms of injury and spinoglenoid notches and decompressing structural and will be discussed in detail. lesions that may be contributing to the neuropathy. The physical examination plays a critical role in Keywords: suprascapular neuropathy, suprascapular discerning the site of suprascapular nerve injury. notches, spinoglenoid notches, cyst decompression, arthro- Clinical observation of the patient’s shoulder girdle is scopic release important. More proximal injury, as seen with supra- | HISTORICAL PERSPECTIVE scapular notch compression, may result in atrophy of both the supraspinatus and infraspinatus, whereas more Isolated injury to the suprascapular nerve has long been distal compression at the spinoglenoid notch will result recognized as an etiologic entity producing shoulder pain in isolated infraspinatus weakness and atrophy (Fig.
    [Show full text]
  • Bone Limb Upper
    Shoulder Pectoral girdle (shoulder girdle) Scapula Acromioclavicular joint proximal end of Humerus Clavicle Sternoclavicular joint Bone: Upper limb - 1 Scapula Coracoid proc. 3 angles Superior Inferior Lateral 3 borders Lateral angle Medial Lateral Superior 2 surfaces 3 processes Posterior view: Acromion Right Scapula Spine Coracoid Bone: Upper limb - 2 Scapula 2 surfaces: Costal (Anterior), Posterior Posterior view: Costal (Anterior) view: Right Scapula Right Scapula Bone: Upper limb - 3 Scapula Glenoid cavity: Glenohumeral joint Lateral view: Infraglenoid tubercle Right Scapula Supraglenoid tubercle posterior anterior Bone: Upper limb - 4 Scapula Supraglenoid tubercle: long head of biceps Anterior view: brachii Right Scapula Bone: Upper limb - 5 Scapula Infraglenoid tubercle: long head of triceps brachii Anterior view: Right Scapula (with biceps brachii removed) Bone: Upper limb - 6 Posterior surface of Scapula, Right Acromion; Spine; Spinoglenoid notch Suprspinatous fossa, Infraspinatous fossa Bone: Upper limb - 7 Costal (Anterior) surface of Scapula, Right Subscapular fossa: Shallow concave surface for subscapularis Bone: Upper limb - 8 Superior border Coracoid process Suprascapular notch Suprascapular nerve Posterior view: Right Scapula Bone: Upper limb - 9 Acromial Clavicle end Sternal end S-shaped Acromial end: smaller, oval facet Sternal end: larger,quadrangular facet, with manubrium, 1st rib Conoid tubercle Trapezoid line Right Clavicle Bone: Upper limb - 10 Clavicle Conoid tubercle: inferior
    [Show full text]
  • Suprascapular Nerve Entrapment Isolated to the Spinoglenoid Notch: Surgical Technique and Results of Open Decompression
    J Shoulder Elbow Surg (2013) 22, e1-e8 www.elsevier.com/locate/ymse Suprascapular nerve entrapment isolated to the spinoglenoid notch: surgical technique and results of open decompression Nathan A. Mall, MD*, James E. Hammond, DO, Brett A. Lenart, MD, Daniel J. Enriquez, MA, Stacy L. Twigg, PA-C, Gregory P. Nicholson, MD Department of Orthopaedic Surgery, Division of Sports Medicine and Shoulder and Elbow Surgery, Rush University Medical Center, St Louis, MO, USA Background: Entrapment of the suprascapular nerve (SSN) at the spinoglenoid notch (SGN) specifically affects the infraspinatus, and isolated external rotation (ER) weakness can result. We describe the tech- nique of open SSN decompression at the SGN for infraspinatus involvement and report the results of a consecutive series. Materials and methods: Twenty-nine shoulders underwent SSN decompression at the SGN. The mean age was 44 years (range, 15-69 years), and the mean follow-up was 4.3 years (range, 1-7 years). On manual muscle testing, ER strength was abnormal in all patients: 2/5 in 3, 3/5 in 21, and 4/5 in 5. The mean preop- erative American Shoulder and Elbow Surgeons (ASES) score was 48 (range, 23-83). Atrophy of the infra- spinatus was visible or palpable in 72% of shoulders. Magnetic resonance imaging showed ganglion cysts at the SGN in only 20.7% of shoulders. Results: Of the patients, 19 (66%) regained full ER strength, 9 (31%) improved to 4/5, and 1 (3%) had ER strength of 3/5. The mean ASES score improved to 75 (range, 60-100) (P < .05).
    [Show full text]
  • Classification of the Superior Angle of the Scapula and Its Correlation with the Suprascapular Notch: a Study on 303 Scapulas
    Surgical and Radiologic Anatomy (2019) 41:377–383 https://doi.org/10.1007/s00276-018-2156-4 ORIGINAL ARTICLE Classification of the superior angle of the scapula and its correlation with the suprascapular notch: a study on 303 scapulas Lei Zhang1,2 · Xiaoguang Guo1,2 · Yang Liu1,2 · Min Ou1,2 · Xiaoyan Lin1,2 · Ji Qi3 · Yanxiao Xu3 · Guoyou Wang1,2 · Shijie Fu1,2 Received: 10 October 2018 / Accepted: 7 December 2018 / Published online: 15 December 2018 © Springer-Verlag France SAS, part of Springer Nature 2018 Abstract Purpose The aims of this study had been to classify the superior angle of the scapula based on morphological features, and to investigate its correlation with the suprascapular notch. Methods 303 samples of Chinese dried scapular specimens were collected from the Department of anatomy, Southwest Medical University. According to the anatomical morphological characteristics of the superior angle of the scapula, the morphological classification was performed to explore its correlation with the suprascapular notch (SSN). Results The superior angle of the scapula was classified into three types (Hilly shape, Mountain Peak shape and Chimney shape). There were 143 cases of Hilly shape (47.20%), 144 cases of Mountain shape (47.52%), and 16 cases of Chimney shape (5.28%). The angle of Hilly shape (93.36° ± 7.76°) was significantly larger than the Mountain Peak shape (86.60° ± 6.61°) and the Chimney shape (86.22° ± 7.20°), and the difference was statistically significant (P < 0.05). The type I–III of Rengachary’s classification to SSN was low risk of suprascapular nerve entrapment, while the type IV–VI was high risk of suprascapular nerve entrapment.
    [Show full text]
  • Morphology of Suprascapular Notch of Scapula and Its Clinical Implications
    JK SCIENCE ORIGINALARTICLE Morphology of Suprascapular Notch of Scapula and its Clinical Implications Manmeet Kour, Sangeeta Gupta Abstract Morphology of suprascapular notch was studied in a tertiary care teaching hospital of North India on sixty dry adult human scapula of unknown sex. Firstly it was determined, whether the suprascapular notch was present or not. Then the shape of the suprascapular notch was noted i.e. whether it was 'U' shaped, 'V' shaped, 'J' shaped ,or round in the form of Foramen. The foramen is formed due to complete ossification of the superior transverse scapular ligament.The suprascapular nerve passes through it, and in some cases anterior coracoscapular ligament was also found.The study of morphology of suprascapular notch is important as suprascapular nerve entrapment is a common entity which leads to wastage of muscles supplied by it i.e. supraspinatus and infraspinatus.The knowledge of suprascapular notch variations is of importance for surgeons performing suprascapular nerve decompression, especially by means of endoscopic techniques. Key Words Morphometry, Scapula, Suprascapular Notch, Suprascapular Nerve Introduction The scapula of man is one of the interesting bones of shaped or "O" shaped (i.e. as a complete his skeleton. It presents numerous features and foramen).Different authors have classified the dimensions, which are easy to systematically examine suprascapular notch into different types. Authors like and measure, when in good condition, and it also presents Olivier (3) has divided it into 5 types and authors like many variations (1, 2). Scapula has three borders viz; Rengachary (4) has divided into 6 types. In all these types superior, medial and lateral border.
    [Show full text]
  • Bones of the Upper Limb
    This document was created by Alex Yartsev ([email protected]); if I have used your data or images and forgot to reference you, please email me. Bones of the Upper Limb The Clavicle o The clavicle is an S-shaped long bone, which forms part of the pectoral girdle o It articulates proximally with the sternum and distally with the acromion of scapula o Bony features include: . Acromial facet . Sternal facet . Impression for costoclavicular ligament . Subclavian groove . Conoid tubercle . Trapezoid line o Right clavicle Smooth superior surface of the shaft, under the platysma muscle Deltoid tubercle: attachment of the deltoid Acromial facet Conoid tubercle, attachment of the conoid ligament which is the medial part of the Sternal facet coracoclavicular ligament Subclavian groove: site of attachment of the subclavius muscle Acromial facet Impression for the Trapezoid line, attachment of the costoclavicular ligament Rough inferior surface of the trapezoid ligament which binds the clavicle to shaft, over the first rib which is the lateral part of the the first rib coracoclavicular ligament FACTOIDS - Its occasionally pierced by a branch of the supraclavicular nerve - thicker and more curved in manual workers - weakest part is the junction of the middle and lateral thirds: most commonly fractured; more common in children - after a fracture, the sternocleidomastoid elevates the medial fragment of the clavicle, and the shoulder drops. - The lateral fragment of the clavicle gets pulled medially by the arm adductors, eg. pectoralis major - THE CLAVICLE IS THE FIRST LONG BONE TO OSSIFY in the embryo (5th-6th week) - Protects the neurovascular bundle supplying the upper arm, forming a bony boundary of the cervical canal - Transmits traumatic impact force from the upper limb to the axial skeleton - Contains NO MEDULLARY CAVITY - This document was created by Alex Yartsev ([email protected]); if I have used your data or images and forgot to reference you, please email me.
    [Show full text]
  • Morphometric Study of Suprascapular Notch As A
    International Journal of Anatomy and Research, Int J Anat Res 2017, Vol 5(2.3):4015-19. ISSN 2321-4287 Original Research Article DOI: https://dx.doi.org/10.16965/ijar.2017.243 MORPHOMETRIC STUDY OF SUPRASCAPULAR NOTCH AS A FACTOR OF SUPRASCAPULAR NERVE ENTRAPMENT AND DIMEN- SIONS OF SAFE ZONE TO PREVENT SUPRASCAPULAR NERVE INJURY Nutan Nalini Bage *1, Sriambika K 2, Magi Murugan 3, Virender Kumar Nim 4 *1 Professor, Department of Anatomy Pondicherry Institute of Medical Sciences, Ganapathychettikulam, Kalapet, Pondicherry, India. 2 Tutor, Department of Anatomy, Pondicherry Institute of Medical Sciences, Ganapathychettikulam, Kalapet, Pondicherry, India. 3 Associate Professor, Department of Anatomy, Pondicherry Institute of Medical Sciences, Ganapathychettikulam, Kalapet, Pondicherry, India. 4 Professor and Head, Department of Anatomy, Pondicherry Institute of Medical Sciences, Ganapathychettikulam, Kalapet, Pondicherry, India. ABSTRACT Background: The scapula is a large, flat, triangular bone which lies on the postero-lateral aspect of the chest wall Suprascapular nerve entrapment depends on the size and shape of suprascapular notch. Purpose of the study: Aim of the present study is to classify SSN based on morphometry according to Michal Polguj and to obtain a safe zone which would be useful to avoid iatrogenic nerve lesion and to verify the reliability of the existing data for the management of entrapment neuropathy. Materials and Methods: Study included 60 dried human scapulae obtained from the Department of Anatomy, Pondicherry institute of medical sciences. Three measurements were defined and collected for each SSN, Maximum depth (MD), Superior transverse diameter (STD) and Middle transverse diameters (MTD) based on which suprascapular notch was classified.
    [Show full text]
  • Arthroscopic Release of Suprascapular Nerve Entrapment at the Suprascapular Notch: Technique and Preliminary Results
    Arthroscopic Release of Suprascapular Nerve Entrapment at the Suprascapular Notch: Technique and Preliminary Results Laurent Lafosse, M.D., Andrea Tomasi, M.D., Steve Corbett, M.D., Gloria Baier, M.D., Karel Willems, M.D., and Reuben Gobezie, M.D. Purpose: We describe a novel all-arthroscopic technique for suprascapular nerve (SSN) decompres- sion and present our preliminary results for this procedure. Methods: A prospective series of 10 patients with preoperative electromyographic findings consistent with chronic SSN compression, posterior shoulder pain, and subjective weakness were treated with arthroscopic SSN decompression. There were 8 men and 2 women, with a mean age of 50 years. The mean follow-up was 15 months (range, 6 to 27 months). In 8 of 10 patients, we performed an electromyographic examination postoperatively to evaluate nerve recovery after decompression. The clinical outcomes measures used to assess preoperative and postoperative function were the visual analog scale for pain, the Constant score, strength testing of the supraspinatus and infraspinatus, and a subjective satisfaction question- naire. In all patients preoperative and postoperative computed tomography arthrograms were ob- tained to document the absence of a rotator cuff tear. Results: There were no complications resulting from SSN decompression. Of 10 patients, 8 had postoperative electromyography at a mean of 6 months after SSN release and 2 refused to undergo this study after surgery. Of the 8 postoperative electromyograms, 7 had complete normalization of the latency in the motor fibers of the SSN and normalization of the voluntary motor action potential for the supraspinatus and infraspinatus muscles. Two of the electromyograms showed evidence of partial recovery.
    [Show full text]
  • Honeymoon Palsy and Other Upper Extremity Entrapment Neuropathies
    Honeymoon Palsy and other upper extremity Entrapment Neuropathies Michael Wilensky M.D. Senior Neurologist Ochsner Metairie Clinic Less commonly recognized upper extremity neuropathies • Radial motor neuropathy -Saturday night palsy; honeymoon palsy • Suprascapular neuropathy-gymnast; volleyball servers • Dorsal scapular neuropathy –weight lifters • Pronator syndrome – oyster shuckers • Anterior interosseous syndrome- post op; premarital palsy; new mom • Deep palmer ulnar motor neuropathy- bikers; jewelers • Radial sensory neuropathy –hand cuff ; zip ties; CTS splint HONEYMOON PALSY DIFFERENTIATE FROM HONEYMOON SYNDROME – CYSTITIS FROM FIRST TIME OR FREQUENT SEX ON HONEYMOON SATURDAY NIGHT PALSY Radial motor Neuropathy • DRUNK AND FALLING ASLEEP IN UNUSUAL POSITION WITH PRESSURE ON UPPER ARM. • ONE ARM HANGING OVER THE BACK OF CHAIR AT THE BAR Radial motor neuropathy • Clinical weakness in extensor muscles of forearm • Weakness of finger extensors and wrist extensors • Presents as wrist drop • Important to examine finger flexors with wrist supported HONEYMOON PALSY • PRESSURE ON UPPER ARM FROM HEAD LYING ON ARM Suprascapular Neuropathy • ENTRAPMENT @SUPRASCAPULAR NOTCH • SHOULDER DEEP THROBBING PAIN-OCCASIONALLY DOWN ARM • SUPRASPINATUS-WEAKNESS SHOULDER ABDUCTION INITIAL 30 DEGREE • INFRASPINATUS –WEAKNESS SHOULDER EXTERNAL ROTATION • CAUSE –REPETITIVE FORCED ADDUCTION • GYMNASTS,WEIGHT LIFTERS,VOLLEYBALL SERVERS,SWIMMERS Suprascapular Neuropathy DIAGNOSIS & TREATMENT • EMG SHOWS DENERVATION IN SUPRASINATUS AND INFRASPINATUS TX • IDENTIFY PROBLEM • AVOID CAUSATIVE ACTIVITY • NSAID • POSSIBLE SURGICAL DECOMPRESSION DORSAL SCAPULAR ANATOMY shoulder and arm pain, DORSAL SCAPULAR NEUROPATHY • Pain over the medial border of the scapula. • Patients may also experience interscapular pain, weakness of arm abduction, and/or winged scapula. • Sharp, stabbing, burning, or knife-like medial scapular pain, lateral arm and forearm pain, neck and back dull ache, • Rhomboid or levator atrophy.
    [Show full text]
  • Posterior Shoulder Pain and Arthroscopic Decompression of the Suprascapular Nerve
    Sports Injuries DOI 10.1007/978-3-642-36801-1_26-1 # Springer-Verlag Berlin Heidelberg 2014 Posterior Shoulder Pain and Arthroscopic Decompression of the Suprascapular Nerve Kevin D. Planchera,b* and Stephanie C. Pettersonc aPlancher Orthopaedics and Sports Medicine, New York, NY, USA bDepartment of Orthopaedic Surgery, Albert Einstein College of Medicine, New York, NY, USA cOrthopaedic Foundation, Stamford, CT, USA Abstract Posterior shoulder pain is more often than not mistakenly identified as rotator cuff disease or cervical disk disease. While most current thoughts may be buried in the literature as suprascapular nerve entrapment, it is hoped that with a clearer understanding of this disease entity, patients will be treated in a timely manner and receive the expected outcome with great satisfaction. Introduction An article in the New England Journal of Medicine in 1959 opened the gates for discussion about suprascapular nerve entrapment in the clinical setting (Thompson and Kopell 1959). Various authors, including the authors of this chapter, have described the transverse scapular ligament and spinoglenoid notch as two potential sites of entrapment of the Suprascapular nerve (Post and Mayer 1987; Cummins et al. 2000; Plancher et al. 2005a, 2007) (Fig. 1). This injury, when recognized, leads to a multitude of symptoms including pain and weakness with an inability to hold even a 5-kg weight in the horizontal plane. The pain and disability associated with this condition can be unduly prolonged, but it is easily cured now with advanced arthroscopic techniques. While this entity represents a small percentage of the average shoulder surgeons’ practice, recent advancements as well as diagnostic testing have brought this diagnosis of exclusion to the forefront and minds of many surgeons.
    [Show full text]