Cryoneurolysis: Principles and Practice
Mark V. Boswell, B. Eliot Cole in Weiner's Pain Management, 2005
The suprascapular nerve arises from the upper trunk of the brachial plexus and travels downward and laterally to pass through the suprascapular notch to provide innervation to the supraspinatus, infraspinatus, and shoulder joint. Clinically, the patient complains of a poorly localized upper shoulder pain, usually triggered by a lifting injury with the arm internally rotated. Tenderness is elicited by palpation of the suprascapular notch (the “Vulcan death grip”). Diagnostic blocks should be performed using a peripheral nerve stimulator. The classic approach to the suprascapular notch is to advance the needle perpendicular to the scapular spine from above, and then “walk it off” anteriorly until the needle drops into the suprascapular notch. This technique, however, has a high risk of pneumothorax. I recommend instead that the needle (with a peripheral nerve stimulator) be directed perpendicular to the scapula itself, using the scapular wall as a “backstop,” and then directed medially or laterally to find the nerve. This technique works for both the diagnostic nerve block and the cryoneuroablation.
Latarjet (congruent arc technique)
Andreas B. Imhoff, Jonathan B. Ticker, Augustus D. Mazzocca, Andreas Voss in Atlas of Advanced Shoulder Arthroscopy, 2017
Neurovascular injuries following open Latarjet procedure have been reported, and a thorough understanding of the relevant anatomy is crucial to safe coracoid graft harvest and fixation to the anterior glenoid rim. Special attention must also be paid to the anatomy of the suprascapular nerve, as iatrogenic injuries have been reported.32,33 In a cadaveric study, Lädermann et al. demonstrated that the main trunk of the suprascapular nerve was an average of 4 mm from the posterior exit point of the superior screw used to fix the coracoid graft. These authors further observed that the nerve was not in danger as long as the superior screw was oriented less than 10° medial to the plane of the glenoid, and we have applied these results to our preferred technique for screw insertion.28
Cancer pain syndromes
Nigel Sykes, Michael I Bennett, Chun-Su Yuan in Clinical Pain Management, 2008
The suprascapular nerve (C5–6) is part of the brachial plexus. Inter alia, it carries sensory branches from both the glenohumeral and acromioclavicular joints. It traverses the suprascapular notch which is narrow in some patients. Weakness of the rotatory cuff muscles can result in winging of the scapula and leads to repeated traction on the suprascapular nerve. This can lead to inflammation and entrapment with consequential shoulder pain, generally unilateral but occasionally bilateral. Typically, the pain is exacerbated by overhead movement of the arm and when stretching the ipsilateral hand across the thorax and on to the contralateral scapula (Thompson and Kopell test). Tenderness over the suprascapular fossa supports this diagnosis. Risk factors for suprascapular nerve entrapment include: weakness and cachexia with winging of the scapula;when dyspneic patients lean forward and rest on their arms for long periods, e.g. cancer patients with concurrent chronic obstructive pulmonary disease (COPD);excessive use of arms, e.g. in someone with paraplegia or who uses crutches;the use of self-propelled wheelchairs;upper limb lymphedema, with a heavy arm dragging on the shoulder girdle.23
Impact of shoulder subluxation on peripheral nerve conduction and function of hemiplegic upper extremity in stroke patients: A retrospective, matched-pair study
Published in Neurological Research, 2021
Xiangzhe Li, Zhiwei Yang, Sheng Wang, Panpan Xu, Tianqi Wei, Xiaomeng Zhao, Xifeng Li, Yanmei Zhang, Ying Li, Na Mei, Qinfeng Wu
The suprascapular nerve originates from the brachial plexus and it crosses the suprascapular notch and the transverse scapular ligament to innervate the supraspinatus and infraspinatus [30]. Through the X-ray in comparing the position of bilateral scapulae and glenohumeral joints in stroke patients, Culham et al. [26] concluded that the scapulae on the hemiplegic side were generally downward rotation, downward displacement, and outward displacement during the period of flaccid paralysis, so the occurrence of the SS could be more easily. Anatomically, the downward rotation, downward displacement, and outward displacement of the scapula may cause the higher tension of the suprascapular nerve, then lead to pull injury. In the case of scapulothoracic dissociation, excessive traction force and prolonged pull on the infraclavicular brachial plexus may cause the injury of the axillary and suprascapular nerves, and have an adverse effect on the spontaneous recovery of the nerve lesions [31]. However, the exact injury mechanism is still unclear.
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
All surgeries were performed in the supine position. A supraclavicular approach was used for brachial plexus roots exploration and nerve transfer of the spinal accessory to the suprascapular nerve. The spinal accessory nerve was identified on the deep surface of the trapezius muscle and confirmed with a nerve stimulator. The dissection was continued distally to its termination into two or three branches. A vessel loop was placed around it for later identification when it would be transected at this junction for coaptation to the suprascapular nerve stump. The suprascapular nerve was identified as it branches off from the upper trunk of the brachial plexus. It was dissected and traced distally until healthy nerve tissue was encountered. This was verified by its turgor and the visualization of nerve fascicles within the epineurium upon transection of the nerve. When scarred or fibrotic nerve tissue was encountered, the nerve would be progressively cut back distally until a healthy nerve stump was seen. Coaptation of the spinal accessory nerve to the healthy suprascapular nerve stump was performed under magnification with 10–0 nylon sutures, and reinforced with a biological adhesive (TISSEEL Fibrin Sealant, Baxter International Inc.).
Did the prevalence of suprascapular neuropathy in professional volleyball players decrease with the changes occurred in serving technique?
Published in The Physician and Sportsmedicine, 2021
Daniele Mazza, Raffaele Iorio, Piergiorgio Drogo, Edoardo Gaj, Edoardo Viglietta, Giuseppe Rossi, Edoardo Monaco, Andrea Ferretti
If the suprascapular nerve is compressed proximally at the suprascapular notch, atrophy of both the supraspinatus and infraspinatus muscles will be found. Furthermore, proximal entrapment is usually accompanied by pain in the posterior region of the shoulder. Differently, distal entrapment at the spinoglenoid notch will result in selective atrophy of the infraspinatus muscle known as infraspinatus syndrome (IS) [9]. In IS, no further symptoms other than isolated muscle atrophy were reported. Indeed, at the spinoglenoid notch, the sensory branches have yet to leave the nerve [32]. In our study, none of the volleyball players complained of shoulder pain; in recent literature, IS has been considered a totally asymptomatic condition [16,18,19,23,29,32]. External rotation weakness assessed with specific text or dynamometric exams may be the only suspicion finding. Each case of hypotrophy in our study was accompanied by external rotation weakness as compared to the contralateral side. This is in line with the study of Witvrouw et al. [19] who found a significant reduction in external rotation strength of the affected side.
Related Knowledge Centers
- Brachial Plexus
- Infraspinatus Muscle
- Omohyoid Muscle
- Posterior Triangle of The Neck
- Spinal Nerve
- Supraspinatus Muscle
- Mixed Nerve
- Nerve
- Upper Trunk
- Ventral Ramus of Spinal Nerve
- Posterior Triangle of The Neck