suprascapular nerve entrapment
Introduction
Introduction to the scapular nerve compression syndrome Scapular nerve compression is one of the most common causes of shoulder pain. Some foreign scholars believe that intrinsic occupies 1% to 2% of all patients with shoulder pain. In 1909, Ewald described a "neuritis" on the shoulder after trauma. In 1926, Foster reported 16 cases of suprascapular neuropathy. In 1948, 4 of 136 cases of shoulder pain reported by Parsonage and Turner suffered from scapular neuritis. These are the earliest reports of scapular nerve compression syndrome. In 1959, Kopell and Thompson described the compression of the scapular nerve on the scapular incision, and called the suprascapular nerve compression syndrome. (suprascapularnerveentrapment, SNE). Case reports of nerve compression on the scapula have gradually increased. In 1982, Aiello et al. reported cases of SNE compression at the scapular ankle joint. In 1987, Ferretti et al. reported cases of SNE in volleyball players. In recent years, there have been reports of subscapular muscle atrophy and some special compression cases. basic knowledge Proportion of disease: 1% to 2% of all patients with shoulder pain Susceptible people: no special people Mode of infection: non-infectious Complications: edema
Cause
Cause of scapular nerve compression syndrome
(1) Causes of the disease
Scapular nerve compression can be caused by acute injury such as scapular fracture or ankle injury. Shoulder dislocation can also damage the superior scapular nerve, shoulder flexion, especially the flexion of the scapula, which makes the suprascapular nerve activity. Decreased, easy to damage, tumor, ankle joint nodular cyst, and fissure on the scapular scapula are the main reasons for the compression of the scapular nerve. It is reported that the traction of the rotator cuff injury can also cause the shoulder blade. In the upper nerve injury, various local lipomas and nodules can compress the trunk of the superior scapular nerve or the branch of the subscapular nerve, causing compression.
(two) pathogenesis
Sunderland believes that the nerves of the suprascapular nerve are relatively fixed when they are traversed through the scapula, making it easy to be damaged during repeated movements. Repeated movements of the scapula and ankle joint cause the nerve to rub at the incision, and the nerve inflammatory reaction occurs. Edema, which can lead to compression damage, it is known that the movement of the distal scapula can cause the scapular nerve to tighten, causing a "suspension effect", causing the nerve to skeet at the notch, causing neuropathy, Mizuno et al. When the accessory nerve is paralyzed, the scapula sag to the lateral side of the scapula can cause the superior scapular nerve to be pulled by the transverse ligament of the scapula. The scapular nerve shoulder joint can cause ankle pain. This is the most common clinical symptom, scapular nerve lesion. It is mainly unilateral, and there are reports of bilateral morbidity.
Prevention
Scapular nerve compression prevention
There is no effective preventive measure for this disease. Early detection and early diagnosis are the key to the prevention and treatment of this disease.
Complication
Scapular nerve compression complications Complications edema
The main complication of this disease is that when the compression is severe and lasting, it can cause demyelination of nerve fibers, and even the distal axonal disintegration, Waller degeneration of myelin. During limb movement, nerve fibers in the stenotic channel undergo chronic inflammatory inflammation under mechanical stimulation and aggravate the vicious circle of edema-ischemia. This further causes damage, so patients with this disease should actively treat to prevent complications.
Symptom
Symptoms of suprascapular nerve compression syndrome common symptoms traumatic dull pain
Patients often have dull pain in the shoulder area, located in the posterolateral part of the shoulder, can be radiated to the posterior and posterior arm, but the radiation pain is often located in the posterior side of the upper arm. Patients often feel shoulder abduction, external rotation is weak, and progressive cases can be There is atrophy of the supraspinatus muscle. However, in most cases, there is no obvious muscle atrophy. Therefore, clinical diagnosis is difficult.
Usually the patient has a history of trauma or strain. For example, the shoulder is directly traumatized or directly injured. If the hand reaches the shoulder, the shoulder joint is excessively abducted and the sprain is caused. Some patients have excessive shoulder strain, such as sports strain. Engaged in volleyball, basketball, tennis and other sports), the history of shoulder labor injury.
Patients with trauma or strain are mainly suffering from sharp pain in the shoulders. The shoulders can be aggravated when they are active. The pain can be persistent. In severe cases, it affects sleep. There is no obvious muscle atrophy. The arm is difficult to reach or the affected side cannot reach the opposite shoulder. In some cases, there are no symptoms other than shoulder pain, and the pain can last for several years.
The tenderness of the incision on the shoulder blade or the tenderness in the intercostal region between the clavicle and the scapula is the most common sign of the suprascapular nerve compression. The trapezius muscle area may also have tenderness, such as the compression of the shoulder blade, and the tender point in the shoulder. At the site, the shoulder abduction, the external rotation muscle strength is weakened; the supraspinatus muscle, the infraorbital muscle atrophy, especially the infraorbital muscle atrophy; due to the supracondylar joint branch with the acromioclavicular joint, acromioclavicular joint tenderness, such as the shoulder scapula When the incision is pressed, the pain is lighter than that on the incision on the shoulder blade. The tenderness is located at the canopy of the canopy. In addition to the atrophy of the infraorbital muscle, the other manifestations are not obvious.
Examine
Examination of scapular nerve compression syndrome
Myoelectric examination
Electromyography and nerve conduction velocity examination are helpful in the diagnosis of suprascapular nerve compression syndrome. Khaliki found that patients with suprascapular nerve compression syndrome have prolonged evoked potentials, and supraspinatus myoelectrics may have positive waves and fibrillation. Waves and motor potentials decrease or disappear.
2. X-ray inspection
The scapula is tilted 15° to 30° to the tail on the posterior anterior X-ray film to check the shape of the scapula on the scapula, which is helpful for diagnosis.
Diagnosis
Diagnosis and differentiation of suprascapular nerve compression syndrome
Diagnostic criteria
The diagnosis of suprascapular nerve compression syndrome needs to be diagnosed by careful examination of the medical history and physical examination of the system and myoelectric examination.
Scapula traction test
The patient is placed on the contralateral shoulder and the elbow is in a horizontal position, so that the affected elbow is pulled to the healthy side, which can stimulate the compression of the superior scapular nerve and induce shoulder pain.
2. Partial closure of lidocaine injection
Inject 1% lidocaine into the tender point on the shoulder, and if the symptoms are relieved quickly, it will help to diagnose the suprascapular nerve compression syndrome.
3. Myoelectric examination
Electromyography and nerve conduction velocity examination are helpful in the diagnosis of suprascapular nerve compression syndrome. Khaliki found that patients with suprascapular nerve compression syndrome have prolonged evoked potentials, and supraspinatus myoelectrics may have positive waves and fibrillation. Waves and motor potentials decrease or disappear.
4. X-ray inspection
The scapula is tilted 15° to 30° to the tail on the posterior anterior X-ray film to check the shape of the scapula on the scapula, which is helpful for diagnosis.
Differential diagnosis
The disease should be differentiated from shoulder joint diseases such as rotator cuff injury, frozen shoulder, shoulder impact syndrome, and brachial plexus neuritis, cervical disc disease, ankle arthritis, acromioclavicular joint disease, ultrasound, CT, MRI Checking helps to differentiate the diagnosis.
