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Brzoska R, Laprus H, Klaptocz P, Malik SS, Solecki W, Blasiak A. Arm Function After Arthroscopic Decompression of the Suprascapular Nerve at the Spinoglenoid Notch and Suprascapular Notch in Volleyball Players. Orthop J Sports Med 2023; 11:23259671221147892. [PMID: 36874055 PMCID: PMC9974621 DOI: 10.1177/23259671221147892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Accepted: 10/21/2022] [Indexed: 03/03/2023] Open
Abstract
Background Suprascapular nerve (SSN) entrapment in volleyball players leads to infraspinatus (ISP) muscle atrophy and weakness of abduction and external rotation (ER) of the shoulder. Purpose To assess functional outcome after arthroscopic extended decompression of SSN in the spinoglenoid notch and suprascapular notch in a group of volleyball athletes. Study Design Case series; Level of evidence, 4. Methods Volleyballers who underwent arthroscopic SSN decompression were analyzed retrospectively. Assessment tools consisted of range of motion and ER strength on Lovett scale and postoperative ER strength measured by dynamometer, Constant-Murley score (CMS), and visual evaluation of ISP muscle recovery by assessing muscle bulk. Results The study included 10 patients (9 male and 1 female). The mean age was 25.9 years (range, 19-33) and mean follow-up was 77.9 months (range, 7-123). The mean range of postoperative ER at 90° of abduction (ER2) was 105.6° (88°-126°) and 108.5° (93°-124°) for the contralateral side, while ER2 strength was 8 ± 2.6 and 12.65 ± 2.8 kg (P < .01) respectively. Mean CMS was 89.9 (84-100). In 5 cases, there was complete recovery of ISP muscle atrophy whereas 2 patients had partial recovery and 3 had none. Conclusion Arthroscopic SSN decompression in volleyball players improves shoulder function, but results of ISP recovery and ER strength are variable.
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Affiliation(s)
| | | | | | - Shahbaz S Malik
- Worcestershire Acute Hospitals NHS Trust, Worcester, Worcestershire, UK
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Ma HH, Wu WT, Tsai IC, Chang KV. Does suprascapular nerve release provide additional benefits for rotator cuff repair: a systematic review and meta-analysis. J Shoulder Elbow Surg 2022; 31:2421-2430. [PMID: 35738544 DOI: 10.1016/j.jse.2022.05.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Accepted: 05/23/2022] [Indexed: 02/01/2023]
Abstract
BACKGROUND There is still a lack of consensus regarding whether suprascapular nerve decompression should be routinely performed with rotator cuff repair. Therefore, this meta-analysis aimed to evaluate whether additional suprascapular nerve release (SSNR) could improve shoulder functional outcomes and pain relief more than rotator cuff repair alone. MATERIALS AND METHODS We performed a literature review of electronic databases for noncomparative and comparative studies investigating the effect of SSNR in patients undergoing rotator cuff repair. The primary outcome was the change in shoulder function scores from the preoperative status, and the secondary outcome was the change in the visual analog scale (VAS) score of pain after surgery. A subgroup analysis was conducted based on the study design (noncomparative studies vs. comparative studies). RESULTS Nine studies comprising 279 participants were included. Our analysis demonstrated that the group that underwent SSNR had a better shoulder functional score after surgery than at preoperative assessment (standardized mean difference [SMD], 1.333, 95% confidence interval [CI], 0.708-1.959). No significant differences were identified in shoulder function improvement between those with and without SSNR, with an SMD of 0.163 (95% CI, -0.091 to 0.418). Likewise, the group with SSNR showed a decreased VAS score after surgery compared to their preoperative status (SMD, 0.910; 95% CI, 0.560-1.260). However, there was no significant difference in VAS change between those with and without SSNR, with an SMD of 0.431 (95% CI, -0.095 to 0.956). CONCLUSION The present meta-analysis revealed that SSNR might not be routinely needed in rotator cuff tendon repair as no additional benefits in functional improvement or pain relief were identified compared to rotator cuff tendon repair alone.
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Affiliation(s)
- Hsuan-Hsiao Ma
- Department of Orthopedics and Traumatology, Taipei Veterans General Hospital, Taipei, Taiwan; Department of Orthopedics, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan; Department of Orthopedics and Traumatology, Taipei Veterans General Hospital Taitung Branch, Taitung, Taiwan
| | - Wei-Ting Wu
- Department of Physical Medicine and Rehabilitation, National Taiwan University College of Medicine, Taipei, Taiwan; Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Bei-Hu Branch, Taipei, Taiwan
| | - I-Chen Tsai
- Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan; Congenital Heart Disease Study Group, Asian Society of Cardiovascular Imaging, Seoul, Republic of Korea; InnovaRad Inc., Taichung, Taiwan
| | - Ke-Vin Chang
- Department of Physical Medicine and Rehabilitation, National Taiwan University College of Medicine, Taipei, Taiwan; Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Bei-Hu Branch, Taipei, Taiwan; Center for Regional Anesthesia and Pain Medicine, Wang-Fang Hospital, Taipei Medical University, Taipei, Taiwan.
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Alaia EF, Day MS, Alaia MJ. Entrapment Neuropathies of the Shoulder. Semin Musculoskelet Radiol 2022; 26:114-122. [PMID: 35609573 DOI: 10.1055/s-0042-1742752] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Entrapment neuropathies of the shoulder most commonly involve the suprascapular or axillary nerves, and they primarily affect the younger, athletic patient population. The extremes of shoulder mobility required for competitive overhead athletes, particularly in the position of abduction and external rotation, place this cohort at particular risk. Anatomically, the suprascapular nerve is most prone to entrapment at the level of the suprascapular or spinoglenoid notch; the axillary nerve is most prone to entrapment as it traverses the confines of the quadrilateral space.Radiographs should be ordered as a primary imaging study to evaluate for obvious pathology occurring along the course of the nerves or for pathology predisposing the patient to nerve injury. Magnetic resonance imaging plays a role in not only identifying any mass-compressing lesion along the course of the nerve, but also in identifying muscle signal changes typical for denervation and/or fatty atrophy in the distribution of the involved nerve.
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Affiliation(s)
- Erin F Alaia
- Musculoskeletal Division, Department of Radiology, NYU Langone Health, New York, New York
| | - Michael S Day
- WellSpan Orthopedic Group, Chambersburg, Pennsylvania
| | - Michael J Alaia
- Department of Orthopedic Surgery, NYU Langone Orthopedic Hospital/NYU Langone Health, New York, New York
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Wu WT, Chen LR, Chang HC, Chang KV, Özçakar L. Quantitative Ultrasonographic Analysis of Changes of the Suprascapular Nerve in the Aging Population With Shoulder Pain. Front Bioeng Biotechnol 2021; 9:640747. [PMID: 33681173 PMCID: PMC7933457 DOI: 10.3389/fbioe.2021.640747] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Accepted: 02/02/2021] [Indexed: 12/12/2022] Open
Abstract
Background Older people are vulnerable to painful shoulder syndromes, the majority of which are derived from degenerative rotator cuff pathologies. The suprascapular nerve (SSN) is closely related to the rotator cuff complex, and its role in shoulder pain has recently been highlighted. This study aimed to explore the differences in SSN among older people with and without shoulder pain, and to investigate the potential factors influencing the nerve size using ultrasound (US) imaging. Methods Participants aged ≥60 years were enrolled in the study. A systematic and bilateral US examination of the rotator cuff tendons was performed. The SSN was examined from its origin in the brachial plexus to the spinoglenoid notch of the infraspinatus fossa. The association between the nerve’s cross-sectional area (CSA) and rotator cuff lesions was analyzed using the generalized estimation equation. Results Among the 94 participants, 45 (with bilaterally asymptomatic shoulders) were classified into the control group, whereas 49 (with at least one-sided shoulder pain) were classified into the group with shoulder pain. The average CSAs of the SSN at the level of the brachial plexus, supraspinatus fossa, and infraspinatus fossa were comparable between the patients in the control group and those with shoulder pain. There was a higher prevalence of rotator cuff lesions and enlarged distal SSNs in the painful shoulders than in the asymptomatic shoulders of patients with unilateral involvement. A full-thickness tear of the supraspinatus tendon was associated with swelling of the SSN in the supraspinatus fossa (β coefficient = 4.068 mm2, p < 0.001). Conclusion In the older population, full-thickness tears of the supraspinatus tendon are independently associated with enlargement of the distal SSN. In cases with large rotator cuff tendon tears with poor response to conservative treatments, possible SSN entrapment should be considered and managed accordingly.
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Affiliation(s)
- Wei-Ting Wu
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Bei-Hu Branch, Taipei, Taiwan
| | - Lan-Rong Chen
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Bei-Hu Branch, Taipei, Taiwan
| | - Hsiang-Chi Chang
- Department of Physical Medicine and Rehabilitation, Cheng Hsin General Hospital, Taipei, Taiwan
| | - Ke-Vin Chang
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Bei-Hu Branch, Taipei, Taiwan.,Department of Physical Medicine and Rehabilitation, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Levent Özçakar
- Department of Physical and Rehabilitation Medicine, Hacettepe University Medical School, Ankara, Turkey
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Yang P, Wang C, Zhang D, Zhang Y, Yu T, Qi C. Comparison of clinical outcome of decompression of suprascapular nerve at spinoglenoid notch for patients with posterosuperior massive rotator cuff tears and suprascapular neuropathy. BMC Musculoskelet Disord 2021; 22:202. [PMID: 33602212 PMCID: PMC7890909 DOI: 10.1186/s12891-021-04075-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Accepted: 02/10/2021] [Indexed: 11/10/2022] Open
Abstract
PURPOSE In the present study, we aimed to determine whether decompression of suprascapular nerve (SSN) at the spinoglenoid notch could lead to a better functional outcome for the patients who underwent repairment of rotator cuff due to posterosupeior massive rotator cuff tear (MRCT) and suprascapular neuropathy. METHODS A total of 20 patients with posterosuperior MRCT and suprascapular neuropathy were analyzed in the present work. The preoperative magnetic resonance imaging (MRI) showed rotator cuff tear in supraspinatus and infraspinatus. All patients underwent arthroscopic rotator cuff repair. Patients were divided into two groups (group A: non-releasing, group B: releasing) according to whether the SSN at the spinoglenoid notch was decompressed. The modified University of California at Los Angeles shoulder rating scale (UCLA) and visual analog scale (VAS) questionnaire were adopted to assess the function of the affected shoulder preoperatively and 12 months after the operation. Electromyography (EMG) and nerve conduction study (NCS) were used to evaluate the nerve condition. Patients underwent MRI and EMG/NCS at 6 months after operation and last follow-up. RESULTS All patients were satisfied with the treatment. MRI showed that it was well-healed in 19 patients at 6 months after the operation. However, the fatty infiltration of supraspinatus and infraspinatus was not reversed. Only one patient in the non-releasing group showed the retear. The retear rate of group A and group B were 30% (3/10) and 20% (2/10) respectively at 12 months after the operation. One patient undergoing SSN decompression complained of discomfort in the infraspinatus area. His follow-up EMG after 6 months showed fibrillation potentials (1+) and positive sharp waves (1+) in the infraspinatus. The other patients' EMG results showed no abnormality. The postoperative UCLA and VAS scores were improved in both groups, and there was no significant difference in the follow-up outcomes between the two groups. CONCLUSIONS Patients with postersuperior MRCT and suprascapular neuropathy, decompression of suprascapular nerve at spinoglenoid notch didn't lead to a better functional outcome with the repairment of rotator cuff. Arthroscopic rotator cuff repair could reverse the suprascapular neuropathy. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Pu Yang
- Orthopaedic Center, the Affiliated Hospital of Qingdao University, NO.16 Jiangsu road, Qingdao, 266100, China
| | - Chen Wang
- Orthopaedic Center, the Affiliated Hospital of Qingdao University, NO.16 Jiangsu road, Qingdao, 266100, China
| | - Dongfang Zhang
- Orthopaedic Center, the Affiliated Hospital of Qingdao University, NO.16 Jiangsu road, Qingdao, 266100, China
| | - Yi Zhang
- Orthopaedic Center, the Affiliated Hospital of Qingdao University, NO.16 Jiangsu road, Qingdao, 266100, China
| | - Tengbo Yu
- Orthopaedic Center, the Affiliated Hospital of Qingdao University, NO.16 Jiangsu road, Qingdao, 266100, China
| | - Chao Qi
- Orthopaedic Center, the Affiliated Hospital of Qingdao University, NO.16 Jiangsu road, Qingdao, 266100, China.
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Fabiś J, Danilewicz M, Niedzielski KR, Waszczykowski M, Fabiś-Strobin A, Bogucki A. The eccentric mechanotransduction, neuro-muscular transmission, and structural reversibility of muscle fatty infiltration. An experimental advanced disuse muscle-wasting model of rabbit supraspinatus. Arch Med Sci 2021; 17:1400-1407. [PMID: 34522269 PMCID: PMC8425242 DOI: 10.5114/aoms/131956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2020] [Accepted: 12/26/2020] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION Full-thickness rotator cuff tear is present in almost 50% of patients over age 65 years, and its degree is known to be a good predictor of the severity of muscle-wasting (MW) sarcopaenia, also known as fatty degeneration (FD). A FD CT grade > 2° is recognized as a borderline of its reversibility. A disuse model of supraspinatus FD (grade 2) in rabbits provides clinically relevant data. Therefore, the present study evaluates the correlation between eccentric mechanotransduction, neuromuscular transmission (NT), and reversibility of muscle fatty infiltration (MFI) in rabbit supraspinatus FD > 2°. MATERIAL AND METHODS The supraspinatus tendon was detached from the greater tubercle, infraspinatus, and subscapularis in 16 rabbits. The tendon was reinserted after 12 weeks, and the animals were euthanized 24 weeks after reconstruction. MFI was measured in the middle part of the supraspinatus. Single-fibre EMG (SFEMG) examination of the supraspinatus NT was performed on 4 animals. RESULTS The power of analysis was 99%. Significant differences in MFI volume were found between the operated (4.6 ±1.1%) and the opposite control sides (2.91 ±0.61%) (p < 0.001). SFEMG revealed no significant differences between the disuse and the control supraspinatus muscles (p > 0.05); however, 6.5% of the examined muscle fibres exhibited NT disorders combined with blockade of conduction in 2.5% of muscle fibres. CONCLUSIONS Critical MFI in a disuse model of rabbit supraspinatus FD, CT grade > 2°, is substantially reversible by eccentric training despite subclinical impairment of neuromuscular transmission. In addition, 0.63% reversal of MFI is correlated with 1% hypertrophy of type I and II muscle fibre diameter.
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Affiliation(s)
- Jarosław Fabiś
- Department of Arthroscopy, Minimally Invasive Surgery and Sports Traumatology Medical University of Lodz, Lodz, Poland
| | - Marian Danilewicz
- Morphometry Division, Department of Pathology, Medical University of Lodz, Lodz, Poland
| | - Kryspin R. Niedzielski
- Clinic of Orthopaedic and Traumatology Polish Mother’s Memorial Hospital Research Institute, Lodz, Poland
| | - Michał Waszczykowski
- Department of Arthroscopy, Minimally Invasive Surgery and Sports Traumatology Medical University of Lodz, Lodz, Poland
| | - Anna Fabiś-Strobin
- Clinic of Orthopaedic and Traumatology Polish Mother’s Memorial Hospital Research Institute, Lodz, Poland
| | - Andrzej Bogucki
- Department of Extrapyramidal Diseases, Medical University of Lodz, Lodz, Poland
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Ellenbecker TS, Dines DM, Renstrom PA, Windler GS. Visual Observation of Apparent Infraspinatus Muscle Atrophy in Male Professional Tennis Players. Orthop J Sports Med 2020; 8:2325967120958834. [PMID: 33195711 PMCID: PMC7605003 DOI: 10.1177/2325967120958834] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Accepted: 04/22/2020] [Indexed: 12/04/2022] Open
Abstract
Background: Previous studies have reported visually observed apparent muscle atrophy in
the infraspinous fossa of the dominant arm of overhead athletes. Several
mechanisms have been proposed as etiological factors, including eccentric
overload, compressive spinoglenoid notch paralabral cysts, and cumulative
tensile suprascapular neurapraxia. Purpose: To report the prevalence of apparent infraspinatus atrophy in male
professional tennis players and to determine whether the suspected atrophy
correlates with objectively measured weakness of external rotation. Study Design: Cross-sectional study; Level of evidence, 3. Methods: A total of 153 male professional tennis players underwent a musculoskeletal
screening examination that included visual inspection of the infraspinous
fossa. Infraspinatus atrophy was defined as hollowing or loss of soft tissue
bulk inferior to the scapular spine in the infraspinous fossa of one
extremity that was visibly different from the contralateral extremity. This
finding was observed and independently agreed upon by both an orthopaedic
surgeon and a physical therapist during the examination. Also assessed were
rotator cuff instrument-assisted manual muscle testing, visual observation
of scapular kinesis (or motion), and glenohumeral joint range of motion for
internal and external rotation and horizontal adduction. Results: In the 153 players, dominant-arm infraspinatus atrophy was observed in 92
players (60.1%), and only 1 player (0.7%) was identified with nondominant
infraspinatus atrophy. A Pearson correlation showed a significant
relationship between the presence of dominant-arm infraspinatus atrophy and
dominant-arm external rotation strength measured in neutral
abduction/adduction (at the side) (P = .001) as well as
between the presence of dominant-arm infraspinatus atrophy and bilateral
external rotation strength measured at 90° of glenohumeral joint abduction
(P = .009 for dominant arm and .002 for nondominant
arm). No significant correlation was found with scapular dyskinesis,
glenohumeral range of motion, or instrument-assisted manual muscle testing
of the supraspinatus (empty-can test). Conclusion: Visually observed infraspinatus muscle atrophy is a common finding in the
dominant shoulder of asymptomatic male professional tennis players and is
significantly correlated with external rotation weakness. This condition is
present in uninjured players without known shoulder pathology and is not
related to glenohumeral joint internal rotation, total rotation range of
motion, or scapular dysfunction. Players with visually observed
infraspinatus atrophy should be evaluated for external rotation strength and
may require preventive strengthening.
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Affiliation(s)
- Todd S Ellenbecker
- Medical Services, ATP Tour, Ponte Vedra Beach, Florida, USA.,ATP Medical Services Committee, ATP Tour, Ponte Vedra Beach, Florida, USA.,Rehab Plus Sports Therapy Scottsdale, Scottsdale, Arizona, USA
| | - David M Dines
- ATP Medical Services Committee, ATP Tour, Ponte Vedra Beach, Florida, USA.,Sports Medicine and Shoulder Service, Hospital for Special Surgery, New York, New York, USA
| | - Per A Renstrom
- ATP Medical Services Committee, ATP Tour, Ponte Vedra Beach, Florida, USA.,Karolinska Institute, Stockholm, Sweden
| | - Gary S Windler
- ATP Medical Services Committee, ATP Tour, Ponte Vedra Beach, Florida, USA.,South Carolina Sports Medicine & Orthopaedics Center, Charleston, South Carolina, USA
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Al-Redouan A, Holding K, Kachlik D. "Suprascapular canal": Anatomical and topographical description and its clinical implication in entrapment syndrome. Ann Anat 2020; 233:151593. [PMID: 32898658 DOI: 10.1016/j.aanat.2020.151593] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 07/23/2020] [Accepted: 08/16/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND Suprascapular nerve (SN) entrapment syndrome accounts for 1-2% of all shoulder pain. The SN travels within a space between the suprascapular notch (SSN) and the spinoglenoid notch (SGN). PURPOSE To report a detailed topographical study of the suprascapular canal (SSC) and ultimately sort the different types of SN entrapment by its anatomical localization within the canal. BASIC PROCEDURES Observational study on 30 free dissected limbs of formaldehyde-fixed cadavers. The SN and vessels were traced as they passed through the SSC and the boundaries of the SSC were observed and documented. The SSC was then exposed by reflecting away the bordering muscles. Dimensions of the SSC as well as parameters of the SSN and SGN were measured using a digital caliper. Finally, a thorough literature review was made to survey the SN entrapment occurrence by site. MAIN FINDINGS The SSC is situated in the spinoglenoid fossa, has an average width of 13 mm, and runs underneath the supraspinatus muscle with an average distance of 25 mm between the SSN and SGN sloping in an infero-postero-lateral direction. The first segment represents the SSC entrance site and is composed of two spaces: osteofibrous and musculofibrous. The second segment is bordered by the supraspinatus muscle fascia, lateral margin of the supraspinous fossa, glenohumeral joint capsule, and the bony surface of the scapula (spinoglenoid fossa). This represents the SSC passage site. The third segment represents the SSC exit site around the spinoacromial arch at the SGN. PRINCIPAL CONCLUSIONS The SSC is defined as an osteofibrous canal running between the SSN and SGN enclosed by the supraspinatus fascia. It is anatomically composed of three segments: an entrance, a passage, and an exit. The distal SN passes through the SSC via five intervals that correspond to five potential sites of anatomical nerve entrapment: at the pre-entrance site, entrance site, passage site, exit site, and post-exit site. Each of those sites was found to be associated with specific causes and forms of entrapment.
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Affiliation(s)
- Azzat Al-Redouan
- Department of Anatomy, Second Faculty of Medicine, Charles University, Prague, Czechia.
| | - Keiv Holding
- Department of Anatomy, Second Faculty of Medicine, Charles University, Prague, Czechia.
| | - David Kachlik
- Department of Anatomy, Second Faculty of Medicine, Charles University, Prague, Czechia.
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