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Schematic arrangements of types of superior transverse scapular ligament (STSL): (a) fan-shape type of STSL and (b) band-shape type of STSL. DW: distal width, PW: proximal width, STSL: superior transverse scapular ligament, La: lateral, and Me: medial.
Source publication
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 o...
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Abstract
Introduction: Superior border of scapula presents a suprascapular notch. Suprascapular nerve entrapment syndrome may be caused due to
compression of the nerve at the notch. Previous studies have shown that there are various types of suprascapular notch and clinicians must
be aware of these types and their prevalence.
Aim: This study was co...
Citations
... The ligament has been occasionally found to be ossified. 9 A right angled Mixter forceps is put beneath the ligament and it is then divided using a fresh blade. This is done to protect the SSN that travels below the ligament. ...
Distal nerve transfers are frequently used for the treatment of patients having brachial plexus injuries. Spinal accessory nerve to suprascapular nerve transfer by dorsal approach is advantageous since it brings the site of neurotization closer to the neuromuscular end plate and minimizes donor muscle weakness. This surgery is found to be challenging owing to the small and deep operative field. In this article, the authors describe the surgical technique for this procedure.
... Polguj classified into types based on specific geometric parameter. 12 Rengachary et al. 8 classified into 6 types and our present study followed the same classification where type III(52%) is more common and type IV(4%) is least common. 19 (Table No 4 Partial and complete ossification of STSL have also been identified as one of the predisposing factor for suprascapular nerve entrapment.In our study complete ossification was observed in 6% cases , similar with the findings of 4% of Rengachary et al and 5% by Ticker et al. 8,9 According to Polguj, fan shaped STSL (54.6%) is more common than band shaped type(41.9%). ...
... In literature, multifactorial causes of suprascapular neuropathy have been reported such as mass effect [4], repetitive overhead activities with subsequent nerve traction [5] and tear of rotator cuff muscles [6]. Also, presence of multiband STSL [7]; a complete ossified STSL [8] or topography of the suprascapular artery [9] should be taken into consideration as important risk factors in suprascapular nerve entrapment syndrome (SNES). Thus, evaluation of the morphologic variations in the suprascapular region is important from a clinical point of view because it is the most common site of compression and injury of SN [1,10]. ...
... Moreover, the authors added that, the surface area of the foramen below the ossified fan-shaped STSL was greater than those in the band-shaped STSL. Thus, the band -shaped STSL seemed to be a potential risk factor in SN entrapment [9]. These data could explain the comparable frequency of the neuropathy in various populations throughout the world despite the significant differences between them in occurrence of ossified STSL [20]. ...
... Moreover, Tubbs et al. supposed new theory depending on the compression of the suprascapular artery on the close contact fragile suprascapular nerve under the STSL could induce microtrauma to the nerve with subsequent neuropathy [8]. This theory was supported by Polguj et al. [9]. The mechanical compression of the suprascapular artery on the suprascapular nerve could induce nerve injury through stretching and compression of the nerve. ...
... The ossified STSL is a potential risk factor in the formation of suprascapular nerve entrapment. 10 The frequency of completely ossified superior transverse scapular ligament varies throughout the world. Since no such data is available about incidence of ossified STSL in dried Pakistani scapulae, present study was carried out to find out the incidence of ossification of superior transverse scapular ligament in dried Pakistani scapulae. ...
Background: The suprascapular notch of scapula is converted into a foramen by superior transverse scapular ligament (STSL) with the suprascapular nerve passing through the foramen and the suprasca-pular vessels passing above it. The suprascapular notch is the most common site of suprascapular nerve entrapment, which can manifest in disability and pain of the upper limb.The anatomical variations of suprascapular notch are considered to be a risk factor for suprascapular neuropathy entrapment. Complete ossification of STSL with formation of bony foramina is the most recognized predisposing factor for the compression of suprascapular nerve at the suprascapular notch. Aims and Objectives: The aim of this study was to see the incidence of the ossified superior transverse scapular ligament (STSL) on dried Pakistani scapulae, Materials and Methods: Two hundred and four dried scapulae from the Anatomy Departments of Alla-ma Iqbal Medical College, Lahore and Khawaja Muhammad Safdar Medical College, Sialkot were examined. The scapulae included in this study were 97 of right side and 107 of left side. The scapulae were closely observed for the presence of ossified STSL. Results: It was found that complete ossification of superior transverse scapular ligament was found in 4 out of 204 scapulae. The incidence was 1.96% in Pakistani population. Conclusion: The role of STSL in causing suprascapular nerve entrapment is a known fact and proper understanding of the topographical anatomy may be helpful for clinicians and surgeons in routine practice. Present study showed 1.96% incidence of ossified STSL in Pakistani population.
... The ossified STSL is a potential risk factor in the formation of suprascapular nerve entrapment. 10 The frequency of completely ossified superior transverse scapular ligament varies throughout the world. Since no such data is available about incidence of ossified STSL in dried Pakistani scapulae, present study was carried out to find out the incidence of ossification of superior transverse scapular ligament in dried Pakistani scapulae. ...
Background: The suprascapular notch of scapula is converted into a foramen by superior transverse scapular ligament (STSL) with the suprascapular nerve passing through the foramen and the suprasca-pular vessels passing above it. The suprascapular notch is the most common site of suprascapular nerve entrapment, which can manifest in disability and pain of the upper limb.The anatomical variations of suprascapular notch are considered to be a risk factor for suprascapular neuropathy entrapment. Complete ossification of STSL with formation of bony foramina is the most recognized predisposing factor for the compression of suprascapular nerve at the suprascapular notch. Aims and Objectives: The aim of this study was to see the incidence of the ossified superior transverse scapular ligament (STSL) on dried Pakistani scapulae, Materials and Methods: Two hundred and four dried scapulae from the Anatomy Departments of Alla-ma Iqbal Medical College, Lahore and Khawaja Muhammad Safdar Medical College, Sialkot were examined. The scapulae included in this study were 97 of right side and 107 of left side. The scapulae were closely observed for the presence of ossified STSL. Results: It was found that complete ossification of superior transverse scapular ligament was found in 4 out of 204 scapulae. The incidence was 1.96% in Pakistani population. Conclusion: The role of STSL in causing suprascapular nerve entrapment is a known fact and proper understanding of the topographical anatomy may be helpful for clinicians and surgeons in routine practice. Present study showed 1.96% incidence of ossified STSL in Pakistani population.
... Before now, the anatomical variations of the scapular notch have not been studied in the Uruguayan population. Accordingly, it seems useful to contribute our findings to literature published from other countries 9,18,19 . ...
... Some researchers stated that SSN entrapment is responsible of painful shoulder in 0.3-2% of cases, and the incidence of ossification of STSL reaches 5-6% in general population. 2,4,5,9,10,13,20,27,29,32 . Ossification is a risk factor, but as expected, not the only responsible factor for nerve entrapment. ...
Introduction: The scapular notch is a depression on the superior border of the scapula, located medially to the coracoid process, through which suprascapular nerve enters the supraspinous fossa. This paper aims to describe the main anatomical aspects of scapular notch, measuring anatomical parameters for identification of this region during surgical procedures, and compare the obtained data with previous worldwide publications. Material and methods: Sixty-two dry scapulae of Uruguayan specimens were studied at the Anatomy Laboratory of the Faculty of Medicine, Universidad Centro Latinoamericano de Economía Humana (UCLAEH) in Maldonado, and the Faculty of Medicine, University of the Republic in Montevideo, Uruguay, and analyzed for variations. Results: Of the 62 studied scapulae, 33 were right sided and 29 left sided. Anatomical variations were found in 19 specimens, which included 5 flattened shape notches (8.1%), and 14 ossified notches (22.6%), from which 4 (6.5%) were complete and 10 (16.1%) were incomplete. Scapular notch is located at an average distance of 66.7 mm (SD: 4.7) medially from the lateral border of the acromion. Conclusions: Anatomy of the scapular notch is variable. The scapular notch can be located at the junction between the medial two thirds and the lateral one third of the superior scapular border. Anatomical variations of this region play an important role in the development of entrapment neuropathies and in surgical considerations for brachial plexus injuries reconstruction.
... 2,12,13,25,27,35,38 However, the distributions of the Rengachary's classification types vary widely among reports because of differences in age and in the size of the study populations, and the distribution of SS notch variation has not been reported for each age group. In addition, although bifid STSL and calcification of the STSL have been suggested as possible risk factors for SS neuropathy, 6,24,26,28,32 there are no detailed data to support the speculation, and the relation between SS notch morphology and SSN palsy remains unclear. Therefore, there are 2 purposes in this study. ...
Background
The morphology of the suprascapular (SS) notch is a very important factor in treatment of suprascapular nerve (SSN) palsy. Several studies have reported SS notch morphology in cadavers or using three-dimensional computed tomography (3D-CT); however, none has reported the distribution of SS notch morphology according to age group. In addition, the correlation between SS notch morphology and SSN palsy remains unclear. The purposes of this study were to investigate the morphological distribution of the SS notch by age group in a large population and to assess the relationship between SS notch morphology and SSN palsy.
Methods
We studied the 3D-CT images of 1063 shoulders in 1009 patients (mean age, 60.8 years; age range, 14–96 years). There were 53 shoulders with SSN palsy and 1010 shoulders without SSN palsy. Morphology of the SS notch was classified by Rengachary classification (types I–VI). Shoulders with types I–IV were classified into the non-ossified superior transverse scapular ligament (STSL) group (Group N) and those with types V and VI into the ossified STSL group (Group O).
Results
The Rengachary classifications of the 1063 shoulders were as follows: type I: n = 113, 10.6%; type II: n = 313, 29.4%; type III: n = 383, 36.0%; type IV: n = 109, 10.3%; type V: n = 107, 10.0%; type VI: n = 38, 3.6%. Mean age was significantly older in the ossified STSL group, and age was <40 years for only two shoulders in this group. The Rengachary classifications of the SSN palsy cases were as follows: type I: 7.5%, II: 24.5%, III: 34.0%, IV: 15.1%, V: 13.2%, and VI: 5.7%. There was no statistical difference in age, sex, Rengachary type, or ossification between SSN palsy and non-SSN palsy cases.
Conclusions
Ossification of the STSL was significantly more common in older patients, which suggests age-related change. In addition, no relation was identified between narrow notch or ossification of the STSL with the onset of SSN palsy.
... The TSL, which is usually not distinguishable on MR images, was reconstructed by referring to the identifiable bone remnants of the posterior coracoid process and the medial margin of the suprascapular notch on the CT image. According to a previous method, 18 we determined that the TSL had a width of 8 mm and a thickness of 2 mm, similar to the thickness of the scapular wall (Fig. 1C). Moreover, we included the clavicle, thoracic rib bones, and anterior and posterior edges of the scalene muscles because we believe that these structures affect the motion of the SSN. ...
Purpose:
We aimed to analyze changes in suprascapular nerve (SSN) position within the suprascapular notch during in vivo shoulder abduction.
Materials and methods:
Three-dimensional models of the shoulder complex were constructed based on magnetic resonance imaging of the brachial plexus (BP-MR) in a patient diagnosed with SSN dysfunction but normal scapular movement. Using BP-MR in neutral position and computed tomography data on shoulder abduction, shoulder abduction was simulated as the transition between two positions of the shoulder complex with overlapping of a neutral and abducted scapula. SSN movement during abduction was evaluated using the finite element method. Contact stress on the SSN was measured in the presence and absence of the transverse scapular ligament (TSL).
Results:
In the neutral position, the SSN ran almost parallel to the front of the TSL until entering the suprascapular notch and slightly contacted the anterior-inferior border of the TSL. As shoulder abduction progressed, contact stress decreased due to gradual loss of contact with the TSL. In the TSL-free scapula, there was no contact stress on the SSN in the neutral position. Towards the end of shoulder abduction, contact stress increased again as the SSN began to contact the base of the suprascapular notch in both TSL conditions.
Conclusion:
We identified changes in the position of the SSN path within the suprascapular notch during shoulder abduction. The SSN starts in contact with the TSL and moves toward the base of the suprascapular notch with secondary contact. These findings may provide rationale for TSL release in SSN entrapment.
... The diagnosis of SNES is typically based on physical examinations and interview [14,15]. Other additional examinations for the diagnosis of SNES include imaging modalities (ultrasonography, X-ray, and computed tomography), electromyography (EMG), and assessment of conduction velocity from the neck nerve point to the supraspinatus muscles [10,[16][17][18][19]. Although EMG is the gold standard for the diagnosis of SNES, shoulder magnetic resonance imaging (S-MRI) is also useful for the analysis of pathologic abnormalities of the suprascapular notch [2]. ...
... However, no clinical studies have been conducted to prove this theory. Polguj et al. [17] reported that the size of the suprascapular notch is a major risk factor for SNES [22]; however, there is no study to analyze suprascapular notch objectively. In other words, the narrowed suprascapular notch is considered a major morphological parameter of SNES. ...
Background:
Suprascapular nerve entrapment syndrome (SNES) is a peripheral neuropathy caused by compression of the suprascapular nerve. Previous studies have demonstrated that the suprascapular notch`s morphological change is closely correlated with SNES. Thus, we thought that the suprascapular notch cross-sectional area (SSNCSA) might be a good diagnostic parameter to assess SNES.
Methods:
We acquired suprascapular notch data from 10 patients with SNES and from 10 normal individuals who had taken shoulder magnetic resonance imaging (S-MRI) and no evidence of SNES. T2-weighted coronal S-MRI images were acquired at the shoulder. We analyzed the SSNCSA at the shoulder on the S-MRI using our image analysis program. The SSNCSA was measured as the suprascapular notch that was the most affected site in the coronal S-MRI images.
Results:
The mean SSNCSA was 64.50 ± 8.93 mm2 in the control group and 44.94 ± 10.40 mm2 in the SNES group. SNES patients had significantly lower SSNCSA (P < 0.01) than the control group. ROC analysis showed that the best cut-off of the SSNCSA was 57.49 mm2, with 80.0% sensitivity, 80.0% specificity, and AUC of 0.92 (95% confidence interval, 0.79-1.00).
Conclusions:
The SSNCSA was found to have acceptable diagnostic properties for detecting SNES. We hope this result will help to diagnose SNES objectively.
... The shape and morphology of the suprascapular notch is the most critical point that affects the etiology of nerve neuropathy like neuropraxia, for instance. the suprascapular notch was classified according to a fivefold classification (Type I, deeper than wider; Type II, equally deep and wide; type III, wider than deeper; type IV, bony foramen; type V, discreet notch [14,15]. ...
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.
