The Influence of Suprascapular Notch Shape on the Visualization of Structures in the Suprascapular Notch Region: Studies Based on a New Four-Stage Ultrasonographic Protocol

Jezierski, Hubert; Podgórski, Michał; Stefańczyk, Ludomir; Kachlík, David; Polguj, Michał

doi:10.1155/2017/5323628

Cited by 17 publications

(23 citation statements)

References 27 publications

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“…Previously, the diagnostic application of US in suprascapular nerve pathology was mostly limited to scrutinizing space occupying lesions, like the paralabral cyst and engorged suprascapular vessels. Recently, more US research has focused on the shape of the suprascapular notch and the diameter of the suprascapular nerve ( 10 – 12 ). The study performed by Gruber et al proposed a swollen suprascapular nerve as a simple surrogate marker for neuralgic amyotrophy ( 13 ).…”

Section: Introductionmentioning

confidence: 99%

Basis of Shoulder Nerve Entrapment Syndrome: An Ultrasonographic Study Exploring Factors Influencing Cross-Sectional Area of the Suprascapular Nerve

Chang

Mezian

et al. 2018

Front. Neurol.

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As changes in nerves' shape and size are common ultrasonographic findings of entrapment neuropathy, measurement of the nerve cross-sectional area (CSA) becomes the mostly used indicator to differentiate normality from pathology. Recently, more US research has been conducted to measure the shape of the suprascapular notch and the diameter of the suprascapular nerve. Because the suprascapular nerve is paramount for various shoulder disorders, the present study aims to establish normal values of suprascapular nerve sizes at different levels as well as to investigate potential influence of participants' characteristics on the CSA measurements. The present study used a cross-sectional design investigating the CSA values of the suprascapular nerve from the supraclavicular region to spinoglenoid notch. We employed the inside-epineurium and outside-epineurium methods to quantify CSA of cervical roots (C5 and C6) and the suprascapular nerve on US imaging. Univariate comparisons of nerve sizes among different age and gender groups were carried out. Multivariate analysis was performed to analyze the impact of participants' characteristics on nerve CSA. Repeated measurement analysis of variance was conducted to examine segmental variations of CSA of the suprascapular nerve from its origin to infraspinatus fossa. Our study included 60 healthy adults with 120 shoulders and had three major findings: (1) the inside-epineurium method was more reliable than the outside-epineurium approach for CSA measurements due to higher intra- and inter-rater reliability, (2) women had smaller sizes for cervical nerve roots and for the most proximal segment of the suprascapular nerves, and (3) using the outside-epineurium method, the suprascapular nerve CSA was larger in its distal division than the portion proximal to the mid-clavicular line. In conclusion, the inside-epineurium method has better reliability for nerve CSA assessment but the outside-epineurium method is needed for quantifying the size of distal suprascapular nerve. Gender difference in CSA values should be considered during evaluation of the most proximal nerve segment. Using the outside-epineurium method, the distal suprascapular nerve would be estimated larger than its proximal portion and the segmental discrepancy should be not misinterpreted as pathology.

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Section: Introductionmentioning

confidence: 99%

Basis of Shoulder Nerve Entrapment Syndrome: An Ultrasonographic Study Exploring Factors Influencing Cross-Sectional Area of the Suprascapular Nerve

Chang

Mezian

et al. 2018

Front. Neurol.

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“…In addition, the size of the notch should be measured ruinously: it is possible that the two structures can be confused if only the supraspinatus fossa is scanned and the hollow on its lateral edge, with a small vessel present, is assumed to be a suprascapular notch. Therefore, awareness of the presence of the pseudo-suprascapular notch , and more importantly, the use of a systematic and cautious scanning technique8 are key to discriminating these two structures. Such an approach may help to deliver the anesthetics to desired localization.…”

Section: Discussionmentioning

confidence: 99%

“…For the ultrasound examination, the posterior approach was applied according to a 4-step protocol 8. First, the supraspinatus fossa is scanned along its short and long axis.…”

Section: Methodsmentioning

confidence: 99%

“…In addition, it has been suggested that ultrasound guidance is not suitable for performing suprascapular nerve block because neurostimulation is required to guide the needle close enough to the nerve 7. It is possible that such ineffective nerve block may be caused by the presence of a structure mimicking the suprascapular notch; such a structure was identified by one of the authors while performing a standard suprascapular notch examination8 and was hence named pseudo-suprascapular notch .…”

Section: Introductionmentioning

confidence: 99%

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“Pseudo-suprascapular notch”: is it a sonographic trap in suprascapular nerve block?

Podgórski

Rusinek

Cichosz

et al. 2019

Regional Anesthesia &Amp; Pain Medicine

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Background and objectivesThe aim of the study was to describe the radiological anatomy of the pseudo-suprascapular notch—a structure localized at the floor of the supraspinatus fossa, just below the true suprascapular notch. In sonographic examination, it may imitate the suprascapular notch leading to misidentification of these structures.MethodsUltrasound assessment of the suprascapular notch region was performed in 100 patients who underwent chest CT due to other indications. The presence of the suprascapular notch and the pseudo-suprascapular notch was evaluated together with their maximal width and depth using both techniques. The correlation between the dimensions of these two notches was assessed.ResultsThe pseudo-suprascapular notch was recognized in 82 patients. In four of them the suprascapular notch could not be visualized in ultrasound due to obscuring clavicle. In all cases the pseudo-suprascapular notch contained a small artery. In comparison to the suprascapular notch, the pseudo-suprascapular notch was significantly narrower and shallower, except for 10 cases with vestigial suprascapular notch where the pseudo-suprascapular notch was the only hollow in this region. The dimensions of both structures did not correlate with each other. Finally, the pseudo-suprascapular notch did not present any significant asymmetry (p=0.1185) or sexual dimorphism (43 women vs 38 men, p=0.2025).ConclusionsThe pseudo-suprascapular notch is a hollow for nutrient vessels that can be mistaken for the regular suprascapular notch in cases of difficult sonographic navigation.

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“…The examination was performed according to our newly developed four-step protocol. In the first step, the probe was moved along the SSN in a parasagittal plane; in the second step, the probe was moved along the SSN in a paracoronal plane; in the third step, the probe was placed in the paracoronal plane and moved forward until reaching the upper edge of the scapula; finally, in the fourth step, Doppler ultrasound was used to recognise the suprascapular vessels [21]. The BMI of the patients was calculated based on measurements of their height and body mass in light clothing and without shoes.…”

Section: Methodsmentioning

confidence: 99%

Morphological Aspects in Ultrasound Visualisation of the Suprascapular Notch Region: A Study Based on a New Four-Step Protocol

Jezierski¹,

Podgórski

Wysiadecki

et al. 2018

JCM

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Background: Sonographic evaluation of the suprascapular notch (SSN) region is clinically important, because it is the most common location for performing suprascapular nerve block. The aim of the study was to describe the morphology of the SSN region based on ultrasound examination and in accordance with the patients’ body mass index (BMI). Material and Methods: The SSN region was sonographically examined in 120 healthy volunteers according to our new four-step protocol. The morphometry of the SSN and the neurovascular bundle was assessed, and patients’ BMI were calculated. The shape of the suprascapular notch was classified based on its superior transverse diameter (STD) and maximal depth (MD). Result: The type III scapular notch was the most prevalent (64%). The BMI was higher in type IV/V (27.38 ± 3.76) than in type I (24.77 ± 3.49). However, no significant differences were observed in the distribution of SSN notch types with regard to BMI (p = 0.0536). The suprascapular artery was visualised in all of the recognised SSNs, while the suprascapular vein and nerve were visualised only in 74.9% and 48.1% of the SSNs, respectively. The suprascapular nerve was significantly thicker on the right side (3.5 ± 1.1 mm) than on the left (1.3 ± 0.4 mm) (p = 0.001). In contrast, the suprascapular vein (1.5 ± 0.9 mm) was found to be a significantly wider on the left side than the right (1.2 ± 0.7 mm) (p = 0.001). Conclusion: Our original four-step sonographic protocol enabled characterising the morphology of the SSN region, despite the SSN notch types. The suprascapular artery is the best sonographic landmark for the suprascapular notch region. No significant differences were found between sides regarding the thickness of the soft tissue above the suprascapular nerve and vessels. Recognition of the SSN morphology is not affected by the BMI.

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The Influence of Suprascapular Notch Shape on the Visualization of Structures in the Suprascapular Notch Region: Studies Based on a New Four-Stage Ultrasonographic Protocol

Cited by 17 publications

References 27 publications

Basis of Shoulder Nerve Entrapment Syndrome: An Ultrasonographic Study Exploring Factors Influencing Cross-Sectional Area of the Suprascapular Nerve

Basis of Shoulder Nerve Entrapment Syndrome: An Ultrasonographic Study Exploring Factors Influencing Cross-Sectional Area of the Suprascapular Nerve

“Pseudo-suprascapular notch”: is it a sonographic trap in suprascapular nerve block?

Morphological Aspects in Ultrasound Visualisation of the Suprascapular Notch Region: A Study Based on a New Four-Step Protocol

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