Ossification Of Superior Transverse Scapular Ligament Research Articles

Bilateral suprascapular notches are asymmetrically shaped in a third of the Asian population.

The side-to-side differences within an individual's suprascapular notch (SSN) and the clinical characteristics of an ossified superior transverse scapular ligament are unclear. Therefore, the morphological asymmetry of the SSN was investigated, and the factors associated with the ossification of the superior transverse scapular ligament were analyzed. Two hundred and seventy-six computed tomography images were retrospectively analyzed, which included those of both scapulae of Asian patients (mean age, 62.1 ± 19.1years; males, 197) with high-energy injuries or respiratory diseases. Variations in the SSN were classified into six types based on Rengachary's classification using reconstructed three-dimensional computed tomography. The group with a type VI SSN (completely ossified superior transverse scapular ligament) in at least one scapula was compared with the other group for age, sex, and chronic comorbidities. Among 276 patients, 95 (34.4%) had asymmetric SSNs and 15 (5.4%) had type VI SSNs. There were no significant differences in age, sex, or comorbidities between both the groups. However, on comparing age groups, the prevalence of type VI SSN was higher in patients aged > 70years than in those aged < 70years. Fifteen patients had type VI SSNs, which were unilateral in 10 patients. Asymmetric SSNs were observed in a third of the Asian patients. There were variations in SSNs between individuals and also within an individual. In the cases with suprascapular nerve paralysis, the difference in SSN morphology compared to a healthy side should be considered. III.

Morphometry and Contents of the Suprascapular Notch with Potential Clinical Implications: Α Cadaveric Study.

Background The suprascapular notch (SN) represents the point along the route of the suprascapular nerve (SSN) with the greatest potential risk for injury and compression. Thus, factors reducing the area of the notch have been postulated for suprascapular neuropathy development. Methods Thirty-one fresh-frozen shoulders were dissected. The contents of the SN were described according to four types as classified by Polguj et al and the middle-transverse diameter of the notch was measured. Also, the presence of an ossified superior transverse scapular ligament (STSL) was identified. Results The ligament was partially ossified in 8 specimens (25.8%), fully ossified in 6 (19.35%), and not ossified in the remaining 17 (54.85%). The mean middle-transverse diameter of the SN was 9.06 mm (standard deviation [SD] = 3.45). The corresponding for type-I notches was 8.64 mm (SD = 3.34), 8.86 mm (SD = 3.12) was for type-II, and 14.5 mm (SD = 1.02) was for type III. Middle-transverse diameter was shorter when an ossified ligament was present (mean = 5.10 mm, SD = 0.88 mm), comparing with a partially ossified ligament (mean =7.67 mm, SD = 2.24 mm) and a nonossified one (mean = 11.12 mm, SD = 2.92 mm). No statistically significant evidence was found that the middle-transverse diameter depends on the number of the elements, passing below the STSL. Conclusion Our results suggest that SSN compression could be more likely to occur when both suprascapular vessels pass through the notch. Compression of the nerve may also occur when an ossified transverse scapular ligament is present, resulting to significant reduction of the notch's area.

A Study on Morphology of Suprascapular Notch with Specific Emphasis on Completely Ossified Superior Transverse Scapular Ligament

Abstract Background and Aim The superior border of scapula is marked by suprascapular notch which is bridged by suprascapular ligament. Beneath this ligament, passes the suprascapular nerve. Narrow notch and completely ossified superior transverse scapular ligament is one of the risk factors for suprascapular nerve entrapment. This study is done to study morphological variation of suprascapular notch. Knowledge of various types of suprascapular notch will help the clinician in early diagnosis and surgical treatment. Materials and Methods A total of 525 human scapulae of unknown age and sex were studied for morphology of suprascapular notch at the Department of Anatomy, GMERS medical college, Vadnagar and at B. J. Medical College, Ahmedabad. Photographs of various types of suprascapular notch were taken using digital camera and classified as per the Rengachary classification. Result In the present study, as per Rengachary classification, out of 525 scapulae, the most common is Type III (47.1%), least common is Type V (1.9%), and completely ossified superior transverse scapular ligament is Type VI (8.9%). Conclusion Knowledge of various types of suprascapular notch will help the physician in screening high-risk patients as well as diagnosis and treatment of suprascapular nerve entrapment disorder.

An anatomical study on various types of suprascapular notch, its relation with glenoid cavity and morphometry of scapula in south Indian population

Introduction: Superior border of scapula presents a suprascapular notch. Suprascapular nerve entrapment syndrome may be caused due to compression of the nerve at the notch. Previous studies have shown that there are various types of suprascapular notch and clinicians must be aware of these types and their prevalence. Aim: This study was conducted with the following objectives, a: To know the morphometry and morphological variations of suprascapular notch; b: To measure the safe zone distance necessary to avoid iatrogenic injuries to nerve; c: To correlate the major scapular dimensions with that of suprascapular notch. Materials and Methods: We collected 100 dried human scapulae from department of Anatomy and medical students of AIMS&RC, Devanahalli, Karnataka and Sri Narayana Institute of Medical Sciences, Ernakulam, Kerala. The Suprascapular notch was classified according to Rengachary’s classification. Dimensions of all different class of suprascapular notches, that of scapulae and safe zone distance was measured using digital Vernier calipers. Results: Majority of scapulae had type II SSN (33%) and least common variety found was type IV (4%). Least surface area in type V notch measured was 36.16mm2. Mean safe zone distance between SSN and supraglenoid tubercle (S1) in all 100 scapulae is 30.31+/-3 mm. The mean distance between spinoglenoid notch and posterior rim of glenoid (S2) is 16.82+/-2.19 mm. Mean length of all 100 scapulae is 135.12+/-1 mm. Mean width of scapula is 101.69+/-6.8 mm. Mean length and width of glenoid fossa is 33.83+/- 3.25 mm and 24.2+/-2.34 mm respectively. Conclusion: Ossified superior transverse scapular ligament can compress the nerve causing entrapment syndrome. Since suprascapular notch presents various shapes, this study is an attempt to add further data to the existing studies about suprascapular notch, its morphometry and safe zone distance to avoid injury to nerve during surgery. Keywords: Neuropathy, Scapula, Shoulder join

The Incidence of Ossified Superior Transverse Scapular Ligament during Nerve Transfer through Posterior Shoulder Approach.

The purpose of this study was to assess the incidence and importance of bony bridge that covers the supra scapular notch during posterior approach to transfer accessory nerve to suprascapular nerve. Between 2010 and 2015, the frequency and importance of suprascapular bony bridge instead of transverse ligament was assessed among patients with brachial plexus injury candidate to shoulder function restoration by accessory to suprascapular nerve transfer through posterior approach. Forty three patients, 41 male and 2 female, (mean age: 32.5 years, range 14 to 36) were included in this study. Five male patients (11.6%) had a complete bony rim on the superior scapular notch. Suprascapular nerve release needed osteotomy of the bony bridge and related equipment. Although all previous cadaveric studies among different ethnic groups had reported the prevalence between 0.3 to 30% of suprascapular canal, this in vivo study showed the incidence of 11.6%. Preoperative alertness about this variation could make the exploration and release of the suprascapular nerve easier and reduce the risk of nerve injury or failing to anatomize it. IV.

Anomalous Suprascapular Foramen in Adult Indian Scapula

The present study was conducted to highlight the variations of suprascapular foramen in an extensive osteological study of dry scapulae Attempt was also made to establish a comparison between osteological and radiological appearance of such variations In only one scapula an ossified superior transverse scapular ligament was discovered which converted the suprascapular notch into a suprascapular foramen The ossified superior transverse scapular ligament presented as an oblique bony ridge fan shaped in appearance Conversion of suprascapular notch into a foramen is considered as a potential risk factor for the suprascapular nerve entrapment syndrome The present day neurosurgeons radiologists and orthopedic surgeons should be aware of such bony abnormalities as these are imperative in preoperative radiological assessment and intraoperative modification of surgical procedures during arthroscopic decompression of suprascapular nerve

The Importance of Suprascapular Notch and Foramen in Identification

Identification of a unknown dead body during postmortem examination in a very important aspect. There are various methods of identifying a dead body but still the need for new identification data is always evident. This study has been taken up to see the relevance of variations, absence and anomalies of Suprascapular notch and foramen in identification of dead bodies. Anatomical variations and anomalous or ossified superior transverse scapular ligament are also considered to be risk factors for suprascapular neuropathy. This study was taken up with the aim to study the variations of Suprascapular notch and foramen and in turn check the relevance in identification of a person. A total of 200 dry scapulae were collected from the Departments of Anatomy and Forensic Medicine in Gandhi Medical College, Telangana State, India. Various shapes like J, U, V, ʊ, were noted along with absence in some cases. Commonest shapes seen are U, J and V in decreasing frequency respectively. In 6 cases the notch was absent, and there was a mere exaggeration of the superior angle giving a concave shape to the superior border in the current study. The suprascapular notch had converted into a foramen in 8 cases in the present study which amounting to 4% and thereby gaining a new significance though it was rare in all previous studies. A new shape was seen in some cases which has been assigned a name ‘inverted omega (ʊ)’ for further discussion in this study. The suprascapular notch at its junction with the superior border of scapula on either sides had spikes facing each other. As long as we have any old x-rays of the deceased we can always use the variations, anamolies and absence of Suprascapular notch and foramen as a very good tool in identification.

BONY SUPRASCAPULAR FORAMEN, A POTENTIAL SITE FOR SUPRASCAPULAR NERVE ENTRAPMENT: A MORPHOLOGICAL STUDY ON DRIED HUMAN SCAPULAE

Introduction: The superior transverse scapular ligament (STSL) is present above the suprascapular notch . It joins the two superior corners of this notch and converts it into suprascapular foramen through which passes the suprascapular nerve , while the suprascapular artery and vein usually pass above the ligament . The anterior coracoscapular ligament (ACSL) runs in the suprascapular notch, below the superior transverse scapular ligament. Narrowed bony foramen by ossification of STSL and ACSL is one of the predisposing factor of suprascapular nerve entrapment as well as with an injury to the suprascapular nerve in arthroscopic procedures. Aim: The aim of present study was to know the prevalence of suprascapular foramen in Indian dry scapulae and provide a knowledge on the variations along the course of suprascapular nerve which is essential to understanding the source of entrapment syndrome. Methods and Results: The present study was carried out on 73 dried human scapulae irrespective of age and sex. Visual observation revealed that 3 scapulae (4.1%) had completely ossified superior transverse scapular ligament and 2 scapulae (2.7 %) had partially ossified STSL. The incidence of ossified anterior coracoscapular ligament is 1.3 % ( 1 scapula ) in our study. Conclusion: The knowledge of variations in the suprascapular region and ossification of STSL & ACSL is important for anatomists, orthopaedicians, radiologists and neurosurgeons to obtain a safe zone which would be useful to avoid iatrogenic nerve lesion and for better diagnosis and management of the nerve entrapment syndrome.

Double suprascapular foramina: an anatomical variation

Suprascapular notch transmit supra scapular nerve to the supraspinous fossa. Transverse scapular ligament bridges the notch to form a supra scapular foramen. This region is the most common location of supra scapular nerve injury & compression. Most important predisposing factor of supra scapular neuropathy is an ossified superior transverse scapular ligament. We report here a case of double supra scapular foramen found during our routine osteology demonstrations. The etiopathogenesis and clinical implications of such variations are discussed.

Morphometric study of suprascapular notch in Indian dry scapulae with specific reference to the incidence of completely ossified superior transverse scapular ligament.

The suprascapular notch, a depression on the lateral part of the superior border of the scapula, medial to the coracoid process, is bridged by the superior transverse scapular ligament, which is sometimes ossified and the foramen which is thus completed, transmits the suprascapular nerve to the supraspinatus fossa. Variations in the morphology of suprascapular notch have been identified as one of the causes of suprascapular nerve entrapment. Rengachary et al. classified this notch into six types, based on its shape. To study morphological variations of suprascapular notch in Indian dry scapulae and to analyze the incidence of completely ossified superior transverse scapular ligament with other ethnic populations which have been cited earlier. A total of 400 human dry scapulae which were obtained from the Department of Anatomy of selected eight medical colleges were analyzed. The type of suprascapular notch was noted and it was recorded as per the description given by Rengachary et al. The results of the present study were compared with the results of previous authors in different populations. In our study, out of 400 scapulae, 40 (10%), were identified to have completely ossified superior transverse scapular ligaments. The frequencies of various types of suprascapular notches were: Type I -20%, Type II -10%, Type III -52%, Type IV -4%, Type V -4%, Type VI -10%. Since the suprascapular nerve entrapment syndrome might be caused by complete ossification of superior transverse scapular ligament with formation of suprascapular foramen and other morphometric variations of suprascapular notch, the knowledge on such variations is essential for clinicians, for making a proper diagnosis and for planning the most suitable surgical intervention.