An Osteological Study Of Morphometric Variations Of Suprascapular Notch In South Gujarat Region

Background:The suprascapular notch is a depression in the lateral part of superior border of scapula. The suprascapular ligament bridges the notch. Thesuprascapular nerve passes below the ligament and corresponding artery above the ligament. Variation in size and shape of suprascapular notch is identified as one of the causes of suprascapular nerve entrapment.Aim Of Study:To study morphological variations of suprascapular notch in dry scapulae of South Gujarat (Indian) population and compare data with studies in other ethnic populations. Materials And Methods:Total 200 dry human scapulae were obtained from Anatomy departments of three medical collegesof south Gujarat. Three dimensions were defined and measured for each suprascapular notch (SSN) using classical osteometry: maximal depth (MD), superior transverse diameter (STD) and middle transverse diameter (MTD). Based on Micha? Polguj’s classification SSN was classified into five types. The results of the present study were compared with previous studies in different populations.Results:The proportion of Type III SSN is highest (46.5 %) followed by Type V (26 %), Type I (16 %), Type IV (6 %) and Type II (5.5 %). For Type III SSN, proportion of subtype III c is highest (36.5 %), followed by subtype III b (6 %) and subtype III a (4 %). For Type I SSN, proportion of subtype I c is highest (8.5 %), followed by subtype I a (4 %) and Subtype I b (3.5 %).Conclusion:The suprascapular nerve entrapment syndrome, in most cases is due to morphological variations of suprascapular notch particularly complete ossification of suprascapular ligament. So the knowledge of such variations is essential for clinicians,to make a proper diagnosis of shoulder pain and to plan the most suitable surgical intervention.

Frequency of Complete Absence of Suprascapular Notch in Dry Scapulae - An Osteological Study with Clinical Significance

Suprascapular notch is a depression located in the superior border of the scapula near its lateral part, close to the root of the coracoid process. It is bridged by the superior transverse scapular ligament & serves as a path for the suprascapular nerve. The notch is commonly seen in all the scapulae with variable morphology. Sometimes, it is associated with ossified transverse scapular ligament which plays an important role for the suprascapular neuropathies which has been suggested in many previous literatures. But, its absence can also be a reason for nerve entrapment which has been mentioned less frequently. The purpose of this study was to find out the incidence of completely absent suprascapular notch among dry scapulae of north India, especially Gurugram region along with a morphometric evaluation of superior border of scapular where the notch is situated.METHODSOne hundred & ten adult dry scapulae of unknown sex from the osteology museum of SGT Medical College, Gurugram, were obtained for evaluation of absence of suprascapular notch in the superior border of the scapulae near the root of the coracoid process by subjective evaluation (visual inspection). We have also done a morphometric evaluation (length) of the superior border of all the scapulae irrespective of the suprascapular notch. Our observations were compared with other osteological studies performed on other population groups.RESULTSOf the 110 scapulae studied, 43 belonged to right side & 67 scapulae of left side. By visual inspection, 13 scapulae (11.8%) were devoid of suprascapular notch on the upper border & rest 88 scapulae (88.81%) had different variety of suprascapular notch. Among the 13 scapulae without suprascapular notch, 8 scapulae (61.5%) were of right side and 5 scapulae (38.46%) were of left sided bone. Apart from this, the average length of the superior border of the scapulae was 42.73 mm.CONCLUSIONSIncidence of completely absent suprascapular notch in our study is 11.8% which will act as a reference point among Gurugram population in north India. Clinicians should keep in mind about complete absence of suprascapular notch which can be a probable reason for the suprascapular nerve entrapment.

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.

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.

Morphology Of Suprascapular Notch And Its Clinical Significance

Introduction: The suprascapular notch is present on the superior border of the scapula, just medial to thecoracoid process. The suprascapular ligament bridges the edges of notch, which sometimes get ossified andconvert suprascapular notch into foramen.A narrow notch or excess ossified ligament may have a greaterchance of a nerve impingement in the suprascapular foramen.Materials and methods: This study was conducted on the bones that were obtained from the bone bank ofDepartment of Anatomy. A total of 118 (57 right, 61 left) human scapulae derived from adult (35 male and 17female) skeletons were evaluated for the shape of suprascapular notch ,presence of any ossification of thesuprascapular ligament and classified according to Rengachary et al into I –VI types.Results: On analysis of morphological variations of suprascapular notch, we found following types of scapulae:Type I -22.42 %, Type II -12.98 %, Type III -53.98 %, Type IV -0 %, Type V- 7.08 %, Type VI -3.54%.. Out of all specimens,in three specimen suprascapular ligaments (3.54 %) were found to be completely ossifiedConclusion: The knowledge of morphometric variations of suprascapular notch and ossification of suprascapularligament is very important for clinicians. This knowledge is very important in sports medicine as well as fororthopaedic surgeons in management of cases of shoulder pain.

Anatomical classification and clinical significance of scapular notch based on CT 3D reconstruction / 解剖学报

Objective To research the anatomical classification of suprascapular notch based on CT 3D reconstruction and its clinical significance. Methods A total of 300 suprascapular (left 142, right 158) data were collected from Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University were measured based on CT 3D reconstruction. The suprascapular images were reconstructed by CT 3D technique, and the scapular morphological classification was made and geometric data were measured. Results Five types of suprascapular notch were found. Type I (V, a total of 138 cases, 46%) was the most common, followed by type II (U, a total of 125 cases, 41. 7%), type III (V, a total of 20 cases, 6. 7%), type IV (O, atotol of 10 cases, 3. 3%) and type V (Ω, a total of 7 cases, 2. 3%), in addition, found W-shaped, double O-shaped each 1, because of the number was rare, it was not included in the classification. The average depth and width of the left suprascapular notch were (5. 58±1.42) mm and (10. 22±3. 24) mm, and the right scapula were (6. 02± 1. 87) mm and (10. 81±3. 35) mm, respectively (P < 0. 05). The width of the incision of type I and type II was wider than that of the other three types, which were (12. 46±3. 20) mm and (9. 95± 2. 68)mm, and P<0. 05. In addition, the length of the vertical point from the lowest point of the suprascapular notch to the base of the scapula was different. Type I (the shortest) was about (12. 52±2. 56) mm, and type III (the longest) was about (14. 48±4. 29) mm. There was a statistical difference between type I and type III (P<0. 05). Conclusion Based on the result of CT three-dimensional reconstruction, the suprascapular notch is divided into five types, which are V-shaped, U-shaped, V-shaped, O-shaped, and ft-shaped. The probability of suprascapular nerve compression in V-shaped and O-shaped is more, on the contrary, the shape of the √-shaped and U-shaped compression is small.

Assessment of scapular morphometry / Evaluación de la morfometría escapular

The current study was undertaken to assess the incidence of different types of suprascapular notch, acromion dimensions and the lower and upper scapular angles. The suprascapular notch and variations of the acromion are clinically important in suprascapular nerve compression and subacromial impingement. Measurements were taken from 73 Anatolian dry scapulae of unknown age or sex. The suprascapuar notch was classified according to that of Rengachary et al. (1979). Its width and depth, the distance between supraglenoid tubercle and the deepest point of notch, as well as the upper and lower scapular angles were also determine measured. The type of acromion was assessed according to shape (type I (cobra), type II (square), type III (intermediate)) and tilt (type I (flat), type II (curve). Acrmion length and the distance between acromion and coracoid process were also measured. The frequency of different types of suprascapular notch were type I (28.8 %), type II (23.3 %), type III (13.7 %), type IV (20.5 %), type V (2.7 %), type VI (5.5 %)and absence (5.5 %). Acromion type were type I (45.5 %), type II (7.5 %) and type III (47.0 %), acromion tilt type I (15.2 %), and type II (84.8 %). An understanding of the association between the anatomical structures of the scapula and morphometric measurements is clinically important.

En este trabajo se evaluó la incidencia de diferentes tipos de incisura supraescapular, dimensiones de acromion y los ángulos escapulares superior e inferior. La incisura supraescapular y las variaciones del acromion son clínicamente importantes en la compresión del nervio supraescapular y el pinzamiento subacromial. Las mediciones se tomaron de 73 escápulas secas de Anatolia, de edad y sexo desconocidos. La incisura supraescapular se clasificó según Rengachary et al. (1979). Se determinaron también el ancho y la profundidad, la distancia entre el tubérculo supraglenoide y el punto más profundo de la incisura, así como los ángulos escapulares superior e inferior. El tipo de acromion se evaluó de acuerdo con la forma [tipo I (cobra), tipo II (cuadrado), tipo III (intermedio)] y la inclinación [tipo I (plano), tipo II (curvo)]. También se midieron la longitud del elemento y la distancia entre el acromion, como así también el proceso coracoide. La frecuencia de los diferentes tipos de incisura supraescapular fueron: tipo I (28,8 %), tipo II (23,3 %), tipo III (13,7 %), tipo IV (20,5 %), tipo V (2,7 %), tipo VI (5,5 %) y ausencia (5,5 %). Los tipos de acromion fueron: tipo I (45,5 %), tipo II (7,5 %) y tipo III (47,0 %), tipo de inclinación de acromion I (15,2 %) y tipo II (84,8 %). En conclusión, el conocimiento de la asociación entre las estructuras anatómicas de la escápula y las mediciones morfométricas es clínicamente importante.

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.

Morphological Classification Of Suprascapular Notch In Dry Scapulae From Population Of Gujarat: A Database For Shoulder Arthroscopy

Background: The Suprascapular Notch (SSN) is located at the superior edge of the scapula. The information ofvariations in shapes and classification can be obliging to surgeons to correlate the suprascapular nerve entrapmentwith a specific type of notch. The aim of this study is to document the occurrence of morphological variations inshape of suprascapular notch in dry scapulae which belongs to population of Gujarat & evaluate it with prevalenceamong various races of world to know its clinical significance.Methods: Total two hundred dry and intact adult human scapulae were studied of mixed sex of Indian originderived from various medical colleges of Gujarat. All Measurements were taken by classical osteometry with thehelp of electronic calipers with the accuracy of 0.01mm in millimetres.Results and Interpretation: The most common type of SSN observed was Type 2, a notch that was longest in itstransverse diameter. The least common type was Type 4. Type 5 SSN was absent. The most common shape was ‘J’and least common was ‘V’. Partial and complete ossification was also noted.Conclusion: Knowledge of anatomical variations of suprascapular notch is better for understanding locationand source of entrapment syndrome. Since, the present study is performed with a limited number of dry scapulae,so there is need of further clinical, radiological and cadaveric studies.

Variations in the origin and course of the suprascapular artery: case report and literature review / Variações na origem e percurso da artéria supraescapular: relato de caso e revisão da literatura

Abstract The suprascapular artery is normally a branch of the thyrocervical trunk of the subclavian artery. During dissection of the left upper limb of a female cadaver, aged 70 years and fixed in 10% formalin solution, the suprascapular artery was observed aberrantly arising from the first part of the axillary artery. Later, it coursed obliquely behind the clavicle bone and brachial plexus to reach the suprascapular notch, where it was accompanied by the suprascapular nerve. Then, both suprascapular nerve and artery anomalously traversed beneath the transverse scapular ligament. It then irrigated the supraspinatus muscles and took part in the anastomosis around the scapula. On the contralateral side there was no abnormality. Variations in the origin and course of suprascapular artery are of immense value to orthopedic and vascular surgeons, angiographists, and anatomists.

Resumo A artéria supraescapular normalmente se apresenta como um ramo do tronco tireocervical da artéria subclávia. Durante a dissecção do membro superior esquerdo de um cadáver do sexo feminino com idade de 70 anos fixado em solução de formol 10%, observou-se que a artéria supraescapular tinha origem aberrante na primeira parte da artéria axilar. Mais adiante, a artéria cursava obliquamente por trás da clavícula e plexo braquial até atingir a incisura supraescapular, onde era acompanhada pelo nervo supraescapular. A partir daí, tanto o nervo quanto a artéria supraescapulares atravessavam de forma anômala por baixo do ligamento transverso da escápula. Neste ponto, irrigavam os músculos supraespinhosos e faziam parte da anastomose em torno da escápula. No lado contralateral, não havia anormalidade. Variações na origem e percurso da artéria supraescapular são de grande valor para cirurgiões ortopédicos e vasculares, angiografistas e anatomistas.

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

Ossification Of Superior Transverse Scapular Ligament.

The superior transverse scapular ligaments (STSL) bridges the suprascapular notch, located medial to the root of coracoid process of the scapula, and convert it into suprascapular foramen. The suprascapular nerve traverses through the suprascapular foramen of scapula. Sometime ossification of STSL results in compression of suprascapular nerve producing symptoms of suprascapular nerve neuropathy. An unusual variation of STSL ossification was encountered during routine dissection. The knowledge of this rare anatomical variation should be kept in mind by the clinicians and surgeons approaching painful syndrome of the shoulder, suprascapular nerve neuropathy and various surgical procedures of suprascapular nerve decompression.

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.

Morphology of Suprascapular Notch: A Study on 176 Dry Scapulae.

Back ground: Suprascapular notch (SSN) is present along the superior border of the scapula. It is bridged by the supascapular ligament. Suprascapular nerve passes inferior to it. Suprascapular nerve entrapment frequently occurs at the suprascapular notch. A narrow notch or the ossified suprascapular ligament is the frequently encountered culprits. Aim: To study the morphology of suprascapular notch among 176 dry scapulae. Materials and Method: The study was conducted on 176 adult dry human scapulae in the department of Anatomy, KIMS, Bangalore. Among 176 scapulae 88 were right sided & 88 left sided. Various shapes of scapular notches were noted & classified into 6 types based on Rengachary classification. Results: The most common type of suprascapular notch in the study is Type II (R-24, L-37) & least common is Type VI (R-5, L-5). Suprascapular notch was absent in 8 Scapulae. Conclusion: We could find all the 6 types of scapular notches, most common type being type II ((34.65%) and least common type - type VI. This study is an attempt to know the various shapes of suprascapular notch.

Morphometric Analysis of Suprascapular Notch: Review of Literature.

The suprascapular notch which is located on the lateral part of the superior border of the scapula, medial to the coracoid process, is bridged by the superior transverse scapular ligament. The notch serves as a passage for suprascapular nerve to pass to supraspinous fossa. Suprascapular nerve entrapment may be due to the variable morphology of the suprascapular notch or due to ossification of the superior transverse scapular ligament. Morphometric studies of suprascapular notch have been done in various populations. The aim of the present study is to review the morphometric studies of suprascapular notch, identify the most common type of notch and compare the morphometry in different populations.

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.

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.

Suprascapular Notch: A Morphometric and Morphologic Study in North Indian Population.

Background: The suprascapular notch is a semicircular notch located at the superior border of the scapula, just medial to the base of the coracoid process which constitutes the main site of compression of the suprascapular nerve. The aim of present study is to study morphological variations of the suprascapular notch in the North Indian population, classify the suprascapular notch into various types and to correlate the type of notch to the incidence of suprascapular nerve entrapment syndrome. Materials and Methods: Material for the present study comprised of 100 adult scapulae (Right : Left :: 50:50) of unknown age and sex, obtained from Department of Anatomy, Govt. Medical College, Amritsar, Punjab, India. Results: Suprascapular notch was present in 95% bones, was transversely oval in 66%, vertical diameter = 5.9mm (3.29-16.80mm), transverse diameter = 5.96mm(2.93-13.70mm), distance from the base of suprascapular notch to the superior rim of glenoid = 29.98mm (21.7-39.25mm). It was classified as per Natsis et al classification into type I (20%), type II (39%), type III (34%), type IV (5%) and type V (2%). Our results were compared with the studies of other authors. Conclusions: The knowledge of classification and the anatomical variations of suprascapular notch helps the clinician to define easily and quickly the type of notch and be able to correlate suprascapular nerve entrapment with a specific type of notch.

Variations in suprascapular notch morphology and its clinical importance.

Background: Suprascapular notch (SSN) is present towards the medial end of superior border of scapula. The morphometric variations of the SSN have been identified. The suprascapular nerve compression is commonly noted at the site of SSN. Methods: The study was carried out in the department of anatomy, SRMS-IMS medical college, Bareilly and SGRRIM-HS Dehradun. The 120 dried scapulae were randomly selected. The age, sex and race of the scapulae were not known. The scapulae were observed carefully for the different shapes of the suprascapular notch. The various dimensions of suprascapular notch were taken by using a digital vernior caliper. Results: In the present study six types of SSN were noted based on the description by Rengachary SS. et al.22 Type I (15.83%); type II (41.66%); type III (25.00%); type iv (12.50%); type v (1.67%) and type VI (3.33%). We also classified the SSN based on the description by M. Polguj et al. 2011,28 the frequencies were: type I (MVD>STD), 20%; type II (MVD=STD=MTD), 3.33%; type III (STD >MVD), 55.83%; type IV (bony foramen), 3.33% and type V (Without a discrete notch), 17.5%. Conclusion: The suprascapular neuropathy may occur at the various anatomical locations of its course and has a variety of causes. Our study is important for clinician because the narrow SSN increase the risk of suprascapular entrapment neuropathy. So the knowledge of these variations should be kept in the mind of clinicians in the diagnosis and treatment of suprascapular neuropathies.