A study of high division of sciatic nerve in human cadavers and its clinical significance

Background: Sciatic nerve is a mixed nerve which provide sensory and motor supply for skin and muscles of the lower limb by tibial and common peroneal nerve. Anatomical variations of sciatic nerve at high division have been reported by various authors. The path of the sciatic nerve is important while administration of intramuscular injection to prevent nerve injury and nerve blockage failure during anesthesia. This knowledge of high division helps in different surgical approach for sciatic nerve injury or hip dislocation. Aims and Objectives: The aim of the study was to describe incidences of high division variation of Sciatic nerve and different types in cadavers during routine dissection schedule. Materials and Methods: The study was conducted during routine dissection schedule in anatomy department for first MBBS students to observe sciatic nerve course in 30 gluteal regions from 15 adult cadavers fixed by formalin. Location of sciatic nerve in relation to piriformis muscle and its division whether in single nerve sheath or separate sheath and types was recorded. Results: In 12 cadavers (80%), sciatic nerve course found normal which leaves pelvis at inferior border of piriformis muscle and bifurcate in terminal branches tibial nerve and common peroneal nerve as it approaches at the apex of popliteal fossa. In 3 cadavers (20%), two male and one female, we found high division of sciatic nerve where terminal branches, tibial nerve, and common peroneal nerve leave the pelvis below piriformis separately in different sheaths. Conclusion: Knowledge of variations-related high division of sciatic nerve would help surgeons during different interventions related to sciatic nerve and for preventing further complications.

Prevalence and management of refractory meralgia paresthetica in lumbar spine surgery: 5 years of experience / Prevalência e manejo da meralgia parestésica refratária em cirurgia de coluna lombar: experiência de cinco anos / Prevalencia y manejo de la meralgia parestésica refractaria en cirugía de columna lumbar: experiencia de 5 años

ABSTRACT Objective The objective of our study was to report 5 years of experience in the recognition and management of refractory meralgia paresthetica (MP) in patients who had undergone posterior approach lumbar surgery. Methods Patients who were submitted to procedures in the lumbar spine from January 2010 to January 2015 in three different hospital centers in Belo Horizonte/MG were selected for an evaluation of the postoperative development of MP. A prospective observational comparative case series study. Level of evidence III. Evaluation of the following parameters: type of support for the patient, surgical time, body mass index. Results 367 posterior approach lumbar spine surgeries for degenerative pathologies of the lumbar spine were performed. MP was observed in 81 patients (22%). In 65 of those patients (80%), there was complete resolution of the symptoms with conservative management (local measures and medications for neuropathic pain) in less than two months. Twelve patients improved with a corticosteroid depot injection in the inguinal ligament and four patients required a surgical procedure in the third month. Pneumatic support was the least involved in the development of MP, as well as surgical time <1h and body mass index <25. Conclusion Refractory MP may occur in patients submitted to posterior approach lumbar spine surgeries. Management includes local measures, medications for neuropathic pain, and corticosteroid injection in the inguinal ligament. Decompression surgery is reserved for rare refractory cases. Level of evidence III; Prospective observational study with comparative case series.

RESUMO Objetivo O objetivo do presente estudo consiste em relatar a experiência de cinco anos no reconhecimento e manejo da meralgia parestésica (MP) refratária em pacientes submetidos a cirurgias lombares por via posterior. Métodos Pacientes submetidos a procedimentos na coluna lombar, no período de janeiro de 2010 a janeiro de 2015, em três diferentes centros hospitalares de Belo Horizonte/MG, foram selecionados para avaliação do desenvolvimento da MP pós-operatória. Estudo prospectivo observacional com série de casos comparativos. Nível III de evidência. Avaliação dos seguintes parâmetros: tipo de suporte para o paciente, tempo de cirurgia, índice de massa corporal. Resultados Foram feitas 367 cirurgias por via posterior da coluna lombar para patologias degenerativas da coluna lombar. A MP foi observada em 81 pacientes (22%). Em 65 pacientes (80%), houve resolução completa dos sintomas com manejo conservador (medidas locais e medicamentos para dor neuropática) em menos de dois meses. Doze pacientes melhoraram através de infiltração com corticoide de depósito e anestésico no local no ligamento inguinal e, em quatro pacientes houve necessidade de procedimento cirúrgico no terceiro mês. O suporte pneumático foi o menos envolvido no desenvolvimento da MP, assim como o tempo cirúrgico <1h e índice de massa corporal <25. Conclusão A MP refratária pode ocorrer em pacientes submetidos a cirurgias na coluna lombar por via posterior. O manejo inclui medidas locais, medicamentos para dor neuropática e infiltração com corticoide no ligamento inguinal. A cirurgia descompressiva está reservada para os raros casos refratários. Nível de evidência III; Estudo prospectivo observacional com série de casos comparativos.

RESUMEN Objetivo El objetivo del presente estudio consiste en relatar la experiencia de 5 años en el reconocimiento y manejo de la meralgia parestésica (MP) refractaria en pacientes sometidos a cirugías lumbares por vía posterior. Métodos Pacientes sometidos a procedimientos en la columna lumbar, en el período de enero de 2010 a enero de 2015, en tres diferentes centros hospitalarios de Belo Horizonte/MG, fueron seleccionados para evaluación del desarrollo de la MP postoperatoria. Estudio prospectivo observacional con serie de casos comparativos. Nivel III de evidencia. Evaluación de los siguientes parámetros: tipo de soporte para el paciente, tiempo de cirugía, índice de masa corporal. Resultados Se realizaron 367 cirugías por vía posterior de la columna lumbar para patologías degenerativas de la columna lumbar. La MP fue observada en 81 pacientes (22%). En 65 pacientes (80%) hubo resolución completa de los síntomas con manejo conservador (medidas locales y medicamentos para el dolor neuropático) en menos de 2 meses. Doce pacientes mejoraron a través de infiltración de corticoide de depósito y anestésico en el local en el ligamento inguinal y, en cuatro pacientes, hubo necesidad de procedimiento quirúrgico en el tercer mes. El soporte neumático fue el menos involucrado en el desarrollo de la MP, así como el tiempo quirúrgico <1h e índice de masa corporal <25. Conclusión La MP refractaria puede ocurrir en pacientes sometidos a cirugías en la columna lumbar por vía posterior. El manejo incluye medidas locales, medicamentos para el dolor neuropático e infiltración con corticoide en el ligamento inguinal. La cirugía descompresiva está reservada para los raros casos refractarios. Nivel de evidencia III; Estudio prospectivo observacional con serie de casos comparativos.

The Suprascapular Notch: Its Morphology Morphometry And Clinical Significance

Introduction: The Scapula is a large, flat, triangular bone which lies on the posterolateral aspect of the chestwall. The Suprascapular notch is a depression on the superior border of the scapula which gives passage toSuprascapular nerve. Anatomical variations of the shape and size of notch is useful as it is the common site ofSuprascapular nerve entrapment syndrome.Materials and Methods: The present study was carried out on 60 adult dry human Scapulae. Different shapes ofSuprascapular notch was observed, then vertical and transverse dimensions of the notch were measured.Results and Conclusion: Based on Rengachary classification, type III notch was found to be most common.Suprascapular foramen was observed in 5 Scapulae. The mean vertical and transverse diameters were measuredas 6.43mm and 9.81mm respectively. The study of morphology and morphometry of Suprascapular notch helpsto correlate Suprascapular nerve entrapment with specific type of notch.

Effectiveness of lower extremity Dellon triple nerve decompression in treatment of early-stage diabetic Charcot foot / 中国修复重建外科杂志

Objective: To study the effectivenss of lower extremity Dellon triple nerve decompression in the treatment of early-stage diabetic Charcot foot. Methods: The clinical data of 24 patients with Eichenholtz stage 0-1 diabetic Charcot foot who were admitted between September 2017 and February 2019 were retrospectively analyzed. Among them, 14 cases were treated with lower extremity Dellon triple nerve decompression (treatment group), and 10 cases were treated with conservative treatment such as immobilization the affected limbs and nutritional nerve drugs (control group). There was no significant difference between the two groups ( P>0.05) in gender, age, diabetes duration, diabetic foot duration, Eichenholtz stage, and the blood glucose level, bone mineral density (T value), nerve conduction velocity, and two-point discrimination before treatment. Before treatment and at 6 months after treatment, bone mineral density (T value) was measured by dual energy X-ray absorptiometry to evaluate the improvement of osteoporosis. The electromyogram of the lower limbs was used to detect the conduction velocity of the common peroneal nerve, deep peroneal nerve, and tibial nerve, and to evaluate the recovery of nerve function. The two-point discrimination in plantar region was used to evaluate the recovery of skin sensation. Results: Both groups were followed up 6-12 months, with an average of 6.5 months. In the treatment group, 3 patients showed numbness around the incisions, all recovered after 12 months, without affecting the prognosis; all the incisions healed by first intention, and there was no complication such as incision infection, nonunion, or vascular and nerve injury. At 6 months after treatment, there was no significant difference in nerve conduction velocity, bone mineral density (T value), and two-point discrimination when compared with the values before treatment ( P>0.05) in the control group; but the above indicators in the treatment group were significantly improved when compared with preoperative ones, and were all significantly better than those in control group ( P<0.05). Conclusion: Lower extremity Dellon triple nerve decompression can improve the symptoms of Eichenholtz stage 0-1 diabetes Charcot foot, and has the advantages of less trauma, faster recovery, and fewer complications.

Study on the incidence of occurrence of the ossification of superior transverse scapular ligament with its clinical implication

Introduction: Supra scapular notch is present on the superior border of the scapula. It gives passage to thesuprascapular nerve. The supra scapular notch is bridged by the superior transverse scapular ligament andconverted into supra scapular foramen. Ossification of this superior transverse scapular ligament may compressor entrap the suprascapular nerve which is passing through the foramen. The present study was undertaken tofind out the incidence of occurrence of the ossification of superior transverse scapular ligament.Materials and methods: 89 scapulae were collected from the Department of Anatomy, Deccan College of MedicalSciences, Hyderabad. Damaged scapulae were excluded. All the scapulae were examined to note the incidence ofoccurrence of the ossification of the transverse scapular ligament and also any variations of it.Results: 15 scapulae were bearing ossified superior transverse scapular ligament in which 6 were of the rightside and 6 were of the left side. Duplication of the superior transverse scapular ligament was observed in one leftscapula. Incomplete ossification was observed in 2 scapulae 1 on the right and another on the left side.Conclusion: Based on the results of the present study, ossification of the transverse scapular ligament is not veryrare in this populations group. So, the knowledge about the ossification of superior transverse scapular ligamentand the risk of supra scapular nerve entrapment is very much essential for the physicians and the surgeons whiledealing with these cases.

Suprascapular Notch And Its Anatomical Variants

Introduction:The suprascapular notch is situated medial to the root of coracoid and covered by a variable transverse scapular ligament to form a suprascapular foramen, Various shapes of suprascapular notch are observed. Material and Method:The material for the present study comprised of 30 adult scapulae of unknown sex, obtained from the Department of Anatomy, Skims Medical College, Srinagar. Various shapes of suprascapular notch are observed. Result:Suprascapular notches of following shapes were observed: U, V, J. Some scapulae without notches and foramen were also seen. Conclusion:shape of suprascapular notch is important to understand suprascapular nerve entrapment which causes the supraspinatus and infraspinatus muscles to waste.

Comparing the outcome of monitored anaesthesia care and local anaesthesia for carpal tunnel syndrome surgery by neurosurgeons

@#Introduction: Carpal tunnel syndrome (CTS) is the commonest median nerve entrapment neuropathy of the hand, up to 90% of all nerve compression syndromes. The disease is often treated with conservative measures or surgery. The senior author initially intended to treat his own neurosurgical patients concurrently diagnosed with carpal tunnel syndrome in 2014, subsequently, he began to pick up more referrals from the primary healthcare group over the years. This has led to the setup of a peripheral and spine clinic to act as a hub of referrals. Objective: Department of Neurosurgery Sarawak aimed to evaluate the surgical outcome of carpal tunnel release done over five years. Methods: The carpal tunnel surgeries were done under local anaesthesia (LA) given by neurosurgeons (Bupivacaine 0.5% or Lignocaine 2%). Monitored anaesthesia care (MAC) was later introduced by our hospital neuroanaesthetist in the beginning of 2018 (Target-controlled infusion propofol and boluses of fentanyl). We looked into our first 17 cases and compared these to the two anaesthesia techniques (LA versus MAC + LA) in terms of patient’s pain score based on visual analogue scale (VAS). Results: Result showed MAC provided excellent pain control during and immediately after the surgery. None experienced anaesthesia complications. There was no difference in pain control at post-operation one month. Both techniques had equal good clinical outcome during patients’ clinic follow up. Conclusion: Neurosurgeons provide alternative route for CTS patients to receive surgical treatment. Being a designated pain free hospital, anaesthetist collaboration in carpal tunnel surgery is an added value and improves patients overall experience and satisfaction.

Morphometric Study Of Suprascapular Notch In Dry Scapulae Bones

Background: Suprascapular nerve most commonly compressed at the level of suprascapular notch (SSN) andspinoglenoid notch. Variation in morphological features of SSN and spinoglenoid notch plays a crucial role insuprascapular nerve entrapment syndrome.Objective: Present study was conducted to find out the variation in morphology and dimension of SSN and todetermine posterior safe zone for shoulder joint procedures from posterior approach.Materials and Methods: In the present study 83 dry scapulae of south Karnataka region were studied andclassified the SSN based on various shapes according to Iqbal et al and measurements according to Natis et al,along with this, the mean distance from SSN to supraglenoid tubercle and mean distance between posterior rimof glenoid cavity and medial wall of spinoglenoid notch at the base of scapular spine were also measured .Result: Based on Iqbal et al classification ‘U’ shaped notch found to be more common (43.37%) and ‘V’ shapednotch and indentation found to be least common(3.6%). Complete ossification were observed in 3 scapulaebone(3.6%). Based on Natsis classification most common was found to be type –II (TD>VL) (84%) and type VI andIV were not observed. Mean distance between SSN and supraglenoid tubercle was 31.08 mm and mean distancebetween posterior rim of glenoid cavity and medial wall of spinoglenoid notch at base of scapular spine was14.26mm.Conclusion: Since variation in morphologoy of suprascapular notch and ossification of superior transversesuprascapular ligament(STSL) can be a factor for suprascapular nerve entrapment syndrome and safe zone fordifferent population varies. Hence knowing variations in shape and size of SSN, safe zone for different populationis helpful. So this study may be useful for clinicians for better diagnosis and management. Still more populationspecific studies are required related to the morphology of suprascapular notch.

Suprascapular Notch In Human Scapula: A Morphometric Study

Introduction: Suprascapular notch is a depression on the lateral one third of the superior border of the scapula.Suprascapular nerve passes through this notch. The shape of this suprascapular notch can vary among individuals.Various shapes and sizes of the notch and ossified superior transverse scapular ligament can compress thesuprascapular nerve leading to entrapment syndromes. Hence the study of morphometry of the notch is importantto diagnose and treat such entrapment syndromes.Materials and Methods: 58 dried human scapulas were used for the study. The morphology of the suprascapularnotch was studied. Presence and absence of the notch was observed. Type of notch was assessed based on the itsshape according to Rengachery’s classification. The superior transverse diameter, middle transverse diameter,maximum depth of the notch, and the distance between the posterior glenoid rim and the notch was measured.Results: Type II and type III notches are common in Indian population. Type II notch has larger diameters andgreater depth, while type IV has the least diameters and depth. Type V and VI notches are more prone forsuprascapular nerve entrapment due to ossification of superior transverse scapular ligament.Conclusion: Knowledge of different types of notches and its measurements are very helpful in diagnosis andmanagement of cases with shoulder pain due to suprascapular nerve entrapment and also while administeringsuprascapular nerve blocks for the surgeries involving the shoulder

Treatment of Clunial Nerve Entrapment Syndrome with Needle Knife Based on Principle of "Staging, Segmenting and Layering" / 中国中医药信息杂志

Treatment of clunial nerve entrapment syndrome with needle knife has the advantages of quick efficacy and easy application. However, because of the surgeons' lack of knowledge of the disease and the operation of different proficiency, there are differences in the treatment effects. This article introduced the guidance principle of"staging, segmenting and layering", which can improve the efficacy during treatment and be beneficial to the clinical application of all levels of clinical doctors.

Extended duration pulsed radiofrequency for the management of refractory meralgia paresthetica: a series of five cases

Meralgia paresthetica (MP) is a sensory mononeuropathy, caused by compression of the lateral femoral cutaneous nerve (LFCN) of thigh. Patients refractory to conservative management are treated with various interventional procedures. We report the first use of extended duration (8 minutes) pulsed radiofrequency of the LFCN in a case series of five patients with refractory MP. Four patients had follow up for 1–2 years, and one had 6 months follow up. All patients reported remarkable and long lasting symptom relief and an increase in daily life activities. Three patients came off medications and two patients required minimal doses of neuropathic medications. No complications were observed.

Case-control study on Pi needle for the treatment of the cutaneous nerve entrapment low back pain / 中国骨伤

<p><b>OBJECTIVE</b>To explore a safe and effective method for the treatment of low back pain in the cutaneous nerve, and to clarify the indication of Pi needle to treat it.</p><p><b>METHODS</b>From January 2003 to December 2004, 278 patients with cutaneous nerve entrapment low back pain were divided into two groups: Pi needle group and electrical stimulation group. In the Pi needle group, there were 68 males and 70 females, ranging in age from 20 to 60 years old, with an average of(41.92±10.88)years old. In the electrical stimulation group, there were 68 males and 72 females, ranging in age from 18 to 60 years old, with an average of(41.44±10.47) years old. The pain, tenderness and soft tissue tension of the two groups were measured and compared before and after treatment.</p><p><b>RESULTS</b>All of the selected cases were qualified. No suspension, culling and shedding cases occurred in either group. In Pi needle group, visual analog scale(VAS) of pain decreased from 8.78±1.52 before treatment to 1.33±1.33 after treatment;and in electrical stimulation group, VASof pain decreased from 8.59±1.76 before treatment to 5.20±2.64 after treatment;and the VAS of pain of the Pi needle group was lower than that of the electrical stimulation group. In Pi needle group, VAS of tenderness decreased from 9.12±1.24 before treatment to 1.60±1.36 after treatment;and in electrical stimulation group, VAS of pain decreased from 8.79±1.60 before treatment to 5.34±2.60 after treatment;and the VAS of pain of the Pi needle group was lower than that of the electrical stimulation group.</p><p><b>CONCLUSIONS</b>Once tissue texture changes to pain point, cord, nodules, Pi needle is the first line treatment for the cutaneous nerve entrapment low back pain.</p>

Clinical observation of superior gluteal nerve entrapment syndrome treated with needle-in-row combined with herb-partition moxibustion / 中国针灸

<p><b>OBJECTIVE</b>To compare the effects of need-in-row combined with herb-partition moxibustion,need-in-row and conventional acupuncture for superior gluteal nerve entrapment syndrome.</p><p><b>METHODS</b>Totally 105 patients were randomly assigned into a combination group,a need-in-row group and an acupuncture group,35 cases in each one. In the combination group and needle-in-row group,needle-in-row therapy was used at the pain tendon region of the pathological waist-hip part,and TDP was combined. Also,herb-partition moxibustion was applied at the same part after needle-in-row in the combined group. In the acupuncture group,conventional acupuncture was implemented at Weizhong(BL 40),Yanglingquan(GB 34),Zhibian(BL 54),Huantiao(GB 30),Sanyinjiao(SP 6) and Jiaji of L-L(EX-B 2),and TDP was applied. All the treatment was given once a day for four weeks. The changes of pain scores were compared after treatment.</p><p><b>RESULTS</b>The pain scores decreased obviously after treatment in all the groups(all<0.05). The scores of the combination group and the needle-in-row group declined more apparently than that of the acupuncture group(both<0.05). The score of the combination group reduced more obviously than that of the needle-in-low group(<0.05). The markedly effective rates of the combination group and the needle-in-row group were 88.6%(31/35) and 68.6%(24/35),which were higher than 40.0%(14/35) of the acupuncture group(both<0.05),and the markedly effective rate of the combination group was better than that of the needle-in-row group(<0.05).</p><p><b>CONCLUSIONS</b>Need-in-row combined with herb-partition moxibustion show definite effect for superior gluteal nerve entrapment syndrome,and it is better than those of simple needle-in-row therapy and conventional acupuncture.</p>

Pudendal Nerve Entrapment Syndrome due to a Ganglion Cyst: A Case Report

Pudendal nerve entrapment syndrome is an unusual cause of chronic pelvic pain. We experienced a case of pudendal neuralgia associated with a ganglion cyst. A 60-year-old male patient with a tingling sensation and burning pain in the right buttock and perineal area visited our outpatient rehabilitation center. Pelvis magnetic resonance imaging showed the presence of multiple ganglion cysts around the right ischial spine and sacrospinous ligament, and the pudendal nerve and vessel bundle were located between the ischial spine and ganglion cyst at the entrance of Alcock's canal. We aspirated the lesions under ultrasound guidance, and consequently his symptoms subsided during a 6-month follow-up. This is the first report of pudendal neuralgia caused by compression from a ganglion cyst around the sacrospinous ligament.

Unusual morphology of scapulae: incidence and dimensions of ossified ligaments and supraspinous bony tunnels for clinical consideration

<p><b>INTRODUCTION</b>Knowledge of morphological variations of the suprascapular region is important in the management of entrapment neuropathy and interventional procedures. The objective of this study was to collect data on the morphological features and dimensions of ossified ligaments and unusual bony tunnels of scapulae from a North Indian population.</p><p><b>METHODS</b>A total of 268 adult human scapulae of unknown gender were obtained from the bone bank of the Department of Anatomy, Dayanand Medical College and Hospital, Ludhiana, Punjab, India. The scapulae were evaluated for the incidence of ossified superior transverse scapular ligaments (STSLs), ossified inferior transverse scapular ligaments (ITSLs) and bony tunnels (i.e. the bony canal between the suprascapular notch and spinoglenoid notch), found along the course of the suprascapular nerve (SSN). The dimensions of these structures were measured and noted down. Ossified STSLs were classified based on their shape (i.e. fan- or band-shaped) and the dimensions of the ossified suprascapular openings (SSOs) were measured.</p><p><b>RESULTS</b>Ossified STSLs were present in 26 (9.7%) scapulae. Among the 26 scapulae, 16 (61.5%) were fan-shaped (mean area of SSO 16.6 mm(2)) and 10 (38.5%) were band-shaped (mean area of SSO 34.2 mm(2)). Bony tunnels were observed in 2 (0.75%) specimens, while an ossified ITSL was observed in 1 (0.37%) specimen.</p><p><b>CONCLUSION</b>The data obtained in the present study augments the reference literature for SSN decompression and the existing anatomical databases, especially those on Indian populations. This data is useful to clinicians, radiologists and orthopaedic surgeons.</p>

A Morphological Study of the Suprascapular Notch in a Sample of Scapulae at the University of Kwazulu Natal / Estudio Morfológico de la Escotadura Supraescapular en una Muestra de Escápulas de la Universidad de KwaZulu-Natal

The suprascapular notch (SSN) is important, as it is a risk factor in the development of suprascapular nerve entrapment syndrome. The purpose of this study is to describe the morphology of the SSN of a sample of normal scapulae in the Discipline of Clinical Anatomy, University of KwaZulu Natal. Sixty scapulae were used consisting of 37 males and 23 females (mean age 51 years). The superior transverse diameter and maximal depth of the notches were measured. Comparisons were made of the notch in relation to the maximal width and length of the scapulae, laterality and sex. The Rengachary classification method was adopted to describe the shape of the SSN. Analysis of morphological variations showed Type II- wide blunted V-shaped notch to be predominant (65%). Three scapulae had absent notches (Type I). The average notch depth and transverse diameter were 6.51±2.69 mm and 13.18±5.52 mm respectively. The right SSN were significantly deeper than the left (7.54±2.51 mm) (p<0.02). The male scapulae were distinctively larger, with females having a much shallower and wider notch. Understanding the morphological variation of the SSN is important when various radiological imaging techniques are utilized such as during arthroscopic shoulder operations and anaesthesia for landmarking of the suprascapular nerve.

La incisura supraescapular (IS) es importante, ya que es un factor de riesgo en el desarrollo del síndrome de atrapamiento del nervio supraescapular. El propósito de este estudio fue describir la morfología de la IS de una muestra de escápulas normales en la disciplina de Anatomía Clínica de la Universidad de KwaZulu-Natal. Se utilizaron sesenta escápulas, 37 de hombres y 23 de mujeres (edad media 51 años). Se midieron el diámetro transversal superior y la profundidad máxima de las incisuras. Se realizaron comparaciones de la incisura en relación al ancho máximo y la longitud de la escápula, su lateralidad y el sexo. Se utilizó el método de clasificación de Rengachary para describir la forma de la IS. El análisis de las variaciones morfológicas mostró que el Tipo II, muesca amplia roma en forma de V, fue predominante (65%). Tres escápulas no presentaron incisuras (Tipo I). La Media de la profundidad y diámetro transversal fueron 6,51±2,69 mm y 13,18±5,52 mm, respectivamente. Las IS derechas fueron significativamente más profundas que las izquierdas (7,54±2,51 mm) (p<0,02). Las escápulas de los hombres fueron significativamente de mayor tamaño que las de mujeres, con una incisura más superficial y ancha. La comprensión de las variaciones morfológicas de la IS son relevantes ya que diversas técnicas de imágenes radiológicas son utilizadas durante cirugías artroscópicas y anestesia del hombro para estimar puntos anatómicos del nervio supraescapular.

Variations of Suprascapular Notch in Adult Egyptian Scapulae.

Background: The suprascapular notch (SSN) lies on the superior border of scapula, close to the root of coracoid process. The suprascapular nerve passes through the notch, below superior transverse scapular ligament. The objective of the present study was to determine variations in the size and shape of SSN in adult Egyptian scapulae to provide a better diagnosis and management of suprascapular nerve entrapment syndrome. Material and methods: A total of 85 dry adult unpaired scapulae of unknown age and sex were randomly selected. The shape of SSN was determined by direct inspection and the vertical and transverse diameters of the notch were measured in each specimen. The results were recorded and statistically analyzed. Results: In the studied scapulae, the SSN was revealed in 89.41%, absent in 8.24% and replaced by a scapular foramen in 2.35% . Three morphological types of SSN were observed; U-shaped (60.53%), V-shaped (31.58 %) and J-shaped (7.89 %). The SSN had a longest transverse diameter (type II) in 55.26% and had a longest vertical diameter (type III) in 44.74%. The U-shaped variety was observed in 32.61% of type II and 67.39% of type III. All of J-shaped variety (100%) were exclusively observed in type II, whereas half (50%) of the V-shape variety were observed in type II and the other half (50%) in type III Conclusion: The diameters and morphological type of SSN documented in the present study might be easily identified on a plain radiograph that might be helpful in diagnosis of suprascapular nerve entrapment syndrome. Moreover, these anatomical data would improve the safety of arthroscopic nerve decompression.

Modified Infiltration Technique for Cutaneous Nerve Entrapment Syndrome.

Lateral thoracic or abdominal cutaneous nerve entrapment syndrome (C.N.E.S.) refers to the pain originating from thoracic or abdominal wall. It is a common ailment which is often misdiagnosed as arising from a source inside the abdominal cavity mistakenly leading to inappropriate diagnostic investigations, unsatisfactory treatment, and considerable costs. The thoracoabdominal nerves terminate as the cutaneous nerves at a point from which accessory branches are given off in the rectus channel ending in the skin. Peripheral nerve entrapment occurs at anatomic sites where the nerve changes direction to enter a fibrous or osseofibrous tunnel because mechanically induced irritation is most likely to occur at these locations. Controlled investigations demonstrate that satisfactory alleviation is to be gained by immediate intervention by the most widely adopted technique of a fanning infiltration of the region of maximal point of tenderness with anesthetic and anti-inflammatory agents. Unfortunately, we observe that clinicians inexperienced performing this procedure are deterred from this technique owing to fears of inaccurate medication deposition or penetrating the abdominal cavity and perforating viscera. In this paper we describe a method to provide a safe and accurately targeted injection precisely at the necessary location without risking iatrogenic harm. This is easily achieved by raising a mound of the superficial soft tissue at the point of maximal tenderness and inserting the needle oriented parallel to the surface of the anterior body surface. Adoption of this method provides a simple, safe and effective solution for C.N.E.S. and will allow recruiting more physicians to join the circle of those actively treating this condition.

Accessory belly of piriformis, as a cause of superior gluteal neurovascular entrapment.

During routine dissection on 50 years old male cadaver, an accessory belly of piriformis was observed. This accessory belly was superior and parallel to the main piriformis muscle. This was associated with emergence of superior gluteal nerve and superior gluteal artery between the two bellies. Piriformis muscle and its relation to sciatic nerve has been suggested as a cause of piriformis syndrome. But interestingly in the present case, superior gluteal nerve was interposed between two bellies that may help the clinicians to establish a rare yet important cause of piriformis syndrome and a rare cause of undiagnosed chronic pain in gluteal region. As superior gluteal artery was also interposed, so this rare variation holds interest to surgeons especially in isolated buttock claudication despite otherwise normal vascular investigations.

The anterior coracoscapular ligament in Thais: Possible etiological factor of suprascapular nerve entrapment.

Objective: To study the incidence of anterior coracoscapular ligament in Thais as well as morphology of the ligament. Materials and methods: One hundred and twenty seven scapulae from 64 Thais embalmed cadavers were used to scrutinize the presence of the anterior coracoscapular ligament. Relation between the ligament and the suprescapular nerve was also observed. The incidence, morphological feature and dimension of the anterior coracoscapular ligament were recorded. Simultaneously, the photos were taken. Sample of the ligament was randomly collected to process under standard histological technique for microscopic study. Results: The anterior coracoscapular ligament was found in 19 cadavers (28%), 4 cases (6%) were bilateral and 15 (22%) cases were unilateral. The ligament was a fibrous band located inferior to the superior transverse scapular ligament. The ligament attached proximally to anteromedial surface of the root of coracoid process, fibers descended to anterior surface of the scapular in the vicinity of the suprascapular notch. According to its distal attachment, the anterior coracoscapular ligament was divided into 3 types. Furthermore the dimension of the ligament as well as its microscopic feature was also elaborated. Conclusion: The existence of the anterior coracoscapular ligament caused the reduction in the height or narrowed the suprascapular foramen; together with the configuration of suprascapular notch may be one of the predisposing causes of suprascapular nerve entrapment.