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Walker CR, Belisario JCY, Vasudevan JM. Suprascapular Neuropathy in Collegiate Tennis Player: A Case Report. Cureus 2021; 13:e20824. [PMID: 35141080 PMCID: PMC8802659 DOI: 10.7759/cureus.20824] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/30/2021] [Indexed: 11/16/2022] Open
Abstract
Suprascapular neuropathy can be seen in overhead athletes and should be considered when evaluating an overhead athlete presenting with shoulder pain and/or weakness. The suprascapular nerve innervates the supraspinatus and the infraspinatus, but dynamic entrapment as it passes under the spinoglenoid ligament at the spinoglenoid notch can lead to isolated denervation of the infraspinatus. Specific movements common in tennis cause tensioning and compression of the spinoglenoid ligament and may predispose players to dynamic entrapment at this location. We present a case of an 18-year-old male collegiate tennis player presenting with suprascapular neuropathy causing isolated denervation of the infraspinatus. This case illustrates the consequences of noncompliance with physical therapy and serves as a review of the pathophysiology, evaluation, and treatment of suprascapular neuropathy.
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Smith N, Liew Z, Johnson S, Ellard DR, Underwood M, Kearney R. A systematic review of the methods and drugs used for performing suprascapular nerve block injections for the non-surgical management of chronic shoulder pain. Br J Pain 2021; 15:460-473. [PMID: 34840794 PMCID: PMC8611295 DOI: 10.1177/2049463721992091] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Suprascapular nerve block (SSNB) injections are growing in popularity as a treatment option for people with chronic shoulder pain. The optimal method of injection and aftercare is unknown. This review describes the current methods and drugs used for performing SSNB injections in the non-surgical management of adults with chronic shoulder pain in order to inform future research in this area. Systematic searches of CINAHL, MEDLINE (OVID), AMED, Embase databases and the Cochrane Library were undertaken from inception to June 2020. Data on the method and drugs used for injection and aftercare were extracted and summarised for areas of commonality and discrepancy. We included 53 studies in this review. In total, eight different injection methods were reported within the included studies. Indirect surface land-marked methods were the most common method reported in 21 studies. Direct surface land-marked methods were reported in 12 studies. Ultrasound-guided methods used alone were reported in 16 studies. Both fluoroscopy and computed tomography methods used alone were reported in one study each. Electromyography was used in combination with other injection methods in nine studies. Wide variation in the composition of the injectate was observed between studies. Local anaesthetic was used within injectate preparations in all studies. Local anaesthetic used alone was reported in 20 studies, combined with steroid in 29 studies and combined with various other components in 5 studies. Physiotherapy following injection was reported in 26 studies. Reported details of physiotherapy varied considerably. This review identified substantial variation in the methods and drugs used to perform SSNB injection in clinical trials. Current literature demonstrates a wide range of methods used for SSNB injection administration. Consensus research defining standardised practice for SSNB injection is now needed to guide future clinical practice and research.
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Affiliation(s)
- Neil Smith
- Warwick Clinical Trials Unit, The
University of Warwick, Coventry, UK
- Sandwell and West Birmingham Hospitals
NHS Trust, Physiotherapy Department, West Bromwich, UK
| | - Ziheng Liew
- Warwick Clinical Trials Unit, The
University of Warwick, Coventry, UK
| | - Samantha Johnson
- Warwick Clinical Trials Unit, The
University of Warwick, Coventry, UK
| | - David R Ellard
- Warwick Clinical Trials Unit, The
University of Warwick, Coventry, UK
| | - Martin Underwood
- Warwick Clinical Trials Unit, The
University of Warwick, Coventry, UK
| | - Rebecca Kearney
- Warwick Clinical Trials Unit, The
University of Warwick, Coventry, UK
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Borrel F, Desmoineaux P, Delcourt T, Pujol N. Feasibility of arthroscopic decompression of the axillary nerve in the quadrilateral space: Cadaver study. Orthop Traumatol Surg Res 2021; 107:102762. [PMID: 33333278 DOI: 10.1016/j.otsr.2020.102762] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2020] [Revised: 06/07/2020] [Accepted: 07/28/2020] [Indexed: 02/03/2023]
Abstract
INTRODUCTION Axillary nerve compression is a rare, but disabling condition. The three main causes are quadrilateral space syndrome among young athletes, compression due to an inferior glenohumeral osteophyte in early osteoarthritis and isolated teres minor atrophy secondary to triceps hypertrophy. The diagnosis is clinical, but may be reinforced by an electromyogram or corticosteroid injection. The usual surgical treatment is open nerve decompression using a posterior approach. Arthroscopy is a less invasive approach that should be useful in theory. HYPOTHESIS Arthroscopic decompression of the axillary nerve is safe and less invasive than open techniques. MATERIAL AND METHODS Arthroscopic nerve decompression was performed as described by PJ Millet and TR Gaskill on 10 shoulders from 6 frozen cadavers. An open posterior approach was then made to verify the effectiveness of the nerve decompression. RESULTS The axillary nerve and its branches, the circumflex artery and the triceps were always sufficiently released in the space below the joint capsule. When the joints were subsequently opened by a posterior approach, complete nerve decompression was confirmed in all cases with no iatrogenic lesions. DISCUSSION The good results of this study are encouraging, but should be supplemented with a comparative study in patients of open versus arthroscopic axillary nerve release. CONCLUSION We think this arthroscopic technique is a good option for treating axillary nerve compressions. The complication risk is expected to be low. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- François Borrel
- Service de chirurgie orthopédique et traumatologie, CHR de Versailles, hôpital André-Mignot, 177, rue de Versailles, 78150 Le Chesnay, France
| | - Pierre Desmoineaux
- Service de chirurgie orthopédique et traumatologie, CHR de Versailles, hôpital André-Mignot, 177, rue de Versailles, 78150 Le Chesnay, France.
| | - Tiphanie Delcourt
- Service de chirurgie orthopédique et traumatologie, CHR de Versailles, hôpital André-Mignot, 177, rue de Versailles, 78150 Le Chesnay, France
| | - Nicolas Pujol
- Service de chirurgie orthopédique et traumatologie, CHR de Versailles, hôpital André-Mignot, 177, rue de Versailles, 78150 Le Chesnay, France
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Ultrasonographic anatomy of the long thoracic nerve: A reappraisal using high frequency (24-MHz) probe. Diagn Interv Imaging 2020; 102:241-245. [PMID: 33008783 DOI: 10.1016/j.diii.2020.08.003] [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: 07/10/2020] [Revised: 08/25/2020] [Accepted: 08/31/2020] [Indexed: 11/21/2022]
Abstract
PURPOSE The purpose of this study was to analyze the potential of ultrasound with a high frequency probe (24-MHz) in the assessment of the long thoracic nerve (LTN) and describe ultrasonographic landmarks that can be used for standardization. MATERIAL AND METHODS Ultrasonography analysis of the LTN was done on 2 LTNs in a cadaver specimen and then on 30 LTNs in 15 healthy volunteers (12 men, 3 women; mean age, 28.8±3.8 [SD] years; age range: 24-39 years) by two independent radiologists (R1 and R2) using a 24-MHz probe. Interrater agreement was assessed using Kappa test (K) and intraclass correlation coefficient (ICC). RESULTS In the cadaver, dissection confirmed that the India ink was injected near the LTN in the middle scalene muscle. In volunteers, visibility of the LTN above the clavicle was highly reproducible for the branches arising from C5 (R1: 87% [26/30]; R2: 90% [27/30]; K=0.83) and from C6 (R1: 100% [30/30]; R2: 97% [29/30]; K=0.94). Where the nerve emerged from the middle scalene muscle, the mean diameter was 0.85±0.24 (SD) mm (range: 0.4-1.6mm) for R1 and 0.9±0.23 (SD) mm (range: 0.4-1.7mm) for R2 (ICC: 0.96; 95% CI: 0.92-0.98%). Along the thoracic wall, where LTN run along the lateral thoracic artery, the mean diameter was 0.83±0.19 (SD) mm (range: 0.5-1.27mm) for R1 and 0.89±0.21 (SD) mm (range: 0.6-1.2mm) for R2 (ICC: 0.86; 95% CI: 0.72-0.93%). CONCLUSION The LTN can be analyzed with ultrasound using high-frequency probe by using the C5 and C6 roots, the middle scalene muscle above the clavicle and the lateral thoracic artery on the chest wall as landmarks.
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Bozzi F, Alabau-Rodriguez S, Barrera-Ochoa S, Ateschrang A, Schreiner AJ, Monllau JC, Perelli S. Suprascapular Neuropathy around the Shoulder: A Current Concept Review. J Clin Med 2020; 9:E2331. [PMID: 32707860 PMCID: PMC7465639 DOI: 10.3390/jcm9082331] [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] [Subscribe] [Scholar Register] [Received: 05/17/2020] [Revised: 07/16/2020] [Accepted: 07/18/2020] [Indexed: 12/11/2022] Open
Abstract
Suprascapular neuropathy is an uncommon but increasingly recognized cause of shoulder pain and dysfunction due to nerve entrapment. The aim of this review is to summarize some important aspects of this shoulder pathology. An extensive research was performed on PubMed and Clinical Key. The goal was to collect all the anatomical, biomechanical and clinical studies to conduct an extensive overview of the issue. Attention was focused on researching the state of art of the diagnosis and treatment. A total of 59 studies were found suitable and included. This condition is more frequently diagnosed in over-head athletes or patients with massive rotator cuff tears. Diagnosis may be complex, whereas its treatment is safe, and it has a great success rate. Prompt diagnosis is crucial as chronic conditions have worse outcomes compared to acute lesions. Proper instrumental evaluation and imaging are essential. Dynamic compression must initially be treated non-operatively. If there is no improvement, surgical release should be considered. On the other hand, soft tissue lesions may first be treated non-operatively. However, surgical treatment by arthroscopic means is advisable when possible as it represents the gold standard therapy. Other concomitant shoulder lesions must be recognized and treated accordingly.
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Affiliation(s)
- Federico Bozzi
- Department of Orthopaedics and Traumatology, Fondazione Poliambulanza (Brescia)—Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Sergi Alabau-Rodriguez
- Institut Català de Traumatologia i Medicina de l’Esport (ICATME)—Hospital Universitari Quiròn-Dexeus. Universitat Autònoma de Barcelona, 08028 Barcelona, Spain; (S.A.-R.); (S.B.-O.); (J.C.M.); (S.P.)
| | - Sergi Barrera-Ochoa
- Institut Català de Traumatologia i Medicina de l’Esport (ICATME)—Hospital Universitari Quiròn-Dexeus. Universitat Autònoma de Barcelona, 08028 Barcelona, Spain; (S.A.-R.); (S.B.-O.); (J.C.M.); (S.P.)
| | - Atesch Ateschrang
- Orthopedic department, Gemeinschaftsklinikum Mittelrhein, 56073 Koblenz, Germany;
| | - Anna J. Schreiner
- Department of Traumatology and Reconstructive Surgery, BG Trauma Center Tübingen, Eberhard-Karls University of Tübingen, 72076 Tübingen, Germany;
| | - Juan Carlos Monllau
- Institut Català de Traumatologia i Medicina de l’Esport (ICATME)—Hospital Universitari Quiròn-Dexeus. Universitat Autònoma de Barcelona, 08028 Barcelona, Spain; (S.A.-R.); (S.B.-O.); (J.C.M.); (S.P.)
- Department of Orthopaedic Surgery, Hospital del Mar. Universitat Autònoma de Barcelona (UAB), 08028 Barcelona, Spain
| | - Simone Perelli
- Institut Català de Traumatologia i Medicina de l’Esport (ICATME)—Hospital Universitari Quiròn-Dexeus. Universitat Autònoma de Barcelona, 08028 Barcelona, Spain; (S.A.-R.); (S.B.-O.); (J.C.M.); (S.P.)
- Department of Orthopaedic Surgery, Hospital del Mar. Universitat Autònoma de Barcelona (UAB), 08028 Barcelona, Spain
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John TS, Fishman F, Sharkey MS, Carter CW. Current concepts review: peripheral neuropathies of the shoulder in the young athlete. PHYSICIAN SPORTSMED 2020; 48:131-141. [PMID: 31596162 DOI: 10.1080/00913847.2019.1676136] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Peripheral neuropathies of the shoulder and upper extremity are uncommon injuries that may affect the young athletic population. When present, they can result in significant pain and functional impairment. The cause of peripheral neuropathy in young athletes may be an acute, traumatic injury such as a shoulder dislocation or a direct blow to the shoulder girdle. Alternatively, repetitive overuse with resultant compression or traction of a nerve over time may also result in neuropathy; overhead athletes and throwers may be particularly susceptible to this mechanism of nerve injury. Regardless of etiology, young athletes typically present with activity-related pain, paresthesias, and dysfunction of the affected upper extremity. In addition to physical examination, diagnostic studies such as radiographs and magnetic resonance imaging (MRI) are commonly performed as part of an initial evaluation and electrodiagnostic studies may be used to confirm the diagnosis of peripheral neuropathy. Electrodiagnostic studies may consist of electromyography, which evaluates the electrical activity produced by skeletal muscles, and/or a nerve conduction study, which evaluates a nerve's ability to transmit an electrical signal. Although data are not robust, clinical outcomes for young patients with activity-related peripheral neuropathies of the shoulder are generally good, with most young athletes reporting both symptomatic and functional improvement after treatment.
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Affiliation(s)
- Tamara S John
- Orthopaedic Surgeon, Kaiser Permanente - Emory Healthcare, Atlanta, GA, USA
| | - Felicity Fishman
- Orthopaedic Surgery, Stritch School of Medicine at Loyola University, Chicago, IL, USA
| | - Melinda S Sharkey
- Orthopaedic Surgery, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Cordelia W Carter
- Orthopaedic Surgery, New York University School of Medicine, New York, NY, USA
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Gutkowska O, Martynkiewicz J, Urban M, Gosk J. Brachial plexus injury after shoulder dislocation: a literature review. Neurosurg Rev 2020; 43:407-423. [PMID: 29961154 PMCID: PMC7186242 DOI: 10.1007/s10143-018-1001-x] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Revised: 05/17/2018] [Accepted: 06/21/2018] [Indexed: 12/01/2022]
Abstract
Brachial plexus injuries are among the rarest but at the same time the most severe complications of shoulder dislocation. The symptoms range from transient weakening or tingling sensation of the upper limb to total permanent paralysis of the limb associated with chronic pain and disability. Conflicting opinions exist as to whether these injuries should be treated operatively and if so when surgery should be performed. In this review, available literature dedicated to neurological complications of shoulder dislocation has been analysed and management algorithm has been proposed. Neurological complications were found in 5.4-55% of all dislocations, with the two most commonly affected patient groups being elderly women sustaining dislocation as a result of a simple fall and young men after high-energy injuries, often multitrauma victims. Infraclavicular part of the brachial plexus was most often affected. Neurapraxia or axonotmesis predominated, and complete nerve disruption was observed in less than 3% of the patients. Shoulder dislocation caused injury to multiple nerves more often than mononeuropathies. The axillary nerve was most commonly affected, both as a single nerve and in combination with other nerves. Older patient age, higher energy of the initial trauma and longer period from dislocation to its reduction have been postulated as risk factors. Brachial plexus injury resolved spontaneously in the majority of the patients. Operative treatment was required in 13-18% of the patients in different studies. Patients with suspected neurological complications require systematic control. Surgery should be performed within 3-6 months from the injury when no signs of recovery are present.
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Affiliation(s)
- Olga Gutkowska
- Department of Traumatology, Clinical Department of Traumatology and Hand Surgery, Wroclaw Medical University, ul. Borowska 213, 50-556 Wroclaw, Poland
| | - Jacek Martynkiewicz
- Department of Traumatology, Clinical Department of Traumatology and Hand Surgery, Wroclaw Medical University, ul. Borowska 213, 50-556 Wroclaw, Poland
| | - Maciej Urban
- Department of Traumatology, Clinical Department of Traumatology and Hand Surgery, Wroclaw Medical University, ul. Borowska 213, 50-556 Wroclaw, Poland
| | - Jerzy Gosk
- Department of Traumatology, Clinical Department of Traumatology and Hand Surgery, Wroclaw Medical University, ul. Borowska 213, 50-556 Wroclaw, Poland
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8
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Igielska-Bela B, Baczkowski B, Flisikowski K. Shoulder Ultrasound in the Diagnosis of the Suprascapular Neuropathy in Athletes. Open Med (Wars) 2020; 15:147-151. [PMID: 32190738 PMCID: PMC7065423 DOI: 10.1515/med-2020-0022] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Accepted: 01/22/2020] [Indexed: 11/15/2022] Open
Abstract
PURPOSE Shoulder pain and weakness are common symptoms in athletes who play sports connected with overhead throwing. Suprascapular neuropathy may be one of the reason of such signs.The aim of the study was to find out if ultrasound examination of the shoulder in athletes reveals signs of suprascapular neuropathy. METHODS This was a cross-sectional study in which 67 professional volleyball, handball and rugby players of polish teams without shoulder disorders, which have played sport for 10 or more years, were included. An ultrasound examination of both shoulders was performed. Excluding criteria were recent shoulder and/or neck trauma and neurological disorders. RESULTS No ultrasound signs of suprascapular neuropathy were seen in any player. The only finding was enthesopathy of supraspinatus muscle and this finding was connected with athletes' age, type of sport and with dominant hand. It had statistical significance with p-value respectively 0.01 for athletes' age, 0.0208 for sport type and 0.03 for dominant hand. CONCLUSIONS Ultrasonography should not be used as the screening examination of shoulders in athletes, but it can sometimes be an additional tool to help to diagnose shoulder disorders.
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Affiliation(s)
- Barbara Igielska-Bela
- Department of Orthopedic, Specialist Hospital in Koscierzyna, ul.Piechowskiego 36, 83-400Kościerzyna, Poland
| | | | - Karol Flisikowski
- Department of Management and Economics, Gdansk University of Technology, GdanskPoland
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Abstract
Muscle atrophy in shoulders with rotator cuff tendon tears is a negative prognosticator, associated with decreased function, decreased reparability, increased retears after repair, and poorer outcomes after surgery. Muscle edema or atrophy within a neurologic distribution characterizes denervation. Because most nerve entrapments around the shoulder are not caused by mass lesions and show no nerve findings on routine MR imaging sequences, pattern of muscle denervation is often the best clue to predicting location of nerve dysfunction, which narrows the differential diagnosis and guides clinical management. The exception is suprascapular nerve compression in the spinoglenoid notch caused by a compressing cyst.
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Affiliation(s)
- David A Rubin
- All Pro Orthopedic Imaging Consultants, LLC, St Louis, MO, USA; Radsource, Brentwood, TN, USA; NYU Langone Medical Center, New York, NY, USA.
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Martínez-Aparicio C, Jääskeläinen SK, Puksa L, Reche-Lorite F, Torné-Poyatos P, Paniagua Soto J, Falck B. Constitutional risk factors for focal neuropathies in patients referred for electromyography. Eur J Neurol 2019; 27:529-535. [PMID: 31692180 DOI: 10.1111/ene.14118] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2019] [Accepted: 11/04/2019] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND PURPOSE It is well established that patient-related constitutional features predispose to focal peripheral neuropathies. Some of these risk factors were investigated in common focal neuropathies encountered in patients referred for electromyography. METHODS Gender, age, height and body mass index (BMI) were analysed retrospectively as risk factors for 11 focal neuropathies. In all, 9686 patients (age range 18-96 years; 58% women) were included from three different centres, with identical methods and equipment. RESULTS High BMI was related to carpal tunnel syndrome (CTS), ulnar neuropathy at the elbow (UNE), combined CTS and UNE, meralgia paraesthetica and lumbar radiculopathy. In women, CTS and Morton's metatarsalgia were more common, whilst long thoracic neuropathies, suprascapular neuropathies and UNE were more common in men. Older age increased the risk for CTS, UNE, Morton's metatarsalgia and radiculopathies. CONCLUSIONS Age, gender and BMI are important risk factors for many common focal neuropathies.
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Affiliation(s)
- C Martínez-Aparicio
- Doctoral Programme of Medicine and Public Health, University of Granada, Granada, Spain.,Department of Clinical Neurophysiology, Vithas Virgen del Mar Hospital, Almeria, Spain
| | - S K Jääskeläinen
- Department of Clinical Neurophysiology, Turku University Hospital and University of Turku, Turku, Finland
| | - L Puksa
- Department of Clinical Neurophysiology, University of Tartu, Tartu, Estonia
| | - F Reche-Lorite
- Department of Mathematics, University of Almeria, Almeria, Spain
| | - P Torné-Poyatos
- Faculty of Medicine, University of Granada, Hospital Universitario Clinico, Granada, Spain
| | - J Paniagua Soto
- Department of Clinical Neurophysiology, University Hospital Virgen de las Nieves, Granada, Spain
| | - B Falck
- Department of Clinical Neurophysiology, University Hospital, Uppsala, Sweden
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11
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Casaletto E, Lin B, Wolfe SW, Lee SK, Sneag DB, Feinberg JH, Nwawka OK. Ultrasound imaging of nerves in the neck: Correlation with MRI, EMG, and clinical findings. Neurol Clin Pract 2019; 10:415-421. [PMID: 33299669 DOI: 10.1212/cpj.0000000000000767] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Accepted: 09/25/2019] [Indexed: 01/15/2023]
Abstract
Objective We evaluated the performance of ultrasound in the detection of neuropathy of the suprascapular nerve (SSN), long thoracic nerve (LTN), spinal accessory nerve (SAN), and phrenic nerve and compared this performance with MRI. Methods A retrospective review of 56 patients who had undergone ultrasound imaging of the SSN, LTN, SAN, and phrenic nerve was performed. Diagnoses made by ultrasound, MRI, EMG reports, and clinical and operative notes were recorded. Results Ultrasound was successful in visualizing nerves in the neck in the overwhelming majority of cases. Sonographic findings were typically in agreement with MRI and clinical findings. Conclusion Ultrasound is effective in the visualization and diagnostic evaluation of the SSN, LTN, SAN, and phrenic nerve. Classification of evidence This study provides Class IV evidence that ultrasound can effectively visualize and diagnose neuropathy of the SSN, LTN, SAN, and phrenic nerve in the neck.
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Affiliation(s)
- Emily Casaletto
- Department of Radiology and Imaging (EC, BL, DBS, OKN), Department of Orthopedic Surgery (SWW, SKL), and Department of Physiatry (JHF), Hospital for Special Surgery, New York
| | - Bin Lin
- Department of Radiology and Imaging (EC, BL, DBS, OKN), Department of Orthopedic Surgery (SWW, SKL), and Department of Physiatry (JHF), Hospital for Special Surgery, New York
| | - Scott W Wolfe
- Department of Radiology and Imaging (EC, BL, DBS, OKN), Department of Orthopedic Surgery (SWW, SKL), and Department of Physiatry (JHF), Hospital for Special Surgery, New York
| | - Steve K Lee
- Department of Radiology and Imaging (EC, BL, DBS, OKN), Department of Orthopedic Surgery (SWW, SKL), and Department of Physiatry (JHF), Hospital for Special Surgery, New York
| | - Darryl B Sneag
- Department of Radiology and Imaging (EC, BL, DBS, OKN), Department of Orthopedic Surgery (SWW, SKL), and Department of Physiatry (JHF), Hospital for Special Surgery, New York
| | - Joseph H Feinberg
- Department of Radiology and Imaging (EC, BL, DBS, OKN), Department of Orthopedic Surgery (SWW, SKL), and Department of Physiatry (JHF), Hospital for Special Surgery, New York
| | - O Kenechi Nwawka
- Department of Radiology and Imaging (EC, BL, DBS, OKN), Department of Orthopedic Surgery (SWW, SKL), and Department of Physiatry (JHF), Hospital for Special Surgery, New York
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12
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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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13
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Memon AB, Dymm B, Ahmad BK, Sripathi N, Schultz L, Chandok A. Suprascapular neuropathy: A review of 87 cases. Muscle Nerve 2019; 60:250-253. [DOI: 10.1002/mus.26630] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Revised: 07/04/2019] [Accepted: 07/05/2019] [Indexed: 12/17/2022]
Affiliation(s)
- Anza B. Memon
- Department of NeurologyHenry Ford Hospital Detroit Michigan
- School of MedicineWayne State University Detroit Michigan
| | - Braydon Dymm
- Department of NeurologyUniversity of Michigan Ann Arbor Michigan
| | | | - Naganand Sripathi
- Department of NeurologyHenry Ford Hospital Detroit Michigan
- School of MedicineWayne State University Detroit Michigan
| | - Lonni Schultz
- Department of NeurologyHenry Ford Hospital Detroit Michigan
| | - Arun Chandok
- Department of NeurologyHenry Ford Hospital Detroit Michigan
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Abstract
Peripheral neuropathies of the shoulder are common and could be related to traumatic injury, shoulder surgery, infection or tumour but usually they result from an entrapment syndrome. Imaging plays an important role to detect the underlying causes, to assess the precise topography and the severity of nerve damage. The key points concerning the imaging of nerve entrapment syndrome are the knowledge of the particular topography of the injured nerve, and the morphology as well signal modifications of the corresponding muscles. Magnetic Resonance Imaging best shows these findings, although Ultrasounds and Computed Tomography sometimes allow the diagnosis of neuropathy.
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15
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Ultrasonography study of the suprascapular nerve. Diagn Interv Imaging 2017; 98:873-879. [DOI: 10.1016/j.diii.2017.09.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2017] [Revised: 08/25/2017] [Accepted: 09/13/2017] [Indexed: 12/29/2022]
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Gruber L, Loizides A, Löscher W, Glodny B, Gruber H. Focused high-resolution sonography of the suprascapular nerve: A simple surrogate marker for neuralgic amyotrophy? Clin Neurophysiol 2017; 128:1438-1444. [DOI: 10.1016/j.clinph.2017.04.030] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2017] [Revised: 04/18/2017] [Accepted: 04/30/2017] [Indexed: 01/24/2023]
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Fisher S, Wadhwa V, Manthuruthil C, Cheng J, Chhabra A. Clinical impact of magnetic resonance neurography in patients with brachial plexus neuropathies. Br J Radiol 2016; 89:20160503. [PMID: 27558928 DOI: 10.1259/bjr.20160503] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVE To study the impact of brachial plexus MR neurography (MRN) in the diagnostic thinking and therapeutic management of patients with suspected plexopathy. METHODS MRN examinations of adult brachial plexuses over a period of 18 months were reviewed. Relevant data collection included-patient demographics, clinical history, pre-imaging diagnostic impression, pre-imaging treatment plan, post-imaging diagnosis, post-imaging treatment plan, surgical notes and electrodiagnostic (ED) results. Impact of imaging on the pre-imaging clinical diagnosis and therapeutic management were classified as no change, mild change or substantial change. RESULTS Final sample included 121 studies. The common aetiologies included inflammatory in 31 (25.6%) of 121 patients, trauma in 29 (23.9%) of 121 patients and neoplastic in 26 (21.5%) of 121 patients. ED tests were performed in 47 (38.8%) of 121 patients and these showed concordance with MRN findings in 31 (66.0%) of 47 patients. Following MRN, there was change in the pre-imaging clinical impression for 91 (75.2%) of 121 subjects, with a mild change in diagnosis in 57 (47.1%) of 121 patients and a substantial change in 34 (28.0%) of 121 patients. 19 (15.7%) of 121 patients proceeded to therapies that would not have been performed in the same manner without the information obtained from MRN. CONCLUSION MRN of the brachial plexus significantly impacts clinical decision-making and should be routinely performed in suspected brachial plexopathy. Advances in knowledge: MRN significantly impacts the diagnostic thinking and therapeutic management of patients with suspected brachial plexopathy. MRN not only provides concordant information to ED tests in majority of cases, but also supplements with additional diagnostic data in patients who are ED negative.
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Affiliation(s)
- Stephen Fisher
- 1 Musculoskeletal Imaging Division, Department of Radiology, UT Southwestern Medical Center, Dallas, TX, USA
| | - Vibhor Wadhwa
- 2 Department of Radiology, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Christine Manthuruthil
- 1 Musculoskeletal Imaging Division, Department of Radiology, UT Southwestern Medical Center, Dallas, TX, USA
| | - Jonathan Cheng
- 3 Department of Plastic Surgery, UT Southwestern Medical Center, Dallas, TX, USA
| | - Avneesh Chhabra
- 1 Musculoskeletal Imaging Division, Department of Radiology, UT Southwestern Medical Center, Dallas, TX, USA
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Nguyen C, Guérini H, Roren A, Zauderer J, Vuillemin V, Seror P, Ouaknine M, Palazzo C, Bourdet C, Pluot É, Roby-Brami A, Drapé JL, Rannou F, Poiraudeau S, Lefèvre-Colau MM. Scapula alata dynamique d’origine neuromusculaire : diagnostic clinique, électromyographique et à l’imagerie par résonance magnétique. Presse Med 2015; 44:1256-65. [DOI: 10.1016/j.lpm.2015.08.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2015] [Revised: 07/06/2015] [Accepted: 08/25/2015] [Indexed: 11/17/2022] Open
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Spectrum of suprascapular nerve lesions: normal and abnormal neuromuscular imaging appearances on 3-T MR neurography. AJR Am J Roentgenol 2015; 204:589-601. [PMID: 25714290 DOI: 10.2214/ajr.14.12974] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
OBJECTIVE. In this article, we will review the normal anatomy and imaging features of various neuromuscular abnormalities related to suprascapular neuropathy. CONCLUSION. Suprascapular neuropathy can be difficult to distinguish from rotator cuff pathology, plexopathy, and radiculopathy. Electrodiagnostic studies are considered the reference standard for diagnosis; however, high-resolution 3-T MR neurography (MRN) can play an important role. MRN enables direct visualization of the nerve and simultaneous assessment of the cervical spine, brachial plexus, and rotator cuff.
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Guerini H, Pluot E, Pessis E, Thevenin F, Campagna R, Feydy A, Gaudin P, Drapé J. Tears at the myotendinous junction of the infraspinatus: Ultrasound findings. Diagn Interv Imaging 2015; 96:349-56. [DOI: 10.1016/j.diii.2014.11.009] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Evaluation, Treatment, and Outcomes of Suprascapular Neuropathy: A 5-Year Review. PM R 2014; 6:774-80. [DOI: 10.1016/j.pmrj.2014.02.003] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2013] [Revised: 02/07/2014] [Accepted: 02/12/2014] [Indexed: 11/23/2022]
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Boulanger X, Ledoux JB, Brun AL, Beigelman C. Imaging of the non-traumatic brachial plexus. Diagn Interv Imaging 2013; 94:945-56. [DOI: 10.1016/j.diii.2013.06.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
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