MRI diagnosis of suprascapular neuropathy using spinoglenoid notch distension.

PURPOSE: To assess the use of a spinoglenoid notch distension measurement as a radiographic marker on MRI to aid the diagnosis of suprascapular neuropathy. METHODS: Spinoglenoid notch distension was compared on MRI by blinded independent observers for two patient cohorts: one group with an electromyography/nerve conduction study confirmed diagnosis of suprascapular neuropathy who underwent arthroscopic suprascapular nerve decompression, and a control group of patients aged 18-30 years with a normal shoulder MRI. RESULTS: Sixty suprascapular nerve patients (average age 52 years) were compared to 47 control patients (average age 24 years). Intra-rater and inter-rater reliability showed excellent agreement between reviewers for all measurements. There was a significant difference in the mean spinoglenoid notch distension for the SSN group (m = 8.36, SD = 2.42) compared to the control group (m = 5.7, SD = 1.56); [t(212) = 9.40, p < 0.0001]. CONCLUSION: The spinoglenoid notch distension is significantly increased in patients with suprascapular neuropathy. We hypothesize that hypertrophy of the transverse scapular ligament creates a venous obstruction resulting in varicosities of the suprascapular vein which runs with the nerve under the ligament. This distends the spinoglenoid notch and can be enlarged in cases of suprascapular neuropathy which is evident on MRI.

A retrospective review of 112 patients undergoing arthroscopic suprascapular nerve decompression.

BACKGROUND: Arthroscopic suprascapular nerve release has yielded good results previously. However, comprehensive literature is still lacking. PURPOSE: This study assessed results of suprascapular nerve release in patients with intractable shoulder pain with confirmed suprascapular neuropathy. METHODS: Retrospectively reviewed patients undergoing suprascapular nerve release. Patients were evaluated with VAS scores and supraspinatus/infraspinatus strength. RESULTS: 112 patients were included showing reduction in VAS pain scores from the initial visit to final follow up. Additionally, improvement in both supra/infraspinatus strength occurred. There were no major complications. CONCLUSION: This series demonstrates improvement in pain and strength following suprascapular nerve release with limited risk. LEVEL OF EVIDENCE: IV.

Shoulder Double Crush Syndrome: A Retrospective Study of Patients With Concomitant Suprascapular Neuropathy and Cervical Radiculopathy.

PURPOSE: While the double crush phenomena (compression along two points on a nerve) has been established between median neuropathy and cervical radiculopathy, combined suprascapular neuropathy (SSN) and cervical C5/C6 radiculopathy-so-called shoulder double crush syndrome-has not been well examined. We aim to identify the incidence of shoulder double crush syndrome in patients undergoing arthroscopic suprascapular nerve release for SSN. METHODS: One hundred consecutive patients >18 years of age who were positive for SSN on electromyography and motor nerve conduction studies (EMG/NCS) and underwent a suprascapular nerve release were included. Patients with evidence of shoulder double crush syndrome were identified based on x ray, cervical spine magnetic resonance imaging (MRI) and examination findings. Demographics, electrodiagnostics results, treatment courses, and clinical outcomes (visual analog scores and rotator cuff strength) following arthroscopic suprascapular nerve release were compared between patients with double crush syndrome versus isolated SSN. RESULTS: Thirty one percent of patients had evidence of shoulder crush syndrome. Two significant electrophysiologic differences were noted in shoulder double crush patients compared to isolated SSN patients. Patients with double crush had an increased incidence of median neuropathy (51% vs 30%, P = .04). Double crush patients had less supraspinatus motor amplitude difference between the affected side and non-affected side compared to isolated SSN patients (2.62 mV vs 3.44 mV, P = .03). In general, most double crush patients were treated conservatively with regard to their cervical spine pathology. CONCLUSION: A significant percentage of patients with SSN have evidence of shoulder double crush syndrome. Patients with SSN and concomitant median neuropathy should have a detailed neck examination performed.

Anterior cruciate ligament injury in the skeletally immature.

Although ACL injuries in truly skeletally immature patients are relatively uncommon events, they are experienced more frequently than initially reported--especially in the adolescent population. Natural history data is limited but appears to mirror the natural history in adults with this injury if return to high-risk activity is allowed. Treatment of this injury presents unique challenges because of the substantial growth that occurs through the distal femoral and proximal tibial physes. The physiologic skeletal maturity of the patient must be determined prior to deciding treatment. Techniques of reconstruction include physeal sparing, partial transphyseal, and transphyseal methods. Reconstruction is recommended for any patient with an "ACL +" knee (a complete ACL tear and concomitant meniscal injury) or one who is non-compliant with a nonoperative treatment program and develops symptoms of persistent instability. Short-term outcomes of functional return postreconstruction appear promising, but study numbers are small and follow-up times relatively brief in truly immature patients. Long-term outcome studies are still needed.