Foramen escapular osificado en una muestra poblacional colombo-chilena / Ossified scapular foramen in a Colombian-Chilean population sample

RESUMEN: Ocasionalmente la incisura escapular puede ser reemplazada por un foramen óseo producto de la osificación del ligamento transverso superior de la escápula. Esta formación ósea se considera un factor precipitante de la compresión del nervio supraescapular. Ciento noventa y cinco escápulas de individuos adultos pertenecientes a osteotecas de universidades de Colombia (114 escápulas) y de Chile (81 escápulas), fueron estudiadas macroscópicamente para determinar la presencia de un foramen escapular óseo. Ambas escápulas de un mismo individuo colombiano (1,75 % del total) presentaban el foramen escapular y una escápula izquierda (1,23 %) presentaba esta formación en un individuo chileno. La prevalencia de la osificación del ligamento transverso superior de la escápula es muy variable en los distintos estudios y tiende a situarse inferior al 10 %, sin embargo, puede constituirse en un factor de riesgo debido al atrapamiento o compresión del nervio supraescapular, hecho conocido como neuropatía supraescapular.

SUMMARY: Occasionally the scapular notch can be replaced by a bony foramen product of the ossification of the superior transverse scapular ligament. This bone formation is considered a precipitating factor for compression of the suprascapular nerve. One hundred and ninety-five adult scapulae from Colombian (114 scapulae) and Chilean (81 scapulae) university osteotheques were studied macroscopically to determine the presence of a bony scapular foramen. Both scapulae of the same Colombian individual (1.75% of the total) presented the scapular foramen and one left scapula (1.23%) presented this formation in a Chilean individual. The prevalence of ossification of the superior transverse scapular ligament is highly variable in the different studies and tends to be less than 10%; however, it can become a risk factor due to entrapment or compression of the suprascapular nerve, a fact known as suprascapular neuropathy.

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 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>

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.

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.

High Incidence of Complete Ossification of the Superior Transverse Scapular Ligament in Brazilians and its Clinical Implications / Alta Incidencia de Osificación Completa del Ligamento Escapular Transverso Superior en Brasileños y sus Implicancias Clínicas

The aim of this study was to verify the prevalence of the ossified superior transverse scapular ligament (STSL) on dry bones of scapulae. 221 dry bones were analyzed, (111 rights and 110 lefts), proceeding from Rio de Janeiro and of Santa Catarina, Brazil. As exclusion criterion, were not analyzed bones of children or damaged. For the quantitative analysis of the data, the software Graphad Instat was used. Fisher exact test was used considering the p ≤ 0,05 as significant. After analysis of the scapulae, 30,76% (68/ 221) presented the ossified STSL (p ≤ 0,0001) of which, 52,94% (36/68) were ossified on the right side and 47,05% (32/68) on the left one. The 153 scapulae that did not present the ossified STSL, it was observed in 19,6 % (30/153) of these bones, the superior edge varying in the transverse plan, increasing superior angulation and, modified the width and depth of the scapular incisure. This anatomical curiosity should be kept in mind by clinicians that approaches painful syndrome of the shoulder, as well as, this anatomical curiosity should be kept in mind by students that may manipulate this anatomical area.

El objetivo de este estudio fue verificar la prevalencia del ligamento escapular transverso superior (LETS) osificado, en huesos secos. 221 escápulas secas (111 derechas y 110 izquierdas) fueron analizadas procedentes de Río de Janeiro y de Santa Catarina, Brasil. No fueron analizados huesos de niños o dañados. El tratamiento estadístico de los datos fue realizado con el software Graphpad Instat, siendo seleccionado el test Fisher, con un p ≤ 0.05 como significativo. El 30.76% (68/221) de las escápulas presentaron el LETS osificado (p ≤ 0,0001) de ellos, el 52.94% (36/68) correspondían a escáulas derechas y 47.05% (32/68) a escápulas izquierdas. Las 153 escápulas que no presentaron el LETS osificado, se observó en el 19.6% (30/153) de estos huesos. El margen superior que variaba en el plano transversal, incrementaba la angulación superior y modificaba así el ancho y la profundidad de la incisura escapular. Esta variación anatómica la deben tener presente los clínicos debido al síndrome doloroso del hombro, como también, los estudiantes que manipulan esta área anatómica.

Complete Ossification of the Superior Transverse Scapular Ligament in a Nigerian Male Adult / Osificación Completa del Ligamento Transverso Escapular Superior en un Hombre Adulto Nigeriano

Complete ossification of the superior transverse scapular ligament is generally considered to be rare and has not been previously described in a Nigerian. In the diagnosis of suprascapular nerve entrapment syndrome, variations in the anatomy of the superior transverse scapular ligament must be considered as possible etiologic factors, as illustrated by this case report.

La osificación completa del ligamento transverso escapular superior es generalmente considerado como raro y no existen datos previamente descritos en nigerianos. En el diagnóstico del síndrome de compresión del nervio supraescapular, variaciones anatómicas del ligamento transverso escapular superior pueden ser consideradas un posible factor etiológico, como es el caso descrito.