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Examination of Pediatric Shoulder
Published in Nirmal Raj Gopinathan, Clinical Orthopedic Examination of a Child, 2021
The patient stands with the arm at the side with the elbow at 90°, and the humerus internally rotated to 45°. The examiner then applies an internal rotating force that the patient is asked to resist. Alternatively, the patient may be asked to externally rotate against resistance. Pain or weakness is indicative of a positive test for an infraspinatus tear (Figure 5.14).
Diseases of the Peripheral Nerve and Mononeuropathies
Published in Philip B. Gorelick, Fernando D. Testai, Graeme J. Hankey, Joanna M. Wardlaw, Hankey's Clinical Neurology, 2020
Diana Mnatsakanova, Charles K. Abrams
Entrapment sites (Figure 25.25): Suprascapular notch.Spinoglenoid notch.Supraspinatus muscle abducts the upper arm up to 30 degrees (deltoid takes over abduction at that point).Infraspinatus muscle assists in external rotation of the upper arm at the shoulder.
Answers
Published in Andrew Schofield, Paul Schofield, The Complete SAQ Study Guide, 2019
Andrew Schofield, Paul Schofield
Tears in the supraspiatus tendon are the commonest rotator cuff tear. These usually result from degeneration or less commonly from a fall or sudden jolts. The rotator cuff muscles are the supraspinatus, infraspinatus, teres minor and subscapularis. Rotator cuff tears can either be partial or complete. Complete rotator cuff tears need a prompt orthopaedic review, with a view to either open or arthroscopic repair.
Anatomical feasibility study of the infraspinatus muscle neurotization by lower subscapular nerve
Published in Neurological Research, 2023
Aneta Krajcová, Michal Makel, Gautham Ullas, Veronika Němcová, Radek Kaiser
After transection of the skin and removal of the subcutaneous fat, the infraspinatus muscle was dissected, cut along the inferior border of the scapular spine and from the medial edge of the scapula. It was then detached from the floor of the infraspinous fossa and rotated caudo-laterally as in the standard Judet approach [11] for the treatment of scapular body fractures. The entire course of the IB-SSN was dissected from the spinoglenoid notch to the terminal branches (Figures 2, 3). It was then cut as proximally in the spinoglenoid notch as possible and mobilized from the muscle. Then, the circumflex scapular artery was found within the infraspinatus muscle and followed by blunt dissection caudo-laterally outside the scapular body. The length of the distal stump of the IB-SSN was measured to the end of the first branch and it was then rotated inferiorly into the triangular space along the circumflex scapular artery. The infraspinatus muscle was then rotated back to its original position.
Shoulder abduction reconstruction for C5–7 avulsion brachial plexus injury by dual nerve transfers: spinal accessory to suprascapular nerve and partial median or ulnar to axillary nerve
Published in Journal of Plastic Surgery and Hand Surgery, 2022
Gavrielle Hui-Ying Kang, Fok-Chuan Yong
In C5–6 ± C7 brachial plexus avulsion injuries, shoulder abduction reconstruction by a single neurotization to the suprascapular nerve with the spinal accessory nerve alone had modest results (Narakas’drawings [1], Malessy et al [2], Chuang et al. [3]. Only a minority of patients achieved a mean shoulder glenohumeral joint abduction of 45° and external rotation up to 70° [2]. Shoulder abduction at the glenohumeral joint is more efficiently initiated by the supraspinatus muscle before 45°. Any further abduction in the coronal plane to 90° requires external rotation of the humerus for its head to clear the mechanical block of the acromial process. Beyond 90°, it is essentially the deltoid muscle (nerve supply from the axillary nerve) that works under the best mechanical conditions for abduction and external rotation [4,5]. The external rotator muscles of the shoulder joint include the infraspinatus (nerve supply from the suprascapular nerve) and the teres minor (nerve supply from the axillary nerve). Thus, where the infraspinatus may fail, the other shoulder external rotator muscle (the teres minor) can be reinnervated to initiate humeral external rotation for improvement of shoulder abduction range. Significant improvement in shoulder abduction and external rotation outcomes have been reported with the method of dual neurotization to the suprascapular nerve and the axillary nerve with nerve transfers from the spinal accessory nerve and nerve to triceps respectively [6,7].
Restoration of shoulder external rotation by means of the infraspinatus muscle reinnervation with a radial nerve branch transfer
Published in British Journal of Neurosurgery, 2020
Paulo L. Tavares, Mario G. Siqueira, Roberto S. Martins, Monise Zaccariotto, Luciano Foroni, Carlos O. Heise, Davi Solla
Muscles relating to the approach are demonstrated in Figure 2. Dissecting in the posterior suprascapular area the supraspinatus and infraspinatus branches of the suprascapular nerve were separated, after opening the superior transverse scapular ligament (Figure 3), and the infraspinatus branch was dissected in the supraspinatus fossa until the spinoglenoid notch. After lateral and superior displacement of the deltoid muscle, the infraspinatus muscle was partially detached from the scapular spine and a layer between the scapula and the infraspinatus fascia was developed, from the most lateral portion of the inferior border of the spine of the scapula and from the surface of the scapula itself. The infraspinatus muscle originates from the medial two-thirds of the posterior surface of the scapula, below the spine of the scapula, which makes it simpler to displace the muscle posteriorly and inferiorly, given its loose adhesion to the most lateral part of the scapula. The infraspinatus branch of the suprascapular nerve was identified in the region of the spinoglenoid notch, next to the suprascapular artery. Once identified, the nerve was dissected in a proximal direction, as far as the point at which it goes round the side of the spine of the scapula and enters the infraspinous fossa (Figure 4).