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Tsakotos G, Tudose RC, Triantafyllou G, Koutserimpas C, Rusu MC, Flevas D, Piagkou M. Systematic Review and Meta-analysis of Suprascapular Notch Morphological Variability: Do We Know Everything? Cureus 2024; 16:e55852. [PMID: 38590476 PMCID: PMC11001262 DOI: 10.7759/cureus.55852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/09/2024] [Indexed: 04/10/2024] Open
Abstract
The suprascapular notch represents a depression on the lateral part of the superior border of the scapula, medially to the coracoid process. The current paper presents a systematic review with a meta-analysis of the suprascapular notch morphological variability. Related clinical implications were further discussed as well to emphasize the value of the topic. A total of 31 articles were included in the meta-analysis, which depicted great heterogeneity. Thus, due to the different classification systems, difficulties were faced in creating a complete and united classification. All the problems and pitfalls that arise from each classification system were discussed, and we concluded with the most complete one. The knowledge of the suprascapular notch morphological anatomy is of great importance, especially for orthopedic surgeons, due to its relationship with the suprascapular nerve. Thus, further research in this area is adequate.
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Affiliation(s)
- George Tsakotos
- Department of Anatomy, School of Medicine, Faculty of Health Sciences, National and Kapodistrian University of Athens, Athens, GRC
| | - Răzvan C Tudose
- Department of Anatomy, Faculty of Dentistry, "Carol Davila" University of Medicine and Pharmacy, Bucharest, ROU
| | - George Triantafyllou
- Department of Anatomy, School of Medicine, Faculty of Health Sciences, National and Kapodistrian University of Athens, Athens, GRC
| | - Christos Koutserimpas
- Department of Orthopedics and Traumatology, "251" Hellenic Air Force General Hospital of Athens, Athens, GRC
- Department of Anatomy, School of Medicine, Faculty of Health Sciences, National and Kapodistrian University of Athens, Athens, GRC
| | - Mugurel C Rusu
- Department of Anatomy, Faculty of Dentistry, "Carol Davila" University of Medicine and Pharmacy, Bucharest, ROU
| | | | - Maria Piagkou
- Department of Anatomy, School of Medicine, Faculty of Health Sciences, National and Kapodistrian University of Athens, Athens, GRC
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Chawla M, Sinsinwar P, Mishra A, Sorout J, Rao A. Suprascapular notch morphometric study. RUDN JOURNAL OF MEDICINE 2022. [DOI: 10.22363/2313-0245-2022-26-3-338-343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Relevance. The suprascapular notch is one of the most crucial areas of the scapula from a clinical standpoint. Aside from its anatomical relevance, the suprascapular notch type may also have some clinical implications for suprascapular nerve entrapment. Aim of the study was the determination of the different dimensions of the suprascapular notch based on the maximum depth (MD) and superior transverse diameter (STD), as well as the clinical relation between those dimensions and suprascapular nerve entrapment. Materials and Methods. The study’s materials were 100 unknown dry human scapulae from the from the anatomy department of the Mahatma Gandhi Medical College, Sitapura, Jaipur, Rajasthan. Each scapula was studied for suprascapular notch. From each of the scapulae, maximum depth and superior transverse diameter were determined. Fifty were from right side and Fifty were from left side. Different types of suprascapular notches were observed based on maximum depth and superior transverse diameter. Results and Discussion. In this study, the overall percentage distribution frequency of the suprascapular notch in 100 scapulae is MD STD (25 %), MD = STD (0 %), STD MD (60 %) and SSN Absent (15 %) respectively. The most common SSN type is STD MD (60 %) type and least common SSN type is MD = STD (0 %) type. Conclusion. Morphological examination of the scapular notch reveals a common site of nerve compression and also demonstrates the surgical importance of the scapular nerve during shoulder surgery.
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Al-Redouan A, Hudak R, Nanka O, Kachlik D. The morphological stenosis pattern of the suprascapular notch is revealed yielding higher incidence in the discrete type and elucidating the inevitability of osteoplasty in horizontally oriented stenosis. Knee Surg Sports Traumatol Arthrosc 2021; 29:2272-2280. [PMID: 32712687 DOI: 10.1007/s00167-020-06168-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Accepted: 07/16/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE To identify the morphological patterns of suprascapular notch stenosis. METHODS Suprascapular notch space capacity was assessed by morphometric analysis of 333 dry scapulae. Suprascapular notch parameters-superior transverse distance, middle width, depth, medial border length and lateral border length-were measured. The probable suprascapular notch stenosis was referenced by (1) comparing each obtained parameter measurement to the range of the suprascapular nerve diameter, and (2) quantifying the reduced parameters. Finally, the morphological pattern was determined based on the collective reduction of the parameters and their alignments. RESULTS Five types of suprascapular notch based on depth to superior transverse distance ratio were identified and assessed. Type-I showed low incidence of stenosis (6/333) and low frequency within type (6/28) with potential risk of horizontal compression. Type-II showed relatively low incidence of stenosis (9/333) and low frequency within type (9/50) with undetermined pattern. Type-III showed relatively higher incidence of stenosis (47/333) but low frequency within type (47/158) with potential risk of vertical compression. Type-IV (foramen) showed low incidence of stenosis (6/333) and relatively lower frequency within type (6/26) with potential risk of encircled compression. Finally, type-V (discrete) showed relatively high incidence of stenosis (40/333) and high frequency within type (40/71) with potential risk of vertical compression. The suprascapular notch was found to be stenosed beyond its capacity to accommodate the suprascapular nerve in 49/333. Type-V is at most risk followed by Type-III. CONCLUSIONS Suprascapular notch stenosis takes three morphological patterns: horizontal, vertical or mixed. An osteoplasty of suprascapular notch margins may be required beside the common surgical approach of the superior transverse scapular ligamentectomy.
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Affiliation(s)
- Azzat Al-Redouan
- Department of Anatomy, Second Faculty of Medicine, Charles University, V Uvalu 84, 150 06, Prague, Czech Republic.
| | - Radovan Hudak
- Department of Anatomy, Second Faculty of Medicine, Charles University, V Uvalu 84, 150 06, Prague, Czech Republic
- Department of Orthopaedics, Second Faculty of Medicine, Charles University and Motol University Hospital, Prague, Czech Republic
| | - Ondrej Nanka
- Department of Anatomy, Second Faculty of Medicine, Charles University, V Uvalu 84, 150 06, Prague, Czech Republic
- Department of Anatomy, First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - David Kachlik
- Department of Anatomy, Second Faculty of Medicine, Charles University, V Uvalu 84, 150 06, Prague, Czech Republic
- College of Polytechnics, Jihlava, Czech Republic
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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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Zhang L, Wei HR, Guo XG, Fu SJ, Xu YX, Zhong SZ, Huang WH. Variable morphology of the suprascapular notch: A proposal for classification in Chinese population. Ann Anat 2019; 221:173-178. [DOI: 10.1016/j.aanat.2018.09.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Revised: 09/11/2018] [Accepted: 09/12/2018] [Indexed: 11/30/2022]
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Agrawal D, Singh B, Dixit SG, Ghatak S, Bharadwaj N, Gupta R, Agrawal GA, Nayyar AK. Morphometry and variations of the human suprascapular notch. Morphologie 2015; 99:132-40. [PMID: 26381685 DOI: 10.1016/j.morpho.2015.04.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2014] [Revised: 03/03/2015] [Accepted: 04/26/2015] [Indexed: 11/27/2022]
Abstract
AIM The present study proposes a simple method to study variations in shape and dimensions of suprascapular notch, to classify different types and subtypes of notch and to measure the thickness of superior transverse scapular bar (ossified superior transverse ligament of scapula). MATERIAL AND METHODS Seven hundred and twenty-eight dried scapulae were observed, examined and studied in detail. Scapulae with suprascapular notch, with suprascapular foramen having varying degree of ossification in the form of transverse scapular bar were included in the present study. Measurements of suprascapular notch and superior transverse scapular bar were taken with the help of digital vernier calliper and recorded in millimetres. The superior transverse diameter, inferior transverse diameter, depth, maximum thickness of suprascapular notch and thickness at lateral and medial end of transverse scapular bar, mean thickness of superior transverse scapular bar were recorded. The data was analyzed statistically. OBSERVATIONS AND RESULTS We observed five types of notch in scapulae, type I: without a discrete notch (ill defined), 25 (3.43%); type II: a "V" shaped notch, 192 (26.37%); type III: "U" shaped notch, 383 (52.60%); type IV: inverted "V" shaped notch, 28 (3.84%); type V with absent suprascapular notch: 6 (0.82%). Type II and type III were again subclassified into subtypes (a, b, c and d) on the basis of depth of notch. Scapulae with superior transverse scapular bar (n=94, 12.91%) were classified according to variation in mean thickness of transverse scapular bar (MTSB). CONCLUSION This study will help clinicians to correlate suprascapular nerve entrapment with a specific type of suprascapular notch and notch with ossified transverse scapular ligament.
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Affiliation(s)
- D Agrawal
- Department of Anatomy, All India Institute of Medical Sciences (AIIMS), Jodhpur 342005, Rajasthan, India.
| | - B Singh
- Department of Anatomy, All India Institute of Medical Sciences (AIIMS), Jodhpur 342005, Rajasthan, India
| | - S G Dixit
- Department of Anatomy, All India Institute of Medical Sciences (AIIMS), Jodhpur 342005, Rajasthan, India
| | - S Ghatak
- Department of Anatomy, All India Institute of Medical Sciences (AIIMS), Jodhpur 342005, Rajasthan, India
| | - N Bharadwaj
- Department of Anatomy, Era's Lucknow Medical College, Lucknow, India
| | - R Gupta
- Department of Anatomy, All India Institute of Medical Sciences (AIIMS), Jodhpur 342005, Rajasthan, India
| | - G A Agrawal
- Dr. Sarvepali Radhakrishnan Rajasthan Ayurved University, Jodhpur, India
| | - A K Nayyar
- Department of Anatomy, All India Institute of Medical Sciences (AIIMS), Jodhpur 342005, Rajasthan, India
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