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Yoon JY, Park WS, Jeong HJ, Jeon YD, Kim JU, Oh JH. Spontaneous resolution of spinoglenoid ganglion cyst: a case series. J Shoulder Elbow Surg 2024; 33:1828-1835. [PMID: 38237721 DOI: 10.1016/j.jse.2023.11.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Revised: 11/07/2023] [Accepted: 11/20/2023] [Indexed: 05/05/2024]
Abstract
BACKGROUND Spontaneous resolution of a spinoglenoid notch ganglion cyst (SGC) without surgical treatment has been rarely reported; however, we have encountered this phenomenon occasionally. Therefore, we aimed to describe a case series of consecutive patients with SGC in whom it spontaneously resolved without surgical treatment. METHODS We retrospectively reviewed 12 patients with magnetic resonance imaging (MRI)-confirmed SGC in whom it resolved without surgical treatment between January 2011 and March 2023. We included patients without abnormally increased signal intensity or muscle atrophy due to denervation from suprascapular neuropathy on MRI. Resolution of the SGC was confirmed via MRI or ultrasound at the follow-up visit, and suprascapular neuropathy was assessed using electromyography and nerve conduction studies when needed. For functional assessments, the visual analog scale for pain and active range of motion of the shoulder were used to compare pre and postresolution follow-ups. RESULTS Eleven men and 1 woman with a median age of 54.0 years (interquartile range [IQR] 37.0-65.3) were included in this study. The SGCs resolved spontaneously at a median of 13.2 months with an IQR of 8.2-23.0 after initial evaluation using MRI. The SGCs were multiloculated cysts with superior labrum anterior and posterior II-IX lesions, with a median diameter of 2.5 cm (IQR 2.0-2.8). The median visual analog scale for pain (pre-resolution 5.0 [IQR 4.0-7.0] vs postresolution 1.0 [IQR 0.0-1.0], P = .002) and internal rotation at the back (preresolution 8.0 [IQR 7.0-10.3] vs postresolution 7.5 [IQR 7.0-8.0], P = .034) were significantly improved after the resolution. CONCLUSIONS Surgical treatment may not be necessary in all cases of SGC. Nonsurgical treatment may be a viable option in the absence of suprascapular nerve involvement or superior labrum anterior and posterior-related physical findings.
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Affiliation(s)
- Ji Young Yoon
- Department of Orthopaedic Surgery, National Police Hospital, Seoul, Republic of Korea
| | - Wan Soo Park
- Department of Orthopaedic Surgery, National Police Hospital, Seoul, Republic of Korea
| | - Hyeon Jang Jeong
- Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Young Dae Jeon
- Department of Orthopaedic Surgery, Ulsan University College of Medicine, Ulsan University Hospital, Ulsan, Republic of Korea
| | - Ji Un Kim
- Department of Orthopaedic Surgery, Korea University College of Medicine, Korea University Ansan Hospital, Ansan, Republic of Korea
| | - Joo Han Oh
- Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea.
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Alaia EF, Day MS, Alaia MJ. Entrapment Neuropathies of the Shoulder. Semin Musculoskelet Radiol 2022; 26:114-122. [PMID: 35609573 DOI: 10.1055/s-0042-1742752] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Entrapment neuropathies of the shoulder most commonly involve the suprascapular or axillary nerves, and they primarily affect the younger, athletic patient population. The extremes of shoulder mobility required for competitive overhead athletes, particularly in the position of abduction and external rotation, place this cohort at particular risk. Anatomically, the suprascapular nerve is most prone to entrapment at the level of the suprascapular or spinoglenoid notch; the axillary nerve is most prone to entrapment as it traverses the confines of the quadrilateral space.Radiographs should be ordered as a primary imaging study to evaluate for obvious pathology occurring along the course of the nerves or for pathology predisposing the patient to nerve injury. Magnetic resonance imaging plays a role in not only identifying any mass-compressing lesion along the course of the nerve, but also in identifying muscle signal changes typical for denervation and/or fatty atrophy in the distribution of the involved nerve.
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Affiliation(s)
- Erin F Alaia
- Musculoskeletal Division, Department of Radiology, NYU Langone Health, New York, New York
| | - Michael S Day
- WellSpan Orthopedic Group, Chambersburg, Pennsylvania
| | - Michael J Alaia
- Department of Orthopedic Surgery, NYU Langone Orthopedic Hospital/NYU Langone Health, New York, New York
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3
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Takayama K, Ito H. An anatomical study for the location of suprascapular and spinoglenoid notches using three-dimensional computed tomography images of scapula. JSES Int 2022; 6:669-674. [PMID: 35813135 PMCID: PMC9264012 DOI: 10.1016/j.jseint.2022.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Background The optimal position for creating portals for arthroscopic suprascapular nerve decompression has not been sufficiently verified. Therefore, this study aimed to investigate the anatomical characteristics of the scapula for optimal portal creation using 3-dimensional computed tomography images. The posterolateral corner of the acromion was designated as the starting point for measurements because there is no secondary ossification center present. Methods This study included 223 patients (females, 129; males, 94) who underwent computed tomography of the shoulder joint. Three-dimensional images of the scapula were created, and the distance from the posterolateral corner of the acromion to the suprascapular and spinoglenoid notches was measured. Additionally, the correlation coefficient with height and the differences between the female and male groups were investigated. Results The distances from the posterolateral corner of the acromion to the suprascapular and spinoglenoid notches were 42.9 ± 4.6 and 31.5 ± 3.6 mm, respectively, and their correlation coefficients with height were 0.12 and 0.067, respectively. There was no significant difference in the distance from the posterolateral corner of the acromion to the suprascapular (42.5 ± 4.1 vs. 43.9 ± 5.1 mm, P = .098) and to the spinoglenoid (31.4 ± 3.3 mm vs. 32.0 ± 3.9 mm, P = .12) notches between the female and male groups. Conclusion Regardless of height and sex, the distances from the posterolateral corner of the acromion to the suprascapular and spinoglenoid notches were approximately 43 and 32 mm, respectively. Therefore, creating portals at these locations may be effective for arthroscopic suprascapular nerve decompression.
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Affiliation(s)
- Kazumasa Takayama
- Corresponding author: Kazumasa Takayama, MD, 1-1-1 Miwa, Kurashiki, Okayama 7108602, Japan.
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Plancher KD, Evely TB, Brite JE, Briggs KK, Petterson SC. Endoscopic/arthroscopic decompression of the suprascapular nerve at the spinoglenoid notch: indications and surgical technique. JSES REVIEWS, REPORTS, AND TECHNIQUES 2021; 1:198-206. [PMID: 37588953 PMCID: PMC10426469 DOI: 10.1016/j.xrrt.2021.04.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 08/18/2023]
Abstract
Suprascapular nerve compression at the spinoglenoid notch can lead to posterior shoulder pain, muscle weakness, and longstanding muscle atrophy of the infraspinatus. Although rare, it is most commonly seen in overhead athletes and laborers who perform repetitive overhead activities. Early diagnosis requires a thorough history and physical examination including imaging, diagnostic injections, and electromyography to avoid a missed diagnosis. While a course of nonoperative treatment is most often prescribed, early surgical intervention may be prudent to avoid irreversible damage especially if a space occupying lesion is present. This article will describe the history, physical examination findings, diagnostic workup, and our surgical technique for arthroscopic decompression of the suprascapular nerve at the spinoglenoid notch through a simple posterior approach avoiding the subacromial space.
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Affiliation(s)
- Kevin D. Plancher
- Department of Orthopaedic Surgery, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY, USA
- Department of Orthopedic Surgery, Weill Cornell Medical College, New York, NY, USA
- Plancher Orthopaedics & Sports Medicine, New York, NY, USA
- Orthopaedic Foundation, Stamford, CT, USA
| | - Thomas B. Evely
- Plancher Orthopaedics & Sports Medicine, New York, NY, USA
- Orthopaedic Foundation, Stamford, CT, USA
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5
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Ellenbecker TS, Dines DM, Renstrom PA, Windler GS. Visual Observation of Apparent Infraspinatus Muscle Atrophy in Male Professional Tennis Players. Orthop J Sports Med 2020; 8:2325967120958834. [PMID: 33195711 PMCID: PMC7605003 DOI: 10.1177/2325967120958834] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Accepted: 04/22/2020] [Indexed: 12/04/2022] Open
Abstract
Background: Previous studies have reported visually observed apparent muscle atrophy in
the infraspinous fossa of the dominant arm of overhead athletes. Several
mechanisms have been proposed as etiological factors, including eccentric
overload, compressive spinoglenoid notch paralabral cysts, and cumulative
tensile suprascapular neurapraxia. Purpose: To report the prevalence of apparent infraspinatus atrophy in male
professional tennis players and to determine whether the suspected atrophy
correlates with objectively measured weakness of external rotation. Study Design: Cross-sectional study; Level of evidence, 3. Methods: A total of 153 male professional tennis players underwent a musculoskeletal
screening examination that included visual inspection of the infraspinous
fossa. Infraspinatus atrophy was defined as hollowing or loss of soft tissue
bulk inferior to the scapular spine in the infraspinous fossa of one
extremity that was visibly different from the contralateral extremity. This
finding was observed and independently agreed upon by both an orthopaedic
surgeon and a physical therapist during the examination. Also assessed were
rotator cuff instrument-assisted manual muscle testing, visual observation
of scapular kinesis (or motion), and glenohumeral joint range of motion for
internal and external rotation and horizontal adduction. Results: In the 153 players, dominant-arm infraspinatus atrophy was observed in 92
players (60.1%), and only 1 player (0.7%) was identified with nondominant
infraspinatus atrophy. A Pearson correlation showed a significant
relationship between the presence of dominant-arm infraspinatus atrophy and
dominant-arm external rotation strength measured in neutral
abduction/adduction (at the side) (P = .001) as well as
between the presence of dominant-arm infraspinatus atrophy and bilateral
external rotation strength measured at 90° of glenohumeral joint abduction
(P = .009 for dominant arm and .002 for nondominant
arm). No significant correlation was found with scapular dyskinesis,
glenohumeral range of motion, or instrument-assisted manual muscle testing
of the supraspinatus (empty-can test). Conclusion: Visually observed infraspinatus muscle atrophy is a common finding in the
dominant shoulder of asymptomatic male professional tennis players and is
significantly correlated with external rotation weakness. This condition is
present in uninjured players without known shoulder pathology and is not
related to glenohumeral joint internal rotation, total rotation range of
motion, or scapular dysfunction. Players with visually observed
infraspinatus atrophy should be evaluated for external rotation strength and
may require preventive strengthening.
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Affiliation(s)
- Todd S Ellenbecker
- Medical Services, ATP Tour, Ponte Vedra Beach, Florida, USA.,ATP Medical Services Committee, ATP Tour, Ponte Vedra Beach, Florida, USA.,Rehab Plus Sports Therapy Scottsdale, Scottsdale, Arizona, USA
| | - David M Dines
- ATP Medical Services Committee, ATP Tour, Ponte Vedra Beach, Florida, USA.,Sports Medicine and Shoulder Service, Hospital for Special Surgery, New York, New York, USA
| | - Per A Renstrom
- ATP Medical Services Committee, ATP Tour, Ponte Vedra Beach, Florida, USA.,Karolinska Institute, Stockholm, Sweden
| | - Gary S Windler
- ATP Medical Services Committee, ATP Tour, Ponte Vedra Beach, Florida, USA.,South Carolina Sports Medicine & Orthopaedics Center, Charleston, South Carolina, USA
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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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7
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Ming TS, Min LD, Andrew TH. Unusual Case of a Volleyball Athlete Presenting with Posterior Shoulder Pain and Infraspinatus Muscle Wasting. J Orthop Case Rep 2019; 8:11-14. [PMID: 30740365 PMCID: PMC6367296 DOI: 10.13107/jocr.2250-0685.1186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Introduction: Entrapment of the suprascapular nerve is an uncommon but important differential in patients who present with posterior shoulder pain. Frequently misdiagnosed as rotator cuff or cervical disc disease, this increasingly recognized entity can result from traction-related or compression-related etiology. Two sites of compression include the suprascapular and spinoglenoid notches with the latter less commonly encountered. Case Report: In our study, we describe a case of arthroscopic decompression of suprascapular nerve entrapment at the spinoglenoid notch due to hypertrophied spinoglenoid ligament using an improvised arthroscopic technique. Conclusion: Spinoglenoid notch compression of the suprascapular nerve is an important cause of posterior shoulder pain with infraspinatus wasting. A clear understanding of the nerve anatomy and the common site of compression allow for accurate diagnosis. The modified arthroscopic technique described is easily reproducible and provides good visualization of the anatomy, allowing adequate and safe decompression of the suprascapular nerve.
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Affiliation(s)
- Tan Shi Ming
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore
| | - Lim Dao Min
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore
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8
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Loirat MA, Tierny M, Hervé A, Lignel A, Berton E, Ropars M, Thomazeau H. A new approach for endoscopic neurolysis of the suprascapular nerve at the spinoglenoid notch: A preliminary cadaver study. Orthop Traumatol Surg Res 2017; 103:861-864. [PMID: 28705649 DOI: 10.1016/j.otsr.2017.04.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2017] [Revised: 04/09/2017] [Accepted: 04/18/2017] [Indexed: 02/02/2023]
Abstract
The suprascapular nerve (SSN) can become compressed at its 2 scapular attachments: the suprascapular and the spinoglenoid notch. The objective of this study was to describe a new arthroscopic approach for SSN neurolysis at the spinoglenoid notch. Ten cadaver shoulders were used. Two were dissected to simulate the "classical" arthroscopic approach and to help in the creation of a new "direct medial retrospinal" approach. Eight other shoulders were used to validate this new approach, with control of the whole juxta-glenoid course of the SSN as criterion of success. The retrospinal posterior approach allowed the entire juxta-glenoid segment of the SSN to be explored in 6 cases out of 8. One exploration was incomplete, another not feasible. SSN neurolysis at the spinoglenoid notch was feasible in cadavers on a retrospinal approach.
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Affiliation(s)
- M-A Loirat
- Service de chirurgie orthopédique et traumatologique, université de Rennes-1, CHU de Ponchaillou, 2, rue Henri-le-Guilloux, 35033 Rennes, France; Laboratoire M2S (mouvement sport santé), université Rennes 2, école Normale-Supérieure-Bretagne-université européenne de Bretagne, campus de Ker-Lann, Bruz, France.
| | - M Tierny
- Service de chirurgie orthopédique et traumatologique, université de Rennes-1, CHU de Ponchaillou, 2, rue Henri-le-Guilloux, 35033 Rennes, France
| | - A Hervé
- Service de chirurgie orthopédique et traumatologique, université de Rennes-1, CHU de Ponchaillou, 2, rue Henri-le-Guilloux, 35033 Rennes, France
| | - A Lignel
- Service de chirurgie orthopédique et traumatologique, université de Rennes-1, CHU de Ponchaillou, 2, rue Henri-le-Guilloux, 35033 Rennes, France
| | - E Berton
- Laboratoire d'anatomie, université de Rennes-1, 2, avenue du Professeur-Léon-Bernard, 35000 Rennes, France
| | - M Ropars
- Service de chirurgie orthopédique et traumatologique, université de Rennes-1, CHU de Ponchaillou, 2, rue Henri-le-Guilloux, 35033 Rennes, France; Laboratoire M2S (mouvement sport santé), université Rennes 2, école Normale-Supérieure-Bretagne-université européenne de Bretagne, campus de Ker-Lann, Bruz, France; Laboratoire d'anatomie, université de Rennes-1, 2, avenue du Professeur-Léon-Bernard, 35000 Rennes, France
| | - H Thomazeau
- Service de chirurgie orthopédique et traumatologique, université de Rennes-1, CHU de Ponchaillou, 2, rue Henri-le-Guilloux, 35033 Rennes, France
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Protective and Predisposing Morphological Factors in Suprascapular Nerve Entrapment Syndrome: A Fundamental Review Based on Recent Observations. BIOMED RESEARCH INTERNATIONAL 2017; 2017:4659761. [PMID: 28691025 PMCID: PMC5485264 DOI: 10.1155/2017/4659761] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/07/2016] [Revised: 03/23/2017] [Accepted: 05/15/2017] [Indexed: 11/17/2022]
Abstract
Suprascapular nerve entrapment syndrome (SNES) is a neuropathy caused by compression of the nerve along its course. The most common compression sites include the suprascapular notch and the spinoglenoid notch. The aim of this article was to review the anatomical factors influencing the occurrence of SNES in the light of the newest reports. Potential predisposing morphological factors include a V-shaped, narrow, or "deep" suprascapular notch; a band-shaped, bifurcated, or completely ossified superior transverse scapular ligament (STSL); particular arrangements of the suprascapular nerve and vessels at the suprascapular notch. A very recent report indicates structures at the suprascapular notch region that may protect from SNES, such as the suprascapular notch veins (SNV). The role of the anterior coracoscapular ligament (ACSL) is still not clear. While some studies indicate that it may predispose for SNES, the newest study proposes a protective function. Knowledge of these variations is essential for arthroscopic and other surgical procedures of this area in order to avoid iatrogenic injury of the suprascapular nerve or unexpected bleeding from the suprascapular vessels running alongside the STSL.
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Kostretzis L, Theodoroudis I, Boutsiadis A, Papadakis N, Papadopoulos P. Suprascapular Nerve Pathology: A Review of the Literature. Open Orthop J 2017; 11:140-153. [PMID: 28400882 PMCID: PMC5366386 DOI: 10.2174/1874325001711010140] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2016] [Revised: 04/19/2016] [Accepted: 04/20/2016] [Indexed: 01/02/2023] Open
Abstract
Background: Suprascapular nerve pathology is a rare diagnosis that is increasingly gaining popularity among the conditions that cause shoulder pain and dysfunction. The suprascapular nerve passes through several osseoligamentous structures and can be compressed in several locations. Methods: A thorough literature search was performed using online available databases in order to carefully define the pathophysiology and to guide diagnosis and treatment. Results: Suprascapular neuropathy diagnosis is based on a careful history and a thorough clinical and radiological examination. Although the incidence and prevalence of the condition remain unknown, it is highly diagnosed in specific groups (overhead athletes, patients with a massive rotator cuff tear) probably due to higher interest. The location and the etiology of the compression are those that define the treatment modality. Conclusion: Suprascapular neuropathy diagnosis is based on a careful history and a thorough clinical and radiological examination. The purpose of this article is to describe the anatomy of the suprascapular nerve, to define the pathophysiology of suprascapular neuropathy and to present methodically the current diagnostic and treatment strategies.
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Affiliation(s)
- Lazaros Kostretzis
- Department of Orthopaedics, Medical School of Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Ioannis Theodoroudis
- Department of Orthopaedics, Medical School of Aristotle University of Thessaloniki, Thessaloniki, Greece
| | | | - Nikolaos Papadakis
- Department of Orthopaedics, Medical School of Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Pericles Papadopoulos
- Department of Orthopaedics, Medical School of Aristotle University of Thessaloniki, Thessaloniki, Greece
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11
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How evolution of the nailing system improves results and reduces orthopedic complications: more than 2000 cases of trochanteric fractures treated with the Gamma Nail System. Musculoskelet Surg 2015; 100:1-8. [PMID: 26667625 DOI: 10.1007/s12306-015-0391-y] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2014] [Accepted: 11/21/2015] [Indexed: 10/22/2022]
Abstract
PURPOSE The incidence of trochanteric fractures has increased significantly during the last few decades, especially in elderly patients with osteoporosis. The dynamic/sliding hip screw and the cephalomedullary nail are the most commonly used fixation methods to treat trochanteric fractures. The improvements in the Gamma Nail System (GNS) associated with a correct surgical technique reduced the postoperative orthopedic complications. The purpose of this study was to compare the results of the different Gamma Nails. METHODS The present study is a retrospective analysis of 2144 patients treated with GNS between January 1997 and December 2011 for trochanteric fractures, classified according to AO classification method. The patients were divided into three groups according to the nailing system: 525 were treated with Standard Gamma Nail (SGN), 422 with Trochanteric Gamma Nail (TGN) and 1197 with Gamma3 Nail. RESULTS The overall incidence of intra-operative complications was 1.21 %; the incidence of intra-operative complications for each group was 1.71 % for SGN group, 0.47 % for TGN group and 1.25 % for Gamma3 Nail group. The overall incidence of postoperative complications was 5.48 %, and the incidence for each group was 10.73 % for SGN group, 9.92 % for TGN group and 2.92 % for Gamma3 Nail group. CONCLUSION The GNS is a safe device with a low rate of intra-operative complications. The evolution of this nail system reduces postoperative complications, thus improving the results at follow-up and confirming that the Gamma3 Nail is a safe and predictable device to fix trochanteric fracture.
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12
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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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13
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Plancher KD, Petterson SC. Posterior Shoulder Pain and Arthroscopic Decompression of the Suprascapular Nerve at the Transverse Scapular Ligament. OPER TECHN SPORT MED 2014. [DOI: 10.1053/j.otsm.2014.06.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Mall NA, Hammond JE, Lenart BA, Enriquez DJ, Twigg SL, Nicholson GP. Suprascapular nerve entrapment isolated to the spinoglenoid notch: surgical technique and results of open decompression. J Shoulder Elbow Surg 2013; 22:e1-8. [PMID: 23664748 DOI: 10.1016/j.jse.2013.03.009] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2012] [Revised: 02/26/2013] [Accepted: 03/10/2013] [Indexed: 02/01/2023]
Abstract
BACKGROUND Entrapment of the suprascapular nerve (SSN) at the spinoglenoid notch (SGN) specifically affects the infraspinatus, and isolated external rotation (ER) weakness can result. We describe the technique of open SSN decompression at the SGN for infraspinatus involvement and report the results of a consecutive series. MATERIALS AND METHODS Twenty-nine shoulders underwent SSN decompression at the SGN. The mean age was 44 years (range, 15-69 years), and the mean follow-up was 4.3 years (range, 1-7 years). On manual muscle testing, ER strength was abnormal in all patients: 2/5 in 3, 3/5 in 21, and 4/5 in 5. The mean preoperative American Shoulder and Elbow Surgeons (ASES) score was 48 (range, 23-83). Atrophy of the infraspinatus was visible or palpable in 72% of shoulders. Magnetic resonance imaging showed ganglion cysts at the SGN in only 20.7% of shoulders. RESULTS Of the patients, 19 (66%) regained full ER strength, 9 (31%) improved to 4/5, and 1 (3%) had ER strength of 3/5. The mean ASES score improved to 75 (range, 60-100) (P < .05). Of 29 shoulders, 23 (79%) showed improved ER strength within 1 week of surgery. All ganglion cyst cases regained full ER strength within a mean of 6 weeks. In all cases, ER strength improved by at least 1 full strength grade. DISCUSSION A ganglion cyst is not necessary to produce SSN compression at the SGN. SSN compression at the SGN can present as an isolated entity or can occur in conjunction with rotator cuff pathology or a ganglion cyst. An index of suspicion, physical examination, magnetic resonance imaging, and electromyography confirm the diagnosis. The described operative approach detaches no muscle and allows rapid recovery, and in all cases, ER strength improved to normal or by 1 full grade.
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Affiliation(s)
- Nathan A Mall
- Department of Orthopaedic Surgery, Division of Sports Medicine and Shoulder and Elbow Surgery, Rush University Medical Center, St Louis, MO, USA.
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J Salata M, J Nho S, Chahal J, Van Thiel G, Ghodadra N, Dwyer T, A Romeo A. Arthroscopic anatomy of the subdeltoid space. Orthop Rev (Pavia) 2013; 5:e25. [PMID: 24191185 PMCID: PMC3808800 DOI: 10.4081/or.2013.e25] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2013] [Accepted: 05/14/2013] [Indexed: 11/23/2022] Open
Abstract
From the first shoulder arthroscopy performed on a cadaver in 1931, shoulder arthroscopy has grown tremendously in its ability to diagnose and treat pathologic conditions about the shoulder. Despite improvements in arthroscopic techniques and instrumentation, it is only recently that arthroscopists have begun to explore precise anatomical structures within the subdeltoid space. By way of a thorough bursectomy of the subdeltoid region, meticulous hemostasis, and the reciprocal use of posterior and lateral viewing portals, one can identify a myriad of pertinent ligamentous, musculotendinous, osseous, and neurovascular structures. For the purposes of this review, the subdeltoid space has been compartmentalized into lateral, medial, anterior, and posterior regions. Being able to identify pertinent structures in the subdeltoid space will provide shoulder arthroscopists with the requisite foundation in core anatomy that will be required for challenging procedures such as arthroscopic subscapularis mobilization and repair, biceps tenodesis, subcoracoid decompression, suprascapular nerve decompression, quadrangular space decompression and repair of massive rotator cuff tears.
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Affiliation(s)
- Michael J Salata
- Division of Orthopaedic Surgery, University Hospitals Case Medical Center , Cleveland, OH, USA
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Won HJ, Won HS, Oh CS, Han SH, Chung IH, Yoon YC. Morphological study of the inferior transverse scapular ligament. Clin Anat 2013; 27:707-11. [PMID: 23813778 DOI: 10.1002/ca.22283] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2013] [Revised: 05/27/2013] [Accepted: 05/29/2013] [Indexed: 11/09/2022]
Abstract
The suprascapular nerve can be compressed by the inferior transverse scapular ligament (ITSL), also known as the spinoglenoid ligament, and this entrapment results in dysfunction of the external rotation of the upper arm owing to isolated weakness of the infraspinatus muscle. The morphology of the ITSL has not been adequately characterized. The aim of this study was to clarify the morphological characteristics of the ITSL. In total, 110 shoulders from 72 cadavers were dissected in this study. The ITSL was present in 73 (66.4%) of the 110 specimens, and comprised membrane in 40 (36.4%), ligament in 25 (22.7%), and both membrane and ligament in eight (7.3%). This structure could be classified into three types on the basis of its shape: band-like (33.6%, type I), triangular (15.5%, type II), or irregular (17.3%, type III). In the spinoglenoid notch, the suprascapular nerve was always close to the lateral margin of the scapular spine. The length of the ligament between its origin and insertion sites ranged from 8.7 to 23.4 mm at its superior margin and from 8.9 to 17.5 mm at its inferior margin. The ligament width and thickness at its midportion ranged from 1.6 to 10.0 mm and from 0.1 to 1.2 mm, respectively. The results of this study improve understanding of the ITSL and will be helpful for successful diagnoses and treatments for selective suprascapular nerve entrapment.
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Affiliation(s)
- Hyung-Jin Won
- Department of Anatomy, Samsung Biomedical Research Institute, Sungkyunkwan University School of Medicine, Suwon, Korea
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Salles JI, Cossich VRA, Amaral MV, Monteiro MT, Cagy M, Motta G, Velasques B, Piedade R, Ribeiro P. Electrophysiological correlates of the threshold to detection of passive motion: an investigation in professional volleyball athletes with and without atrophy of the infraspinatus muscle. BIOMED RESEARCH INTERNATIONAL 2013; 2013:634891. [PMID: 23484136 PMCID: PMC3581095 DOI: 10.1155/2013/634891] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/16/2012] [Revised: 11/21/2012] [Accepted: 12/02/2012] [Indexed: 11/18/2022]
Abstract
The goal of the present study is to compare the electrophysiological correlates of the threshold to detection of passive motion (TTDPM) among three groups: healthy individuals (control group), professional volleyball athletes with atrophy of the infraspinatus muscle on the dominant side, and athletes with no shoulder pathologies. More specifically, the study aims at assessing the effects of infraspinatus muscle atrophy on the cortical representation of the TTDPM. A proprioception testing device (PTD) was used to measure the TTDPM. The device passively moved the shoulder and participants were instructed to respond as soon as movement was detected (TTDPM) by pressing a button switch. Response latency was established as the delay between the stimulus (movement) and the response (button press). Electroencephalographic (EEG) and electromyographic (EMG) activities were recorded simultaneously. An analysis of variance (ANOVA) and subsequent post hoc tests indicated a significant difference in latency between the group of athletes without the atrophy when compared both to the group of athletes with the atrophy and to the control group. Furthermore, distinct patterns of cortical activity were observed in the three experimental groups. The results suggest that systematically trained motor abilities, as well as the atrophy of the infraspinatus muscle, change the cortical representation of the different stages of proprioceptive information processing and, ultimately, the cortical representation of the TTDPM.
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Affiliation(s)
- José Inácio Salles
- Neuromuscular Research Laboratory, National Institute of Traumatology and Orthopaedics (INTO), Avenida Brasil 500, 20940-070 Rio de Janeiro, RJ, Brazil
- Brazilian Volleyball Confederation, Shopping Città America Avenida das Américas 700, Bloco 7, Barra da Tijuca, 22640-100 Rio de Janeiro, RJ, Brazil
| | - Victor Rodrigues Amaral Cossich
- Neuromuscular Research Laboratory, National Institute of Traumatology and Orthopaedics (INTO), Avenida Brasil 500, 20940-070 Rio de Janeiro, RJ, Brazil
| | - Marcus Vinicius Amaral
- Neuromuscular Research Laboratory, National Institute of Traumatology and Orthopaedics (INTO), Avenida Brasil 500, 20940-070 Rio de Janeiro, RJ, Brazil
| | - Martim T. Monteiro
- Neuromuscular Research Laboratory, National Institute of Traumatology and Orthopaedics (INTO), Avenida Brasil 500, 20940-070 Rio de Janeiro, RJ, Brazil
| | - Maurício Cagy
- Biomedical Engineering Program, Centre of Technology, Federal University of Rio de Janeiro, Avenida Horácio Macedo 2030, Bloco H, Sala 327, Cidade Universitária, 21941-901 Rio de Janeiro, RJ, Brazil
| | - Geraldo Motta
- Neuromuscular Research Laboratory, National Institute of Traumatology and Orthopaedics (INTO), Avenida Brasil 500, 20940-070 Rio de Janeiro, RJ, Brazil
| | - Bruna Velasques
- Neuromuscular Research Laboratory, National Institute of Traumatology and Orthopaedics (INTO), Avenida Brasil 500, 20940-070 Rio de Janeiro, RJ, Brazil
- Brain Mapping and Sensorimotor Integration Laboratory, Institute of Psychiatry, Federal University of Rio de Janeiro, Avenida Venceslau Brás 71, Botafogo, 22290-140 Rio de Janeiro, RJ, Brazil
- Institute of Applied Neuroscience (IAN), Rua Pacheco Leão 704, 25 Jardim Botânico, 22460-030 Rio de Janeiro, RJ, Brazil
| | - Roberto Piedade
- Brain Mapping and Sensorimotor Integration Laboratory, Institute of Psychiatry, Federal University of Rio de Janeiro, Avenida Venceslau Brás 71, Botafogo, 22290-140 Rio de Janeiro, RJ, Brazil
| | - Pedro Ribeiro
- Brain Mapping and Sensorimotor Integration Laboratory, Institute of Psychiatry, Federal University of Rio de Janeiro, Avenida Venceslau Brás 71, Botafogo, 22290-140 Rio de Janeiro, RJ, Brazil
- Institute of Applied Neuroscience (IAN), Rua Pacheco Leão 704, 25 Jardim Botânico, 22460-030 Rio de Janeiro, RJ, Brazil
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Abstract
The vascular anatomy at the spinoglenoid and suprascapular notches appears to be more variable than previously thought. In patients presenting with signs of suprascapular nerve compression, vascular causes must be considered. Especially when considering percutaneous or arthroscopic treatment, awareness of these entities may help to guide treatment decisions, aid in identification of the anatomy, and prevent unwanted vascular insult.
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Affiliation(s)
- Carlton Houtz
- Highland Clinic, 1455 E Bert Kouns Industrial Loop, Ste 210, Shreveport, LA 71105, USA.
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Blum A, Lecocq S, Louis M, Wassel J, Moisei A, Teixeira P. The nerves around the shoulder. Eur J Radiol 2013; 82:2-16. [DOI: 10.1016/j.ejrad.2011.04.033] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2011] [Accepted: 03/29/2011] [Indexed: 11/27/2022]
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Moen TC, Babatunde OM, Hsu SH, Ahmad CS, Levine WN. Suprascapular neuropathy: what does the literature show? J Shoulder Elbow Surg 2012; 21:835-46. [PMID: 22445163 DOI: 10.1016/j.jse.2011.11.033] [Citation(s) in RCA: 73] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2011] [Revised: 11/23/2011] [Accepted: 11/28/2011] [Indexed: 02/01/2023]
Abstract
Suprascapular neuropathy remains a rare, albeit increasingly recognized, diagnosis. Despite its relatively low prevalence, it must be kept in the shoulder surgeon's mind as a potential cause of shoulder pain, particularly in patients where the history, physical examination, and imaging studies do not adequately explain a patient's symptoms or disability. Although challenging to identify, suprascapular neuropathy can be successfully treated. The current literature shows that the location and mechanism of nerve injury are the most important factors guiding management. Different treatment strategies are required, depending on the specific location and type of nerve injury. Controversy regarding if and when to perform an isolated suprascapular nerve release continues. Furthermore, no recommendations regarding suprascapular nerve release in conjunction with rotator cuff repair can be made at this time, and further research is necessary to better delineate the indications in the future.
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Affiliation(s)
- Todd C Moen
- Center for Shoulder, Elbow and Sports Medicine, Columbia University Medical Center, New York, NY, USA
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Abstract
Although historically considered a diagnosis of exclusion, suprascapular neuropathy may be more common than once believed, as more recent reports are describing the condition as a cause of substantial pain and weakness in patients with and without concomitant shoulder pathology. The etiology is traction or compression of the suprascapular nerve. This can result from a space-occupying lesion, such as a ganglion cyst, or a traction injury as a result of repetitive overhead activities. More recent studies have cited cases of traction injuries occurring with retraction of a large rotator cuff tear. Atrophy of the infraspinatus and/or supraspinatus rotator cuff muscles with resultant weakness in forward flexion and/or external rotation of the shoulder on physical examination may be demonstrated. Magnetic resonance imaging (MRI) is the preferred modality to assess atrophy of the rotator cuff muscles as well as assess potential causes of suprascapular nerve compression. Electromyography and nerve conduction velocity studies remain the gold standard for confirmation of the diagnosis of suprascapular neuropathy; however, nerve pain may occur even in the setting of a negative electromyography. Initial management is usually nonoperative, consisting of activity modification, physical therapy, and nonsteroidal anti-inflammatory drugs. Surgical intervention is considered for patients with nerve compression by an external source or for symptoms refractory to conservative measures. Decompression of the suprascapular nerve may be accomplished through an open approach, although arthroscopic surgical approaches have become more common in the past several years.
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Affiliation(s)
- Michael T Freehill
- Harvard Shoulder Service, Massachusetts General Hospital, Boston, MA 02114, USA.
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Tan EW, Dharamsi FM, McCarthy EF, Fayad LM, McFarland EG. Intramuscular synovial cyst of the shoulder: a case report. J Shoulder Elbow Surg 2010; 19:e20-4. [PMID: 20189838 DOI: 10.1016/j.jse.2009.11.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2009] [Revised: 11/03/2009] [Accepted: 11/06/2009] [Indexed: 02/01/2023]
Affiliation(s)
- Eric W Tan
- Division of Sports Medicine and Shoulder Surgery, the Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, MD, USA
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Donegan DJ, Gay AN, Baldwin K, Morales EE, Esterhai JL, Mehta S. Use of medical comorbidities to predict complications after hip fracture surgery in the elderly. J Bone Joint Surg Am 2010; 92:807-13. [PMID: 20360502 DOI: 10.2106/jbjs.i.00571] [Citation(s) in RCA: 74] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Comorbidities before and complications following hip fracture surgery can impact the return of function. We hypothesized that the American Society of Anesthesiologists (ASA) classification of medical comorbidities is a useful surrogate variable for the patient's general medical condition and would be a strong predictor of perioperative medical complications following hip fracture surgery. METHODS A retrospective review of the cases of 197 elderly patients who had undergone operative management of a hip fracture was performed. The ASA class, data regarding perioperative medical and surgical complications, and demographic data were obtained. Medical complications were defined as those requiring intervention by an internist or medical specialist. Differences in complication rates among the ASA classes were determined. RESULTS Medical complications were more common in patients in ASA class 3 (p < 0.001) and those in class 4 (p = 0.001) than in those in class 2. Patients in ASA class 3 had a 3.78 times greater chance of having a medical complication than did those in class 2 (p < 0.001). Patients in ASA class 4 had a 7.39 times greater chance of having medical complications than did those in class 2 (p = 0.001). No significant relationship was identified between the ASA class and surgical complications. CONCLUSIONS The ASA class is strongly associated with medical problems in the perioperative period following hip fracture surgery in the elderly. Patients identified as being at higher risk (in ASA class 3 or 4) preoperatively should be closely managed medically so that perioperative medical complications can be managed and evolving medical issues can be addressed in a timely fashion.
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Affiliation(s)
- Derek J Donegan
- Department of Orthopaedic Surgery, Hospital of the University of Pennsylvania, 2 Silverstein, 3400 Spruce Street, Philadelphia, PA 19104, USA
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Affiliation(s)
- Sonia Singh Kharay
- Department of Anatomy, Dayanand Medical College and Hospital, Ludhiana, Punjab, India.
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Abstract
Suprascapular neuropathy is a relatively uncommon but significant cause of shoulder pain and dysfunction. The suprascapular nerve follows a tortuous course from the neck to the posterior shoulder. There are several potential causes of nerve entrapment along this path, particularly at the vulnerable suprascapular and spinoglenoid notches, where nerve excursion is limited by bony and ligamentous constraints. Additional extrinsic compression may be caused by glenohumeral joint-related ganglion cysts or soft-tissue masses. Traction neuropathy may occur following excessive nerve excursion during overhead sports or as a result of massive, retracted rotator cuff tears in older patients. Diagnosis is based on a careful history, physical examination, focused imaging, and electrodiagnostic studies. In the absence of a clear structural compression or overtensioning of the nerve, treatment initially should be nonsurgical, with activity modification and physical therapy. Discrete nerve compression or failure of nonsurgical measures warrants early surgical intervention. Arthroscopic alternatives to the traditional open suprascapular and/or spinoglenoid notch decompressions have the benefit of simultaneously diagnosing and addressing intra-articular and/or subacromial pathology while minimizing morbidity. In most patients, both open and arthroscopic approaches provide reliable pain relief and improvements in function; return of strength and muscle bulk is less predictable.
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Cummins CA, Schneider DS. Peripheral Nerve Injuries in Baseball Players. Phys Med Rehabil Clin N Am 2009; 20:175-93, x. [DOI: 10.1016/j.pmr.2008.10.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Sebestyén A, Boncz I, Tóth F, Péntek M, Nyárády J, Sándor J. [Correlation between risk factors and mortality in elderly patients with femoral neck fracture with 5-year follow-up]. Orv Hetil 2008; 149:493-503. [PMID: 18343762 DOI: 10.1556/oh.2008.28228] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
UNLABELLED Hip fractures are associated with increased mortality in the elderly. There are only a few studies based on large patient number covering a nationwide health care system. AIM The aim of this study was to investigate the mortality following primary treatment in patients over 60 with acute, monotraumatic femoral neck fracture on monthly and annual base during a 5-year follow-up period; and to evaluate the effect of different risk factors on mortality during the follow-up. METHODS Data were derived from the nationwide database of the National Health Insurance Fund Administration. The evaluation includes patients with femoral neck fracture discharged from inpatient care institutions in 2000 following a primary surgical treatment. Weekly, monthly and annual mortality rates, and its monthly and annual trends according to risk factors were calculated. Logistic and Cox regression analysis was performed to evaluate the correlation between risk factors and mortality. RESULTS 3783 patients were involved in the study with a mean age of 77,97 years (SD 8,52). The mortality rates were 1,71% (during the first week), 8,99% (30 days), 30,74% (first year) and 61,88% (in 5 years). Mortality showed a declining trend up to the 5th month, and is stagnant after the first year. Risk factor analysis showed that higher risk of mortality is associated with male sex and higher age group up to 5 years, co-morbidities up to 4 years, lateral type femoral neck fracture and 12 hours delay of primary treatment up to 2 years, early local complications up to 1 year and surgical treatment during week-end up to 1 month. Surgical treatment delivered in national health institutes and university clinics resulted in a lower mortality risk up to 1 year. CONCLUSIONS In order to reduce mortality during the management of hip fractures, the authors emphasize the importance of delay of treatment within 12 hours, appropriate selection of methods corresponding to fracture type, providing the same conditions for primary treatment during all days of the week, to organize the treatment to special centres, appropriate acute care and follow-up corresponding to the general health status and co-morbidities of patients.
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Abstract
Hip fracture (HF) is a major health care problem in the Western world, associated with significant morbidity, mortality and loss of function. Its incidence is expected to increase as the population ages. The authors discuss the role of a coordinated multidisciplinary team in the management of patients during hospital stay, at discharge and during rehabilitation. Orthogeriatric care should not just be viewed as a multidisciplinary activity, but as a radical alternative to the traditional model of care, an alternative based on all those strategies in which evidence shows an improvement in outcomes in the fractured elderly. Therefore, key points of the care are early surgery, immediate mobilization, prevention and management of delirium, pain and malnutrition, as well as an integrated and multidisciplinary approach. Comprehensive geriatric assessment is useful in identifying frail elderly and in providing information that is essential in formulating clinical recommendations and making care plans. In each hospital, the orthogeriatric unit should represent a center of excellence for treating elderly patients with major fractures. However, when an orthogeriatric project is implemented, it is essential that detailed data about the case-mix of patients, process of care and outcomes are collected, to compare the results with historical data and to be able to participate in audit processes.
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Soubeyrand M, Bauer T, Billot N, Lortat-Jacob A, Gicquelet R, Hardy P. Original portals for arthroscopic decompression of the suprascapular nerve: an anatomic study. J Shoulder Elbow Surg 2008; 17:616-23. [PMID: 18276165 DOI: 10.1016/j.jse.2007.10.002] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2006] [Revised: 07/31/2007] [Accepted: 10/03/2007] [Indexed: 02/01/2023]
Abstract
Operative treatment of suprascapular nerve entrapment consists of decompression of the nerve, either at the suprascapular notch or the spinoglenoid notch. The aim of this study was to describe new arthroscopic portals to approach these 2 notches at the same time. Twenty shoulders in 10 fresh frozen cadavers were investigated. Four portals were used in line with the scapular spine (S1, S2, S3, S4). The suprascapular pedicle was visualized passing under the supraspinatus muscle. The technique was performed for each specimen. The efficacy and safety of the technique were assessed by open dissection. No injury to the nerve was identified after performing the technique. Decompression was complete in 18 of 20 cases at the suprascapular notch and in all cases at the spinoglenoid notch. With this technique, arthroscopic decompression of the nerve at the suprascapular and spinoglenoid notches is anatomically possible.
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Affiliation(s)
- Marc Soubeyrand
- Department of Orthopaedic Surgery, Hôpital Universitaire de Bicêtre, and University of Paris-Sud, Le Kremlin-Bicetre, France
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Plancher KD, Luke TA, Peterson RK, Yacoubian SV. Posterior shoulder pain: a dynamic study of the spinoglenoid ligament and treatment with arthroscopic release of the scapular tunnel. Arthroscopy 2007; 23:991-8. [PMID: 17868839 DOI: 10.1016/j.arthro.2007.03.098] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2006] [Revised: 03/23/2007] [Accepted: 03/27/2007] [Indexed: 02/02/2023]
Abstract
PURPOSE The purpose of this study was to determine the pressure exerted on the suprascapular nerve by compression of the spinoglenoid ligament during glenohumeral range of motion. In addition, a 2-portal technique was described to arthroscopically visualize and safely release the spinoglenoid ligament while visualizing the suprascapular nerve, artery, and vein. METHODS Ten cadaveric shoulders were used for visual observation of variation in the position and tension of the spinoglenoid ligament. In 15 additional shoulders, a transducer was used to sense the pressure changes and was recorded in voltage. Pressure changes created by the spinoglenoid ligament on the distal suprascapular nerve in the scapular tunnel during glenohumeral motion were recorded. RESULTS Internal rotation, rather than external rotation, in any position of the shoulder created a visual increase of tension in the spinoglenoid ligament. Increased pressure readings were noted with internal rotation and with 90 degrees of abduction, full abduction, and full adduction of the shoulder. The suprascapular nerve occupying the space created by the spinoglenoid ligament experiences an increased pressure during glenohumeral range of motion and positions that mimic overhead throwing. The dynamic nature of the ligament with its insertion on the posterior capsule required a new minimally invasive technique for its release that can be safe and straightforward. CONCLUSIONS The spinoglenoid ligament was affected by the position of the glenohumeral joint. These changes in pressure in combination with repetitive shoulder movement are likely components that cause repeated trauma or compression on the distal suprascapular nerve created by a scapular tunnel syndrome. The surgical technique provides a treatment option when conservative treatment fails in the patient with posterior shoulder pain. CLINICAL RELEVANCE The spinoglenoid ligament was affected by the position of the shoulder, with the most pressure noted with the arm in full adduction and internal rotation. This pressure can be treated with arthroscopic release.
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Affiliation(s)
- Kevin D Plancher
- Plancher Orthopaedics & Sports Medicine, New York, New York 10128, USA.
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Farchi S, Camilloni L, Giorgi Rossi P, Chini F, Lori G, Tancioni V, Papini P, Borgia P, Guasticchi G. Agreement between emergency room and discharge diagnoses in a population of injured inpatients: determinants and mortality. ACTA ACUST UNITED AC 2007; 62:1207-14. [PMID: 17495726 DOI: 10.1097/01.ta.0000221538.00856.b9] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
BACKGROUND Various factors contribute to the quality of care of an injured patient at the emergency room (ER), and a correct diagnosis can improve and accelerate care. The aim of this study was to evaluate the agreement between diagnoses assigned in the ER and those assigned after hospital admission to patients with unintentional injuries. We also tried to determine the factors that influenced the disagreement, and to evaluate if discordant diagnoses were associated with higher mortality risk. METHODS All ER visits for unintentional injuries that were followed by hospital admission at the 60 emergency departments in the Lazio Region in 2000. Concordant diagnoses (ER/discharge) were established based on the Barell matrix cells. Logistic regression was used to assess the role of individual and ER care factors on the probability of concordance. A logistic regression was performed, where death within 30 days was the outcome and concordance was the determinant. RESULTS We considered 22,892 ER visits for injury that were followed by hospital admission. In 62.2% of cases, the ER and discharge diagnoses were concordant. Higher concordance was found for older patients and less urgent cases. Factors influencing concordance were the hour of the visit, ER specialization degree, initial outcome, and length of hospital stay. Patients who had disconcordant diagnoses had a 30% higher probability of death. CONCLUSIONS A correct diagnosis (i.e. confirmed at hospital discharge) at first contact with the emergency room is associated with lower mortality. Comparing administrative ER and hospital discharge data can be useful in emergency department management studies.
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Affiliation(s)
- Sara Farchi
- Public Health Agency of Lazio Region, Rome, Italy.
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Mathes AM, Riemer I, Link A, Rensing H. Operative Versorgung einer pertrochantären Femurfraktur unmittelbar nach Stent-PTCA eines akuten Myokardinfarkts. Anaesthesist 2007; 56:232-5. [PMID: 17221261 DOI: 10.1007/s00101-006-1125-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Due to the high risk of perioperative adverse events, elective surgery should be suspended for at least 4 weeks after myocardial infarction and coronary stent revascularization, as current guidelines suggest. This report describes the successful management of a patient who underwent urgent surgery for a displaced hip fracture immediately after stent revascularization of an acute myocardial infarction. No new perioperative ischemia was detected. The therapeutic options and the timing of surgical procedures after stent revascularization are discussed.
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Affiliation(s)
- A M Mathes
- Klinik für Anästhesiologie, Intensivmedizin und Schmerztherapie, Universitätsklinikum des Saarlandes, Kirrberger Strasse, 66421 Homburg (Saar), Deutschland.
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Westerheide KJ, Dopirak RM, Karzel RP, Snyder SJ. Suprascapular nerve palsy secondary to spinoglenoid cysts: results of arthroscopic treatment. Arthroscopy 2006; 22:721-7. [PMID: 16843807 DOI: 10.1016/j.arthro.2006.03.019] [Citation(s) in RCA: 80] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2005] [Revised: 03/15/2006] [Accepted: 03/15/2006] [Indexed: 02/02/2023]
Abstract
PURPOSE The purpose of this study was to investigate the results of arthroscopic treatment in 14 patients with suprascapular nerve palsy secondary to spinoglenoid ganglion cysts. METHODS Fourteen patients underwent arthroscopic decompression of ganglion cysts associated with suprascapular neuropathy. The most common presenting symptoms were pain and weakness, which lasted an average of 7.5 months. Ten of 14 patients were noted on examination to have atrophy, and all 14 patients had weakness of the infraspinatus. Magnetic resonance imaging (MRI) showed spinoglenoid ganglion cysts in all 14 patients; average cyst size was 3 cm. MRI revealed labral pathology in 12 of 14 cases; labral pathology was identified intraoperatively in all 14 patients. RESULTS Postoperatively, the average Simple Shoulder Test (SST) score was 11.5 (12 maximum), which was improved from an estimated preoperative score of 4.3. Improvement in external rotation strength was seen in 100% of patients who were examined postoperatively. No patients were taking pain medicine at latest follow-up. No complications were reported, and there were no clinical or symptomatic recurrences at an average follow-up of 51 months. CONCLUSIONS Arthroscopic treatment of patients with spinoglenoid ganglion cysts is safe and effective, resulting in good clinical outcomes. In our study of 14 patients, no recurrences were seen at an average of 51 months of follow-up. Level of Evidence: Level IV, therapeutic case series. LEVEL OF EVIDENCE Level IV, therapeutic case series.
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