suprascapular nerve palsy - lennard funk 2015
TRANSCRIPT
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Suprascapular Nerve
Lennard Funk
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‣ Motor innervation: ‣ Supraspinatus & infraspinatus muscles
‣Sensory branches to: ‣ Coracohumeral & coracoacromial ligaments ‣ Subacromial bursa ‣ AC & GH joints
‣Cutaneous innervation: ‣ ? Proximal-lateral one-third of the arm.
Amjani. J Anat. 1994 Horiguchi. J Anat. 1980
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Causes
• Idiopathic • Paralabral Cyst / Ganglion • Trauma
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Suprascapular Notch
Spinoglenoid Notch
Sites
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Natural History
No Cyst Mostly recover in 1yrCyst Less likely to recover
Cummins. JBJS. 2000.
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Suprascapular Nerve Palsy• Supraspinatus +/- Infraspinatus
• Wasting • Weakness
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Clinical
• Supraspinatus +/- Infraspinatus • Wasting • Weakness
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Investigations
• MRI Scan: • Ganglion Cyst / Mass lesion
Suprascapular Spinoglenoid
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Electro-diagnostic• EMG + Nerve Conduction Velocities:
• Proximal - Suprascapular Notch • Distal - Spinoglenoid Notch
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Nerve Conduction Velocity
‣ From Erb’s point: ‣ Supraspinatus = 2.7 ± 0.5ms ‣ Infraspinatus = 3.3 ± 0.5ms
Kraft. Arch Phys Med and Rehab. 1972
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EMG
‣ Increased in denervated muscles: ‣ Spontaneous activity ‣ Fibrillations ‣ Positive sharp waves
‣ Also: ‣ Polyphasic activity ‣ Reduced amplitude of evoked potentials.
Kraft. Arch Phys Med and Rehab. 1972
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Note...
‣ After 3 weeks of onset
‣ Operator dependent
‣ Other Periscapular Muscles must be assessed
‣ Repeat studies should be same operator
‣ Discuss!
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Treatment
‣ No Cyst - Early decompression appears to show better results (Level 4 studies)
‣Cyst
‣ Aspiration
‣ Open decompression (doesn’t deal with associated pathology)
‣ Arthroscopic Decompression
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Aspiration UltrasoundCourtesy of Prof Waqar Bhatti
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Arthroscopic Decompression‣ Suprascapular Notch
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Position
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Portals
1
3
2
4
1 = standard posterior portal
2 = standard anterior portal
3 = anterolateral portal
4 = Nevasier portal
5
5 = Lateral portal
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Identify CAL
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Identify Coracoid & CCL
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Follow Coracoid Base medial to CCL into Scapula Notch
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Create Superior (Nevasier) Portal & retract Supraspinatus with probe
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Identify Artery & STSL (Superior Transverse Scapular Ligament)
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6wks Postop
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Spinoglenoid Cyst
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Chronic Posterior Shoulder Pain in the Overhead Athlete
‣ Chronic Posterior Pain
‣ Normal EMG & MRI
‣ Exclusion
‣ High index of suspicion
Kevin Plancher
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Spinioglenoid Ligament
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Summary:
‣ Spinoglenoid / Suprascapular Notch
‣Always get: EMG & MRI
‣ No cyst = Non-operative initially
‣ Cyst = Surgery
‣ Surgery - train on cadaver
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