Concept: Supraspinatus muscle
A unique anatomical variation of the suprascapular notch was discovered in one scapula from 610 analyzed by three-dimensional CT reconstruction. Two bony bridges were found, converting it into a double suprascapular foramen, in the left upper extremity of an 56-year-old Caucasian female. This variation might be a risk factor for suprascapular nerve entrapment. Suprascapular nerve running through inferior suprascapular foramen was discovered. Suprascapular vessels passed through superior suprascapular foramen (artery lay medially and vein laterally). A new hypothesis of double suprascapular foramen formation (mechanism of creation) is presented based on recent anatomical findings (e.g., the discovery in 2002 of the anterior coracoscapular ligament). Knowledge of the anatomical variations described in this study should be helpful in arthroscopic and open procedures at the suprascapular region and also confirms the safety of operative decompression for the suprascapular nerve.
The suprascapular notch is the most common site of suprascapular nerve entrapment, which can manifest in disability and pain of the upper limb. Here, we present three cases of a very rare anatomical variation in the suprascapular region: the coexistence of the suprascapular notch and the suprascapular foramen. The variation was found during radiological and anatomical investigations. The suprascapular foramen was situated inferior to the suprascapular notch. A bony bridge lay between them, likely created by an ossified anterior coracoscapular ligament (ACSL). This anatomical variation probably increased the risk of suprascapular nerve entrapment by nerve irritation of the bony margins during passsage through the foramen and by a lack of the elasticity that the ACSL normally demonstrates. Also, a bony bridge passing through the middle part of the suprascapular notch reduces the space available for nerve passage (bony bridge decreases the space by about 36.5-38.6 %). One patient who underwent the radiological study had typical symptoms of suprascapular nerve entrapment. Based on his medical history and the presence of this rare variation of the suprascapular notch at the suprascapular region we suspect this neuropathy.
PURPOSE: It is commonly stated that supraspinatus initiates abduction; however, there is no direct evidence to support this claim. Therefore, the aims of the present study were to determine whether supraspinatus initiates shoulder abduction by activating prior to movement and significantly earlier than other shoulder muscles and to determine if load or plane of movement influenced the recruitment timing of supraspinatus. METHODS: Electromyographic recordings were taken from seven shoulder muscles of fourteen volunteers during shoulder abduction in the coronal and scapular planes and a plane 30° anterior to the scapular plane, at 25%, 50% and 75% of maximum load. Initial activation timing of a muscle was determined as the time at which the average activation (over a 25ms moving window) was greater than three standard deviations above baseline measures. RESULTS: All muscles tested were activated prior to movement onset. Subscapularis was activated significantly later than supraspinatus, infraspinatus, deltoid and upper trapezius, while supraspinatus, infraspinatus, upper trapezius, lower trapezius, serratus anterior and deltoid all had similar initial activation times. The effects of load or plane of movement were not significant. CONCLUSIONS: Supraspinatus is recruited prior to movement of the humerus into abduction but not earlier than many other shoulder muscles, including infraspinatus, deltoid and axioscapular muscles. The common statement that supraspinatus initiates abduction is therefore, misleading.
Trigger Point Dry Needling as an Adjunct Treatment for a Patient With Adhesive Capsulitis of the Shoulder
- The Journal of orthopaedic and sports physical therapy
- Published over 6 years ago
Study Design Case report. Background Prognosis for adhesive capsulitis has been described as self-limiting and can persist for 1-3 years. Conservative treatment including physical therapy is commonly advised. Case Description The patient was a 54 year old female with primary symptoms of shoulder pain and loss of motion consistent with adhesive capsulitis. Manual physical therapy intervention initially consisted of joint mobilizations of the shoulder region and thrust manipulation of the cervicothoracic region. Although manual techniques seemed to cause some early functional improvement, continued progression was limited by pain. Subsequent examination identified trigger points in the upper trapezius, levator scapula, deltoid and infraspinatus muscles that were treated with dry needling to decrease pain and allow for higher grades of manual intervention. Outcomes The patient was treated for a total of 13 visits over a 6 weeks period. After trigger point dry needling was introduced on the third visit, improvements in pain-free shoulder range of motion and functional outcome measures, including SPADI and QuickDASH, exceeded the minimal clinically important difference after 2 treatment sessions. At discharge the patient had achieved significant improvements in shoulder range of motion in all planes and outcome measures were significantly improved. Discussion This case report describes the clinical reasoning behind the use of trigger point dry needling in the treatment of a patient with adhesive capsulitis. The rapid improvement seen in this patient following the initiation of dry needling to the upper trapezius, levator scapula, deltoid and infraspinatus muscles suggests that surrounding muscles may be a significant source of pain in this condition. Level of Evidence Therapy, level 4. J Orthop Sports Phys Ther, Epub 21 November 2013. doi:10.2519/jospt.2014.4915.
- Journal of orthopaedic science : official journal of the Japanese Orthopaedic Association
- Published over 7 years ago
Rotator cuff tear is one of the most common shoulder diseases. It is interesting that some rotator cuff tears are symptomatic, whereas others are asymptomatic. Pain is the most common symptom of patients with a tear. Even in patients with an asymptomatic tear, it may become symptomatic with an increase in tear size. Physical examination is extremely important to evaluate the presence, location, and extent of a tear. It also helps us to understand the mechanism of pain. Conservative treatment often works. Patients with well-preserved function of the supraspinatus and infraspinatus are the best candidates for conservative treatment. After a successful conservative treatment, the symptom once disappeared may come back again. This recurrence of symptoms is related to tear expansion. Those with high risk of tear expansion and those with less functional rotator cuff muscles are less likely to respond to conservative treatment. They may need a surgical treatment.
Objective: To compare the effects of platelet-rich plasma injection with those of dry needling on shoulder pain and function in patients with rotator cuff disease. Design: A single-centre, prospective, randomized, double-blinded, controlled study. Setting: University rehabilitation hospital. Participants: Thirty-nine patients with a supraspinatus tendon lesion (tendinosis or a partial tear less than 1.0 cm, but not a complete tear) who met the inclusion criteria recruited between June 2010 and February 2011. Intervention: Two dry needling procedures in the control group and two platelet-rich plasma injections in the experimental group were applied to the affected shoulder at four-week intervals using ultrasound guidance. Measurements: The Shoulder Pain and Disability Index, passive range of motion of the shoulder, a physician global rating scale at the six-month follow-up, adverse effects monitoring and an ultrasound measurement were used as outcome measures. Results: The clinical effect of the platelet-rich plasma injection was superior to the dry needling from six weeks to six months after initial injection (P < 0.05). At six months the mean Shoulder Pain and Disability Index was 17.7 ± 3.7 in the platelet-rich plasma group versus 29.5 ± 3.8 in the dry needling group (P < 0.05). No severe adverse effects were observed in either group. Conclusions: Autologous platelet-rich plasma injections lead to a progressive reduction in the pain and disability when compared to dry needling. This benefit is certainly still present at six months after treatment. These findings suggest that treatment with platelet-rich plasma injections is safe and useful for rotator cuff disease.
Regional anesthesia has become the preferred method of anesthesia for many upper extremity operations and generally results in decreased hospital stays, postoperative opioid requirement, and postoperative nausea. Complications of regional anesthesia are rarely reported in the literature, possibly because of limited anesthesiologist-patient follow-up. Three cases of suprascapular nerve palsy after ultrasound-guided supraclavicular nerve block for routine outpatient upper extremity surgery are reported. All cases occurred in men who originally presented with shoulder pain, which resolved with time, followed by weakness in the supraspinatus and infraspinatus, which improved over time but did not resolve. One case resulted in ipsilateral phrenic nerve palsy as well. A review of the literature on the subject accompanies the report of these 3 cases.
The responses of foods to microwave exposure are usually evaluated only in terms of physicochemical properties, thus undervaluing the importance of DNA in an authentication process by PCR-based methods. In this study, the time effect of microwave heating on some meat physicochemical properties and DNA quality has been investigated.
A proposal for classification of the superior transverse scapular ligament: variable morphology and its potential influence on suprascapular nerve entrapment
- Journal of shoulder and elbow surgery / American Shoulder and Elbow Surgeons ... [et al.]
- Published over 7 years ago
BACKGROUND: The suprascapular region is the most common site of suprascapular nerve entrapment. The aim of the present study was to determine the morphologic variation of the superior transverse scapular ligament (STSL) and measure the reduction in size of the suprascapular opening. Other structures that might be potentially significant during open and arthroscopic procedures in this region are also described. MATERIALS AND METHODS: The study used 86 randomized formalin-fixed human cadaveric shoulders. After dissection of the suprascapular region, the following measurements were defined and collected for every STSL: length, proximal width, distal width, and thickness at the proximal and distal ends. Measurements were also taken of the area of the suprascapular opening (aSSO) and the middle width of the suprascapular opening (mwSSO). RESULTS: Three types of STSL may be distinguished: a fan-shaped type (54.6%), a band-shaped type (41.9%), and a bifid type (3.5%). Statistically significant differences between the specimens with fan-shaped and band-shaped types of STSL were observed in aSSO and mwSSO of the suprascapular opening. Anterior coracoscapular ligaments (ACSL) were present in 44 of 86 shoulders. The aSSO and mwSSO were smaller in specimens with an ACSL than in those without; however, this difference was only significant in the band-shaped type of STSL. CONCLUSION: Knowledge of the morphologic variations of STSL presented in this study is important for better understanding the possible anatomic conditions that can promote suprascapular nerve entrapment and should be taken into particular consideration during surgical and arthroscopic procedures around the suprascapular notch.
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.