1
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Kim DH, Sohn HJ, Kim JH, Cho CH. Clinical Outcomes Following Arthroscopic Decompression and Repair versus Repair Alone in Patients with a Concomitant Spinoglenoid Cyst and SLAP Lesion: A Systematic Review. Diagnostics (Basel) 2023; 13:2364. [PMID: 37510107 PMCID: PMC10378101 DOI: 10.3390/diagnostics13142364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 07/06/2023] [Accepted: 07/12/2023] [Indexed: 07/30/2023] Open
Abstract
(1) Background: Patients with a superior-labrum-from-anterior-to-posterior (SLAP) tear associated with a spinoglenoid ganglion cyst have undergone various procedures. The purpose of this study is to evaluate clinical outcomes following arthroscopic treatment in patients with a concomitant spinoglenoid ganglion cyst and SLAP lesion. (2) Methods: This study followed PRISMA (preferred reporting items for systematic reviews and meta-analyses) guidelines, utilizing the PubMed, EMBASE, Cochrane Library, and Scopus databases. The keywords included shoulder, SLAP, labral tear, spinoglenoid notch, paralabral cyst, arthroscopy, and treatment. (3) Results: A total of 14 articles (206 patients) were included. Repair alone was administered in 114 patients (Group R), and 92 patients underwent additional cyst decompression (Group RD). Both groups showed excellent and similar clinical scores. The rate of the complete resorption of the cyst was 95.5% in Group RD, and 92.2% in Group R. The complication rate was 3.5% in Group RD, and 11.4% in Group R. The reoperation rate was 0% in Group RD, and 5.3% in Group R. (4) Conclusion: Reliable clinical outcomes without serious complications were obtained from the use of both procedures. The decompression of the cyst is a safe method that will alleviate pressure on the suprascapular nerve.
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Affiliation(s)
- Du-Han Kim
- Department of Orthopedic Surgery, Keimyung University Dongsan Hospital, Keimyung University School of Medicine, Daegu 42601, Republic of Korea
| | - Hyuk-Joon Sohn
- Department of Orthopedic Surgery, Keimyung University Dongsan Hospital, Keimyung University School of Medicine, Daegu 42601, Republic of Korea
| | - Ji-Hoon Kim
- Department of Orthopedic Surgery, Keimyung University Dongsan Hospital, Keimyung University School of Medicine, Daegu 42601, Republic of Korea
| | - Chul-Hyun Cho
- Department of Orthopedic Surgery, Keimyung University Dongsan Hospital, Keimyung University School of Medicine, Daegu 42601, Republic of Korea
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2
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Comparisons between treatment of isolated posterosuperior paralabral cysts and simultaneous treatment of cysts combined with associated shoulder pathologies: arthroscopic treatment of posterosuperior paralabral cysts. Arch Orthop Trauma Surg 2023; 143:665-675. [PMID: 34398279 DOI: 10.1007/s00402-021-04128-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Accepted: 08/12/2021] [Indexed: 10/20/2022]
Abstract
INTRODUCTION The purpose of this study is to report the radiologic and clinical outcomes of arthroscopic intervention for isolated posterosuperior paralabral cysts and simultaneous treatment of cysts combined with associated shoulder pathologies. MATERIALS AND METHODS From March 2008 through December 2016, 70 cases (48 males and 22 females) operated on for symptomatic posterosuperior paralabral cysts were included. Mean age was 45 (range 18-69). These patients were classified into two groups depending on if they had accompanying lesions: Group I (isolated group, 27 patients) and Group II (concomitant group, 43 patients). Arthroscopic cyst decompression with a labral repair or posterior capsulotomy for patients without labral tear were performed. All concomitant pathologies were also operated simultaneously. Follow-up MRI were performed at postoperative 6 months and clinical outcomes were evaluated during the follow-up. RESULTS Arthroscopic all intra-articular cyst decompression and labral repair was performed on 67 patients. In three patients, posterior capsulotomy without labral repair was performed for cyst removal. For 43 patients with concomitant lesions, 31 rotator cuff repairs, three SLAP repairs along with biceps tenodesis, two distal clavicle resections due to A-C joint arthritis, one calcific deposit removal, four Bankart repairs, and two acromioplasties were performed. The follow-up MRI showed complete cyst resorption except for two patients. The mean VAS, ASES, UCLA, SST and CS scores significantly improved at the last follow-up. Although both groups showed significantly improved range of motion after the surgery, improvement of ROM in Group II lagged at early periods of the rehabilitation. CONCLUSIONS Arthroscopic labral repair with all intra-articular cysts decompression or simple posterior capsulotomy were both effective treatment modalities. If paralabral cysts were associated with other shoulder lesions, simultaneous treatment of combined lesions could be performed for the improved clinical outcomes at final follow-up with expected lag in the early rehabilitation period. LEVEL OF EVIDENCE Level III, Retrospective Comparative Trial, Treatment Study.
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3
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Li L, McGuinness BK, Layer JS, Song Y, Jensen MA, Dai B. Longitudinal assessments of strength and dynamic balance from pre-injury baseline to 3 and 4 months after labrum repairs in collegiate athletes. Physiother Theory Pract 2022; 38:2505-2513. [PMID: 34098835 PMCID: PMC8648851 DOI: 10.1080/09593985.2021.1934925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Revised: 01/26/2021] [Accepted: 04/10/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND There is a lack of quantitative assessments of athletes' functional strength and dynamic balance following labrum repairs. PURPOSE To compare the upper extremity strength and dynamic balance among pre-injury baseline and approximately 3 and 4 months after labrum surgeries in collegiate athletes to identify critical values to inform rehabilitation. METHODS Fifteen male and one female collegiate athletes between 18 and 22 years old were tested at pre-injury baseline (n = 14) and 2.7 (n = 16) and 3.8 months (n = 12) after labrum surgeries. Strength was assessed using the peak forces produced in a maximal push-up test. Dynamic balance was assessed using the reaching distances in a reaching test. RESULTS The injured side's peak forces significantly decreased from the baseline to the 3-month post-surgery and then significantly increased between the 3-month and 4-month post-surgery assessments but remained significantly less at the 4-month post-surgery compared to the baseline (p ≤ 0.024; Cohen's dz ≥ 0.75). Peak force asymmetries were greater at the 3-month and 4-month post-surgery assessments than the baseline (p ≤ 0.005; Cohen's dz ≥ 1.02). CONCLUSION With a relatively small sample size, the results support the use of objective functional assessments for rehabilitation and return-to-play decisions among collegiate athletes following labrum repairs.
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Affiliation(s)
- Ling Li
- Division of Kinesiology and Health, University of Wyoming, 1000 E. University Ave. Laramie, WY, USA
| | - Brenna K. McGuinness
- Division of Kinesiology and Health, University of Wyoming, 1000 E. University Ave. Laramie, WY, USA
| | - Jacob S. Layer
- Division of Kinesiology and Health, University of Wyoming, 1000 E. University Ave. Laramie, WY, USA
| | - Yu Song
- Division of Kinesiology and Health, University of Wyoming, 1000 E. University Ave. Laramie, WY, USA
| | - Megan A. Jensen
- Department of Sports Medicine, 1000 E. University Ave.University of Wyoming, Laramie, USA
| | - Boyi Dai
- Division of Kinesiology and Health, University of Wyoming, 1000 E. University Ave. Laramie, WY, USA
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Schubert MF, Duralde XA. Posterior Shoulder Instability in the Throwing Athlete. OPER TECHN SPORT MED 2021. [DOI: 10.1016/j.otsm.2021.150802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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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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Abstract
Suprascapular neuropathy is a potential source of shoulder pain and functional limitation that can present secondary to various etiologies including entrapment or compression. Cystic lesions arising from a labral or capsular tear can compress the nerve along its course over the scapula. Nerve traction is theorized to arise from chronic overhead athletics or due to a retracted rotator cuff tear. The diagnosis of suprascapular neuropathy is based on a combination of a detailed history, a comprehensive physical examination, imaging, and electrodiagnostic studies. Although the anatomic course and variations in bony constraint are well understood, the role of surgical treatment in cases of suprascapular neuropathy is less clear. Recent reviews on the topic have shed light on the outcomes after the treatment of suprascapular neuropathy because of compression, showing that surgical release can improve return to play in well-indicated patients. The incidence of compressive neuropathy is quite high in the overhead athletic cohort, but most patients do not show clinically relevant deficiencies in function. Surgical release is therefore not routinely recommended unless patients with pain or deficits in strength fail appropriate nonsurgical treatment.
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STIRMA GUILHERMEAUGUSTO, LIMA EWERTONBORGESDESOUZA, CHAVES DEGINALDOHOLANDA, BELANGERO PAULOSANTORO, ANDREOLI CARLOSVICENTE, EJNISMAN BENNO. LATARJET PROCEDURE ON ANTERIOR SHOULDER INSTABILITY IN PROFESSIONAL SOCCER PLAYERS. ACTA ORTOPEDICA BRASILEIRA 2020; 28:84-87. [PMID: 32425670 PMCID: PMC7224322 DOI: 10.1590/1413-785220202802225433] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Anterior glenohumeral instability is a frequent cause of professional soccer
players’ removal, reduced performance, and prolonged recovery. Players are
subjected to intense physical contact and high performance, thus demanding lower
rates of recurrence after surgical correction so they can return to sport
quickly.
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8
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Surya P, Pankhania R, Ul Islam S. Suprascapular Neuropathy in Overhead Athletes: A Systematic Review of Aetiology and Treatment Options. Open Orthop J 2019. [DOI: 10.2174/1874325001913010177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/22/2023] Open
Abstract
Suprascapular neuropathy is often overlooked as a cause for shoulder pain in overhead athletes and can be misdiagnosed for many months, even years. With recent advancements in the understanding of the condition as well as its treatment methods, suprascapular neuropathy is now being diagnosed more frequently. However with a multitude of treatment options, it can be difficult to choose the optimal management. In this systematic review, we have carried out a detailed literature search about suprascapular neuropathy looking into evidence-based diagnostic workup and treatment modalities available. Repetitive overhead activities, rotator cuff tear and direct compression of the nerve by space-occupying lesion are important etiologies for suprascapular neuropathy. Whilst MRI is widely used for the identification of space-occupying lesions and rotator cuff injury; Electromyography (EMG) and Nerve Conduction Studies (NCS) remain gold standards for confirming injury to the nerve. Conservative treatment modalities including physiotherapy and activity modification, nerve blocks, arthroscopic and open surgical interventions are the main treatment options for suprascapular neuropathy.
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9
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Phillips CJ, Field AC, Field LD. Transcapsular Decompression of Shoulder Ganglion Cysts. Arthrosc Tech 2018; 7:e1263-e1267. [PMID: 30591872 PMCID: PMC6305895 DOI: 10.1016/j.eats.2018.08.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Accepted: 08/03/2018] [Indexed: 02/03/2023] Open
Abstract
Paralabral cysts are an increasingly recognized cause of suprascapular nerve (SSN) impingement, often causing insidious weakness in the rotator cuff. Compression at the suprascapular notch is often due to the presence of a SLAP tear and leads to pain, weakness, and atrophy of both the supraspinatus and infraspinatus muscles. Compression of the SSN at the spinoglenoid notch leads to weakness and atrophy of the infraspinatus only. Arthroscopic decompression of cysts with repair of labral pathology is typically performed in a sublabral fashion, which may make visualization of the extent of the cyst difficult and places the SSN at increased risk. With any approach, an intimate knowledge of the anatomy of the SSN is vital to safe decompression. We present a surgical technique for decompression of paralabral cysts using an intra-articular transcapsular approach. This approach maximizes visualization and efficiency and reduces possible damage to the SSN.
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Affiliation(s)
| | | | - Larry D. Field
- Address correspondence to Larry D. Field, M.D., Mississippi Sports Medicine and Orthopaedic Center, 1325 E Fortification St, Jackson, MS 39202, U.S.A.
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10
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Promsang T, Kongrukgreatiyos K, Kuptniratsaikul S. Arthroscopic Decompression of Spinoglenoid Notch Cyst and SLAP Repair Through a Single Working Portal. Arthrosc Tech 2018; 7:e963-e967. [PMID: 30258779 PMCID: PMC6153417 DOI: 10.1016/j.eats.2018.05.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Accepted: 05/25/2018] [Indexed: 02/03/2023] Open
Abstract
A SLAP lesion can be found with a concomitant spinoglenoid notch cyst. The cyst can cause suprascapular nerve compression, resulting in shoulder pain and weakness of external rotation. Their management varies from conservative treatment to operative treatment. Cyst decompression through the labral tear is our preferred treatment. Previous studies demonstrated a good result after arthroscopic decompression of the cyst through the labral tear combined with SLAP repair. Many surgeons usually use 3 portals to perform this procedure. However, we prefer to use only 2 portals, 1 anterior viewing portal and 1 posterior working portal. This strategy is more time and cost efficient. The patient is positioned in lateral decubitus. The SLAP lesion is demonstrated by using a probe. Tissue elevator is inserted into the labral lesion to penetrate into the cyst wall. A soft anchor is placed. A birdbeak suture passer penetrates the posterior labrum. Then knot tying is done. The advantages of this single working portal technique are short operative time, a decreased risk of iatrogenic rotator cuff injury from accessory anterolateral portal or posterior labral injury from posterolateral portal, and avoiding unnecessary superior capsule incision for cyst exposure.
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Affiliation(s)
- Trai Promsang
- Department of Orthopaedics, Sikarin Hospital, Bangkok, Thailand
- Address correspondence to Trai Promsang, M.D., M.S., Sikarin Hospital, Department of Orthopaedics, 4/29 Moo 10, Srinakarin road Bang-Na sub-district, Bangkok 10260.
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11
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Schroeder AJ, Bedeir YH, Schumaier AP, Desai VS, Grawe BM. Arthroscopic Management of SLAP Lesions With Concomitant Spinoglenoid Notch Ganglion Cysts: A Systematic Review Comparing Repair Alone to Repair With Decompression. Arthroscopy 2018; 34:2247-2253. [PMID: 29501216 DOI: 10.1016/j.arthro.2018.01.031] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2017] [Revised: 01/17/2018] [Accepted: 01/18/2018] [Indexed: 02/02/2023]
Abstract
PURPOSE To determine if cyst management is necessary in the setting of SLAP lesions with concomitant paralabral ganglion cysts. METHODS We performed a systematic review according to Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines, including all studies that met inclusion criteria from January 1975 to July 2015. We included patients with a SLAP II-VII lesion and a concomitant paralabral ganglion cyst who underwent arthroscopic labral repair with or without cyst decompression. Patients with follow-up of less than 3 months, a SLAP I lesion, or who underwent concomitant cuff repair were excluded. The Methodological Index for Non-randomized Studies (MINORS) scoring system was used to quantify the potential bias in each study. Outcome measures reported were provided in a table format and a subjective analysis was performed. RESULTS Nineteen studies were included yielding a total of 160 patients: 66 patients treated with repair alone [R] and 94 patients with additional cyst decompression or excision [R+D]. The VAS, Rowe, and Constant scores were excellent and similar in both groups. The mean VAS was 0.6 in [R] and ranged between 0 and 2 in [R+D] (0.5, 0, 2, 0.2). The mean Rowe scores were 94 and 98 in [R] and 95 in [R+D]. The mean Constant scores were 97 in [R] and ranged between 87 and 98 in [R+D] (98, 87, 92, 94). In total, 5 of 90 patients were unable to return to work and 2 of 45 were unable to return to sport. All 15 patients who had follow-up electromyographies displayed resolution, and in the 115 patients with follow-up MRIs, 12 did not have complete resolution of the cyst. CONCLUSIONS Despite the lack of high-quality evidence, the studies subjectively analyzed in this review suggest that both groups have excellent results. The results do not show any advantages from performing decompression. LEVEL OF EVIDENCE Level IV, systematic review of Level II and Level IV studies.
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Affiliation(s)
- Amanda J Schroeder
- Department of Orthopaedic Surgery, University of Cincinnati, Cincinnati, Ohio, U.S.A
| | - Yehia H Bedeir
- Department of Orthopaedic Surgery, University of Cincinnati, Cincinnati, Ohio, U.S.A..
| | - Adam P Schumaier
- Department of Orthopaedic Surgery, University of Cincinnati, Cincinnati, Ohio, U.S.A
| | - Vishal S Desai
- Department of Orthopaedic Surgery, University of Cincinnati, Cincinnati, Ohio, U.S.A
| | - Brian M Grawe
- Department of Orthopaedic Surgery, University of Cincinnati, Cincinnati, Ohio, U.S.A
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12
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Perry NPJ, Wolfe JA, Nguyen-Ta K, Christensen D, McDonald LS, Dickens JF, LeClere LE. Biceps Tenodesis and Intra-articular Decompression for Treatment of Superior Labral Tear from Anterior to Posterior and Associated Paralabral Cyst in Active Duty Military. Mil Med 2018; 183:e194-e200. [PMID: 29420745 DOI: 10.1093/milmed/usx019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2017] [Accepted: 10/20/2017] [Indexed: 01/02/2023] Open
Abstract
Background To examine the outcomes of combined biceps tenodesis and indirect, intra-articular arthroscopic paralabral cyst decompression for the treatment of active duty military patients with superior labral from anterior to posterior tears and associated paralabral cysts. Methods Retrospective chart review of all active duty patients at our institution from 2011 to 2014 with superior labral from anterior to posterior tears and associated paralabral cysts at the spinoglenoid notch treated with biceps tenodesis and indirect arthroscopic cyst decompression. Patient charts were examined for pre- and post-operative parameters including strength, range of motion, visual analog scale pain score, American Shoulder and Elbow Surgeon Score, and Single Assessment Numeric Evaluation Score. Results Seven patients met study criteria. All patients presented with chronic shoulder pain and decreased external rotation strength, and three patients had clinically apparent muscular atrophy. Pre- and post-operative assessment showed external rotation strength increased from a median of 4 (range 4-4) to 5 (range 4-5; p-value = 0.014), Single Assessment Numeric Evaluation increased from a median of 50 (range 0-70) to 75 (range 30-95; p-value = 0.031), American Shoulder and Elbow Surgeon increased from a median of 46.0 (range 32.0-58.0) to 66.5 (range 58.0-98.0; p-value = 0.068), and visual analog scale pain score decreased from a median of 3 (range 1-8) to 0 (range 0-5; p-value = 0.017). Median follow-up was 66 wk (range 36-138 wk). The change was statistically significant (p <0.05) for external rotation strength, Single Assessment Numeric Evaluation, and VAS reduction. Post-operatively, all patients returned to full duty at a median of 20 wk (range 12-36 wk). Conclusion The use of biceps tenodesis in conjunction with indirect, intra-articular arthroscopic paralabral cyst decompression is an effective technique in an active patient population with superior labral from anterior to posterior tear with associated paralabral cyst.
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Affiliation(s)
- Nicholas P J Perry
- Department of Orthopaedics, Naval Medical Center San Diego, 34800 Bob Wilson Drive, San Diego, CA 92134-3300
| | - Jared A Wolfe
- Department of Orthopaedics, Walter Reed National Military Medical Center, 8901 Rockville Pike, Bethesda, MD 20889
| | - Kim Nguyen-Ta
- Medical Education and Telemedicine 120, UC San Diego School of Medicine, 9500 Gilman Drive, La Jolla, CA 92093
| | - Daniel Christensen
- Department of Orthopaedics, Walter Reed National Military Medical Center, 8901 Rockville Pike, Bethesda, MD 20889
| | - Lucas S McDonald
- Department of Orthopaedics, Naval Medical Center San Diego, 34800 Bob Wilson Drive, San Diego, CA 92134-3300
| | - Jonathan F Dickens
- Department of Orthopaedics, Walter Reed National Military Medical Center, 8901 Rockville Pike, Bethesda, MD 20889
| | - Lance E LeClere
- United States Naval Academy, Naval Health Clinic Annapolis, Annapolis, MD, 626 MacCubbin Ln, Gambrills, MD 21054
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13
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Momaya AM, Kwapisz A, Choate WS, Kissenberth MJ, Tolan SJ, Lonergan KT, Hawkins RJ, Tokish JM. Clinical outcomes of suprascapular nerve decompression: a systematic review. J Shoulder Elbow Surg 2018; 27:172-180. [PMID: 29221575 DOI: 10.1016/j.jse.2017.09.025] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2017] [Revised: 09/16/2017] [Accepted: 09/20/2017] [Indexed: 02/01/2023]
Abstract
BACKGROUND Suprascapular neuropathy is an uncommon clinical diagnosis. Although there have been a number of case series reporting on this pathologic process, to date there has been no systematic review of these studies. This study aimed to synthesize the literature on suprascapular neuropathy with regard to clinical outcomes. The secondary objective was to detail the diagnosis and treatment of suprascapular neuropathy and any associated complications. METHODS A systematic review was performed to identify studies that reported the results or clinical outcomes of suprascapular nerve decompression. The searches were performed using MEDLINE through PubMed and Cochrane Database of Systematic Reviews. RESULTS Twenty-one studies comprising 275 patients and 276 shoulders met inclusion criteria. The mean age was 41.9 years, and mean follow-up was 32.5 months. The most common symptom was deep, posterior shoulder pain (97.8%), with a mean duration of symptoms before decompression of 19.0 months; 94% of patients underwent electrodiagnostic testing before decompression, and 85% of patients had results consistent with suprascapular neuropathy. The most common outcome reported was the visual analog scale score, followed by the Constant-Murley score. The mean postoperative Constant-Murley score obtained was 89% of ideal maximum. Ninety-two percent of athletes were able to return to sport. Only 2 (0.74%) complications were reported in the included studies. CONCLUSIONS Surgical decompression in the setting of suprascapular neuropathy leads to satisfactory outcomes as evidenced by the patient-reported outcomes and return to sport rate. Furthermore, the rate of complications appears to be low.
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Affiliation(s)
- Amit M Momaya
- Steadman Hawkins Clinic of the Carolinas, Greenville Health System, Greenville, SC, USA
| | - Adam Kwapisz
- Hawkins Foundation, Greenville, SC, USA; Clinic of Orthopedics and Pediatric Orthopedics, Medical University of Łódź, Poland
| | - W Stephen Choate
- Steadman Hawkins Clinic of the Carolinas, Greenville Health System, Greenville, SC, USA
| | - Michael J Kissenberth
- Steadman Hawkins Clinic of the Carolinas, Greenville Health System, Greenville, SC, USA
| | - Stefan J Tolan
- Steadman Hawkins Clinic of the Carolinas, Greenville Health System, Greenville, SC, USA
| | - Keith T Lonergan
- Steadman Hawkins Clinic of the Carolinas, Greenville Health System, Greenville, SC, USA
| | - Richard J Hawkins
- Steadman Hawkins Clinic of the Carolinas, Greenville Health System, Greenville, SC, USA
| | - John M Tokish
- Steadman Hawkins Clinic of the Carolinas, Greenville Health System, Greenville, SC, USA; Mayo Clinic Arizona, Phoenix, AZ, USA.
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14
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Memon M, Kay J, Ginsberg L, Simunovic N, Bak K, Lapner P, Ayeni OR. Arthroscopic management of suprascapular neuropathy of the shoulder improves pain and functional outcomes with minimal complication rates. Knee Surg Sports Traumatol Arthrosc 2018; 26:240-266. [PMID: 28879607 DOI: 10.1007/s00167-017-4694-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2017] [Accepted: 08/21/2017] [Indexed: 01/02/2023]
Abstract
PURPOSE The purpose of this study was to systematically assess the arthroscopic management of suprascapular neuropathy, including the aetiology, surgical decision-making, clinical outcomes, and complications associated with the procedure. METHODS Three databases [PubMed, Ovid (Medline), and Embase] were searched. Systematic literature screening and data abstraction was performed in duplicate to present a review of studies reporting on arthroscopic management of suprascapular neuropathy. The quality of the included studies was assessed using level of evidence and the MINORS (Methodological Index for Nonrandomized Studies) checklist. RESULTS In total, 40 studies (17 case reports, 20 case series, 2 retrospective comparative studies, and 1 prospective comparative study) were identified, including 259 patients (261 shoulders) treated arthroscopically for suprascapular neuropathy. The most common aetiology of suprascapular neuropathy was suprascapular nerve compression by a cyst at the spinoglenoid notch (42%), and the decision to pursue arthroscopic surgery was most commonly based on the results of clinical findings and investigations (47%). Overall, 97% of patients reported significant improvement in or complete resolution of their pre-operative symptoms (including pain, strength, and subjective function of the shoulder) over a mean follow-up period of 23.7 months. Further, there was a low overall complication rate (4%) associated with the arthroscopic procedures. CONCLUSION While most studies evaluating arthroscopic management of suprascapular neuropathy are uncontrolled studies with lower levels of evidence, results indicate that such management provides patients with significant improvements in pain, strength, and subjective function of the shoulder, and has a low incidence of complications. Patients managed arthroscopically for suprascapular neuropathy may expect significant improvements in pain, strength, and subjective function of the shoulder. LEVEL OF EVIDENCE Level IV, systematic review of level II to IV studies.
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Affiliation(s)
- M Memon
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada
| | - J Kay
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada
| | - L Ginsberg
- Department of Life Sciences, McMaster University, Hamilton, ON, Canada
| | - N Simunovic
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada
| | - K Bak
- Sports Clinic, Aleris-Hamlet Parken, Oester Alle 42, 2nd Floor, Copenhagen, Denmark
| | - P Lapner
- Division of Orthopaedic Surgery, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON, Canada
| | - O R Ayeni
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University Medical Centre, McMaster University, 1200 Main St West, 4E15, Hamilton, ON, L8N 3Z5, Canada.
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15
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C.K. S, Varshney A, Yoo YS, Lee SJ. Arthroscopic Intra-articular Spinoglenoid Cyst Resection Following SLAP Repair. Arthrosc Tech 2017; 6:e1795-e1799. [PMID: 29416967 PMCID: PMC5797713 DOI: 10.1016/j.eats.2017.06.056] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2017] [Accepted: 06/28/2017] [Indexed: 02/03/2023] Open
Abstract
Spinoglenoid cyst (SGC) is a ganglion arising in the spinoglenoid notch and is thought to be related to SLAP lesion. This cyst often compresses the suprascapular nerve in the spinoglenoid notch. Symptomatic cysts require surgical treatment when conservative treatment fails. In particular, arthroscopic decompression through the torn labral tissue when the cyst is extending into the joint cavity is easy and convenient. However, if the cyst is confined to the spinoglenoid notch, arthroscopic approach through the torn labral tissue is challenging. Thus, we present our preferred technique of addressing the SGC through an additional superior capsular window after completing SLAP repair. We believe that our technique is easy, reproducible, and reasonable.
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Affiliation(s)
- Sreehari C.K.
- Address correspondence to Sreehari C.K., M.S., Department of Orthopaedic Surgery, Hallym University Dongtan Sacred Heart Hospital, Dongtan, Republic of Korea.Department of Orthopaedic SurgeryHallym University Dongtan Sacred Heart HospitalDongtanRepublic of Korea
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16
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Abstract
Introduction: A spinoglenoid cyst with suprascapular nerve disorders is highly associated with superior labrum anterior posterior (SLAP) lesion. Conservative or surgical treatment is applied to relieve pain and neurological symptoms. The purpose of this study was to evaluate clinical outcomes of patients treated by arthroscopic surgery for SLAP lesion with a spinoglenoid cyst. Methods: The subjects of this study were six patients with SLAP lesion with a spinoglenoid cyst who underwent arthroscopic surgery. There was one female and five males with a mean age of 48.5 years. SLAP lesion was found in all the patients at arthroscopy. A small tear of the rotator cuff was found in the two patients. The SLAP lesion was repaired using suture anchors, and the rotator cuff tears were repaired by suture-bridge fixation. The spinoglenoid cyst was decompressed through the torn labrum in three patients, and through the released superior to posterior portion of the capsule in the other three patients. Results: All patients showed excellent improvement in pain and muscle strength at the final follow-up examination. The mean Constant score was improved from 60.5 points preoperatively to 97.2 points postoperatively. The mean visual analog scale (VAS) score decreased from 4.5 on the day of the surgery to 2.5 within one week postoperatively. Postoperative MRI showed disappearance or reduction of the spinoglenoid cyst in four and two patients, respectively. There were no complications from the surgical intervention and in the postoperative period. Discussion: The patients treated by decompression through the released capsule obtained pain relief at an early period after the surgery. Arthroscopic treatment for a spinoglenoid cyst can provide a satisfactory clinical outcome. Arthroscopic decompression of a spinoglenoid cyst through the released capsule is recommended for a safe and reliable procedure for patients with suprascapular nerve disorders.
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Affiliation(s)
- Hiroshi Hashiguchi
- Department of Orthopaedic Surgery, Nippon Medical School Chiba Hokusoh Hospital 1715 Kamakari Inzai, Chiba 270-1694 Japan
| | - Satoshi Iwashita
- Department of Orthopaedic Surgery, Nippon Medical School Chiba Hokusoh Hospital 1715 Kamakari Inzai, Chiba 270-1694 Japan
| | - Atsushi Ohkubo
- Department of Orthopaedic Surgery, Nippon Medical School Chiba Hokusoh Hospital 1715 Kamakari Inzai, Chiba 270-1694 Japan
| | - Shinro Takai
- Department of Orthopaedic Surgery, Nippon Medical School Hospital 1-1-5 Sendagi Bunkyo-ku, Tokyo 113-8602 Japan
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17
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Jeong JJ, Panchal K, Park SE, Kim YY, Lee JM, Lee JK, Ji JH. Outcome After Arthroscopic Decompression of Inferior Labral Cysts Combined With Labral Repair. Arthroscopy 2015; 31:1060-8. [PMID: 25769479 DOI: 10.1016/j.arthro.2015.01.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2014] [Revised: 12/15/2014] [Accepted: 01/09/2015] [Indexed: 02/02/2023]
Abstract
PURPOSE To analyze the clinical and radiologic outcomes of arthroscopic cyst decompression and labral repair in patients with inferior paralabral cysts with chronic shoulder pain. METHODS Between March 2006 and September 2012, 16 patients who were identified as having inferior paralabral cysts presented with chronic shoulder pain. All patients underwent a thorough physical examination and preoperative magnetic resonance arthrographic evaluation. The mean age was 30 years (range, 17 to 50 years). The mean follow-up period was 38 months (range, 16 to 60 months). Clinical outcome scores (American Shoulder and Elbow Surgeons; University of California, Los Angeles; and Simple Shoulder Test) and passive shoulder range of motion were evaluated at last follow-up. Follow-up magnetic resonance imaging was performed at a mean of 8 months to determine the labral healing status and assess for cyst recurrence. RESULTS The incidence of isolated inferior paralabral cysts was 0.6% (16 of 2,656 cases). Of the patients, 8 had multiple cysts and 8 had a single cyst. The mean length and width of the cysts were 1.0 cm and 0.4 cm, respectively. Eight cases had a history of trauma, and 13 patients were involved in sports activities. Seventy-five percent of cases showed a positive relocation test. The mean American Shoulder and Elbow Surgeons; University of California, Los Angeles; and Simple Shoulder Test scores improved from 64, 22, and 8.7, respectively, preoperatively to 83, 31, and 10, respectively (P < .001), at final follow-up. Shoulder range of motion did not show any significant improvement. The location of the labral tear was as follows: anteroinferior tear in 5 cases, posteroinferior tear in 8 cases, and combined anteroinferior and posteroinferior tear in 3 cases. All cysts were found to be in association with a labral tear. A mean of 2.7 anchors were used for inferior labral repair. These cysts were found only in male patients. None of the patients showed any evidence of cyst recurrence on follow-up magnetic resonance imaging. CONCLUSIONS Inferior labral tears treated with cyst decompression and labral repair showed satisfactory clinical results without any recurrence. Inferior paralabral cysts should be considered in the differential diagnosis in patients presenting with chronic shoulder pain, particularly active male patients. LEVEL OF EVIDENCE Level IV, therapeutic case series.
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Affiliation(s)
- Jae-Jung Jeong
- Department of Orthopedic Surgery, College of Medicine, The Catholic University of Korea, Daejeon St. Mary's Hospital, Daejeon, South Korea
| | - Karnav Panchal
- Department of Orthopedic Surgery, College of Medicine, The Catholic University of Korea, Daejeon St. Mary's Hospital, Daejeon, South Korea
| | - Sang-Eun Park
- Department of Orthopedic Surgery, College of Medicine, The Catholic University of Korea, Daejeon St. Mary's Hospital, Daejeon, South Korea
| | - Young-Yul Kim
- Department of Orthopedic Surgery, College of Medicine, The Catholic University of Korea, Daejeon St. Mary's Hospital, Daejeon, South Korea
| | - Jae-Min Lee
- Department of Orthopedic Surgery, College of Medicine, The Catholic University of Korea, Daejeon St. Mary's Hospital, Daejeon, South Korea
| | - Jun-Ku Lee
- Department of Orthopedic Surgery, College of Medicine, The Catholic University of Korea, Daejeon St. Mary's Hospital, Daejeon, South Korea
| | - Jong-Hun Ji
- Department of Orthopedic Surgery, College of Medicine, The Catholic University of Korea, Daejeon St. Mary's Hospital, Daejeon, South Korea.
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18
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Arthroscopic all-intra-articular decompression and labral repair of paralabral cyst in the shoulder. J Shoulder Elbow Surg 2015; 24:e7-e14. [PMID: 25174937 DOI: 10.1016/j.jse.2014.05.017] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2014] [Revised: 05/06/2014] [Accepted: 05/15/2014] [Indexed: 02/01/2023]
Abstract
BACKGROUND The purpose of this study was to report the outcomes of all-intra-articular arthroscopic decompression and labral repair in patients with symptomatic paralabral cysts. METHODS From 2005 to 2011, 20 consecutive cases of symptomatic paralabral cysts were included in this study. All surgical procedures were conducted with intra-articular arthroscopic decompression by use of a probe through the site of labral tear for cyst evacuation and suture anchor repair for the associated posterosuperior labrum. Clinical scores and magnetic resonance imaging (MRI) were obtained preoperatively and at follow-up. MRI was used to evaluate the size and segmentation of the cyst and the presence of the labral tear. RESULTS MRI revealed paralabral cysts in association with labral tears in all cases. Cysts were extended in the spinoglenoid notch with a mean size of 2.5 × 2.6 × 2.2 cm on MRI. Cysts were nonsegmented in 5 cases (25%) and had multiple segments in 15 cases (75%). Mean follow-up was 42.8 ± 21.22 months. The mean visual analog scale score for pain, the American Shoulder and Elbow Surgeons score, and the Simple Shoulder Test score significantly improved at the last follow-up (P < .001, P < .001, and P = .001, respectively). The postoperative MRI study performed at a mean of 6 months for 18 of 20 cases (90%) revealed complete cyst removal. The satisfaction level with surgery was good to excellent in 18 patients, fair in 1 patient, and poor in 1 patient. No complication was related to the surgical procedure. CONCLUSION Arthroscopic all-intra-articular decompression and labral repair of paralabral cyst can be a simple and effective treatment, regardless of segmentation or size. It also resulted in complete removal of the cyst at a mean of 6 months postoperatively as revealed by MRI. An additional subacromial procedure might not be necessary for complete decompression.
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Lee YK, Han EY, Choi SW, Kim BR, Suh MJ. Type 2 Superior Labral Anterior to Posterior Lesion-Related Paralabral Cyst Causing Isolated Infraspinatus Paralysis: Two Case Reports. Ann Rehabil Med 2015; 39:848-52. [PMID: 26605185 PMCID: PMC4654094 DOI: 10.5535/arm.2015.39.5.848] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2015] [Accepted: 06/02/2015] [Indexed: 11/29/2022] Open
Abstract
Type 2 superior labral anterior to posterior (SLAP) lesion is a common cause of shoulder pain requiring surgical operation. SLAP tears are often associated with paralabral cysts, but they rarely cause nerve compression. However, we experienced two cases of type 2 SLAP-related paralabral cysts at the spinoglenoid notch which were confirmed as isolated nerve entrapment of the infraspinatus branch of the suprascapular nerve by electrodiagnostic assessment and magnetic resonance imaging. In these pathological conditions, comprehensive electrodiagnostic evaluation is warranted for confirmation of neuropathy, while surgical decompression of the paralabral cyst combined with SLAP repair is recommended.
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Affiliation(s)
- Yong Ki Lee
- Department of Rehabilitation Medicine, Jeju National University Hospital, Jeju National University School of Medicine, Jeju, Korea
| | - Eun Young Han
- Department of Rehabilitation Medicine, Jeju National University Hospital, Jeju National University School of Medicine, Jeju, Korea
| | - Sung Wook Choi
- Department of Orthopaedic Medicine, Jeju National University Hospital, Jeju National University School of Medicine, Jeju, Korea
| | - Bo Ryun Kim
- Department of Rehabilitation Medicine, Jeju National University Hospital, Jeju National University School of Medicine, Jeju, Korea
| | - Min Ji Suh
- Department of Rehabilitation Medicine, Jeju National University Hospital, Jeju National University School of Medicine, Jeju, Korea
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Bilsel K, Erdil M, Elmadag M, Ozden VE, Celik D, Tuncay I. The effect of infraspinatus hypotrophy and weakness on the arthroscopic treatment of spinoglenoid notch cyst associated with superior labrum anterior-to-posterior lesions. Knee Surg Sports Traumatol Arthrosc 2014; 22:2209-15. [PMID: 23462957 DOI: 10.1007/s00167-013-2469-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2012] [Accepted: 02/25/2013] [Indexed: 01/02/2023]
Abstract
PURPOSE Patients with spinoglenoid notch cyst associated with superior labrum anterior-to-posterior (SLAP) lesions were evaluated. The patients were all treated by arthroscopic cyst decompression combined with SLAP repair. The hypothesis of the study was that the patients who underwent prolonged conservative treatment period prior to surgery would exhibit significant infraspinatus hypotrophy and weakness, and their postoperative clinical and functional outcomes would be less satisfactory. METHODS Sixteen patients exhibited positive MRI and EMG findings with clinical signs of weakness and pain. The median age was 40.5 years (range 32-52), and the study group consisted of 11 males and 5 females with a median follow-up period of 26 months (12-48). The median duration of symptoms and conservative treatment prior to the surgical intervention was 3.5 months (1-14). Seven patients in group A exhibited infraspinatus hypotrophy. Group B comprised 9 patients without infraspinatus hypotrophy. RESULTS The results of the pre- and postoperative Constant scores, visual analogue scale (VAS) scores, and external rotation strength test rates were compared between groups. They all improved in terms of pain, strength, and function (P < 0.05). Significant differences were observed between the pre- and postoperative external rotation strengths and Constant scores (P < 0.05). However, no significant difference was observed between the pre- and postoperative VAS scores (n.s.). A significant correlation was observed in group A between surgical timing, the preoperative external rotation strength ratio (P = 0.04) and the postoperative VAS scores (P = 0.013). CONCLUSION The arthroscopic treatment was satisfactory with good clinical outcomes. Infraspinatus hypotrophy occurred in cases of prolonged surgical duration and significantly affected external rotation strength and functional outcomes. LEVEL OF EVIDENCE Retrospective comparative study, Level III.
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Affiliation(s)
- Kerem Bilsel
- Orthopaedic and Traumatology Department, Bezmialem Vakif University, Istanbul, Turkey,
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21
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Plancher KD, Petterson SC. Posterior Shoulder Pain and Arthroscopic Decompression of the Suprascapular Nerve at the Spinoglenoid Notch. OPER TECHN SPORT MED 2014. [DOI: 10.1053/j.otsm.2014.06.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
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Saccol MF, Zanca GG, Ejnisman B, de Mello MT, Mattiello SM. Shoulder rotator strength and torque steadiness in athletes with anterior shoulder instability or SLAP lesion. J Sci Med Sport 2013; 17:463-8. [PMID: 24268439 DOI: 10.1016/j.jsams.2013.10.246] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2013] [Revised: 10/07/2013] [Accepted: 10/13/2013] [Indexed: 11/16/2022]
Abstract
OBJECTIVES To investigate shoulder rotator strength and steadiness in athletes with anterior instability and superior labrum anterior posterior (SLAP) lesion. DESIGN Cross-sectional laboratory study. METHODS Athletes with anterior shoulder instability (instability group, n=10) and a SLAP lesion (SLAP group, n=10) were compared with healthy athletes matched by age, anthropometrics and sport (control group for shoulder instability, n=10 and control group for SLAP, n=10). Torque steadiness was evaluated with three 10s submaximal isometric contractions (35% of peak torque) with the arm at 90° of shoulder abduction and 90° of external rotation. The mean isometric torque, standard deviation and coefficient of variation were measured from the steadiness trials. To evaluate shoulder rotator strength, concentric isokinetic tests (90°/s, 180°/s) were performed at the 90-90° position and peak torque to body mass and shoulder external to internal rotation ratio variables were analyzed. The variables were tested with the instability and control groups with respect to shoulder instability and between the SLAP and control groups for SLAP lesion using the Mann-Whitney test. RESULTS The SLAP group presented a higher coefficient of variation than the SLAP control group (p=0.003). Regarding shoulder strength, the internal and external shoulder rotators were weaker in the instability group than in the instability control group (p<0.05). CONCLUSIONS Athletes with anterior shoulder instability presented shoulder rotation weakness, while athletes with a SLAP lesion showed higher torque fluctuation during internal rotation. These results indicate that there are different alterations to strength and sensory motor control in each condition.
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Affiliation(s)
| | - Gisele Garcia Zanca
- Department of Physical Therapy, Federal University of São Carlos, São Carlos, Brazil
| | - Benno Ejnisman
- Department of Orthopaedic Surgery and Sports Medicine, Federal University of São Paulo, São Paulo, Brazil
| | - Marco Túlio de Mello
- Center of Studies on Psychobiology and Exercise, Department of Psychobiology, Federal University of São Paulo, São Paulo, Brazil
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Arthroscopic suprascapular nerve decompression: transarticular and subacromial approach. Arthrosc Tech 2012; 1:e187-92. [PMID: 23766994 PMCID: PMC3678651 DOI: 10.1016/j.eats.2012.07.004] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2012] [Accepted: 07/18/2012] [Indexed: 02/03/2023] Open
Abstract
Entrapment of the suprascapular nerve (SSN) is an increasingly recognized entity that can occur due to traction or compression-related etiology. Traction injuries of the SSN are unlikely to respond to surgical management and frequently improve with rest and avoidance of overhead activity. Compression injuries, on the other hand, frequently require surgical decompression for pain relief. SSN entrapment caused by compression at the suprascapular notch by the transverse scapular ligament gives rise to pain and atrophy of both the supraspinatus and infraspinatus muscles. However, compression at the spinoglenoid notch is more insidious because pain fibers may not be involved, causing isolated external rotation weakness. We present our preferred surgical technique for safe decompression of the SSN at the suprascapular and spinoglenoid notch using a subacromial and intra-articular approach, respectively. The key to ensuring efficient and uncomplicated decompression of the SSN relies on an intimate knowledge of the neurovascular anatomy and related landmarks.
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Bancroft LW, Wasyliw C, Pettis C, Farley T. Postoperative Shoulder Magnetic Resonance Imaging. Magn Reson Imaging Clin N Am 2012; 20:313-25, xi. [DOI: 10.1016/j.mric.2012.01.010] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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