Dataset Information

Quantitative Ultrasonographic Analysis of Changes of the Suprascapular Nerve in the Aging Population With Shoulder Pain.

ABSTRACT:

Background

Older people are vulnerable to painful shoulder syndromes, the majority of which are derived from degenerative rotator cuff pathologies. The suprascapular nerve (SSN) is closely related to the rotator cuff complex, and its role in shoulder pain has recently been highlighted. This study aimed to explore the differences in SSN among older people with and without shoulder pain, and to investigate the potential factors influencing the nerve size using ultrasound (US) imaging.

Methods

Participants aged ?60 years were enrolled in the study. A systematic and bilateral US examination of the rotator cuff tendons was performed. The SSN was examined from its origin in the brachial plexus to the spinoglenoid notch of the infraspinatus fossa. The association between the nerve's cross-sectional area (CSA) and rotator cuff lesions was analyzed using the generalized estimation equation.

Results

Among the 94 participants, 45 (with bilaterally asymptomatic shoulders) were classified into the control group, whereas 49 (with at least one-sided shoulder pain) were classified into the group with shoulder pain. The average CSAs of the SSN at the level of the brachial plexus, supraspinatus fossa, and infraspinatus fossa were comparable between the patients in the control group and those with shoulder pain. There was a higher prevalence of rotator cuff lesions and enlarged distal SSNs in the painful shoulders than in the asymptomatic shoulders of patients with unilateral involvement. A full-thickness tear of the supraspinatus tendon was associated with swelling of the SSN in the supraspinatus fossa (? coefficient = 4.068 mm², p < 0.001).

Conclusion

In the older population, full-thickness tears of the supraspinatus tendon are independently associated with enlargement of the distal SSN. In cases with large rotator cuff tendon tears with poor response to conservative treatments, possible SSN entrapment should be considered and managed accordingly.

SUBMITTER: Wu WT

PROVIDER: S-EPMC7933457 | biostudies-literature | 2021

REPOSITORIES: biostudies-literature

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Publications

Quantitative Ultrasonographic Analysis of Changes of the Suprascapular Nerve in the Aging Population With Shoulder Pain.

Wu Wei-Ting WT Chen Lan-Rong LR Chang Hsiang-Chi HC Chang Ke-Vin KV Özçakar Levent L

Frontiers in bioengineering and biotechnology 20210219

<h4>Background</h4>Older people are vulnerable to painful shoulder syndromes, the majority of which are derived from degenerative rotator cuff pathologies. The suprascapular nerve (SSN) is closely related to the rotator cuff complex, and its role in shoulder pain has recently been highlighted. This study aimed to explore the differences in SSN among older people with and without shoulder pain, and to investigate the potential factors influencing the nerve size using ultrasound (US) imaging.<h4>M ...[more]

PMID: 33681173

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Project description:As changes in nerves' shape and size are common ultrasonographic findings of entrapment neuropathy, measurement of the nerve cross-sectional area (CSA) becomes the mostly used indicator to differentiate normality from pathology. Recently, more US research has been conducted to measure the shape of the suprascapular notch and the diameter of the suprascapular nerve. Because the suprascapular nerve is paramount for various shoulder disorders, the present study aims to establish normal values of suprascapular nerve sizes at different levels as well as to investigate potential influence of participants' characteristics on the CSA measurements. The present study used a cross-sectional design investigating the CSA values of the suprascapular nerve from the supraclavicular region to spinoglenoid notch. We employed the inside-epineurium and outside-epineurium methods to quantify CSA of cervical roots (C5 and C6) and the suprascapular nerve on US imaging. Univariate comparisons of nerve sizes among different age and gender groups were carried out. Multivariate analysis was performed to analyze the impact of participants' characteristics on nerve CSA. Repeated measurement analysis of variance was conducted to examine segmental variations of CSA of the suprascapular nerve from its origin to infraspinatus fossa. Our study included 60 healthy adults with 120 shoulders and had three major findings: (1) the inside-epineurium method was more reliable than the outside-epineurium approach for CSA measurements due to higher intra- and inter-rater reliability, (2) women had smaller sizes for cervical nerve roots and for the most proximal segment of the suprascapular nerves, and (3) using the outside-epineurium method, the suprascapular nerve CSA was larger in its distal division than the portion proximal to the mid-clavicular line. In conclusion, the inside-epineurium method has better reliability for nerve CSA assessment but the outside-epineurium method is needed for quantifying the size of distal suprascapular nerve. Gender difference in CSA values should be considered during evaluation of the most proximal nerve segment. Using the outside-epineurium method, the distal suprascapular nerve would be estimated larger than its proximal portion and the segmental discrepancy should be not misinterpreted as pathology.

Project description:Methods:Patients with shoulder pain were recruited in an outpatient rehabilitation clinic at the Third Affiliated Hospital of Sun Yat-Sen University from January 1, 2017, to June 30, 2018. These shoulder pain patients with or without limitation in joint movement can be included in the study. All of them received musculoskeletal ultrasound scanning. Demographic and imaging data including age, gender, duration of shoulder pain, pain side, and pathologies found by musculoskeletal ultrasound imaging were collected and analyzed. Patients were divided into three groups: <45 years (young group), between 45 and 60 years (middle-aged group), and >60 years (elderly group). The rates of various shoulder pathologies were evaluated and compared between the groups. Results:This study recruited a total of 346 patients with shoulder pain. There were more female (62.1%) than male patients (37.9%), with the largest number of patients in the 45-60 years of age group (40.5%). Forty-eight percent of patients had shoulder pain within a period of 3 months. A total of 380 shoulders were assessed using musculoskeletal ultrasound imaging. The occurrence rate of subacromial disorder (83.8%) was the highest. The rate of supraspinatus tendinopathy, acromioclavicular joint degeneration, and adhesive shoulder capsulitis varied significantly between age groups (P < 0.05). The rate of acromioclavicular joint degeneration was the highest in the elderly group followed by the middle-aged and young groups (P < 0.0167). The rate of supraspinatus tendinopathy and adhesive capsulitis in the middle-aged and elderly groups was significantly higher than that in the young group (P < 0.0167). Conclusions:Musculoskeletal ultrasound can be a useful imaging tool in making an accurate diagnosis of shoulder pain. The occurrence rates of different shoulder pain pathologies in all age groups were thoroughly calculated in this study. More female and more subcoracoid disorder patients than western countries are attributed to repetitive lifting in daily life and work in this study. Correlations between these pathologies and their associated images can be a solid foundation for the development of artificial intelligence in diagnosing the cause of shoulder pain.

Project description:ObjectiveThis prospective, randomized study aimed to compare anterior suprascapular nerve block versus interscalene block in terms of diaphragm paralysis in arthroscopic shoulder surgery.MethodsFifty-two patients undergoing shoulder arthroscopy surgery were prospectively randomly assigned to interscalene block (n=25) or anterior suprascapular nerve block groups (n=27) (each group receiving 5 mL, 0.5% bupivacaine). The ipsilateral diaphrag matic excursion was assessed in all patients using ultrasound imaging before (baseline), 30 minutes, and 24 hours after block completion. Pain scores were recorded 1 hour preoperative, 30-60 minutes in the postoperative recovery unit, and at 6 and 24 hours postoperatively.ResultsNo complete paralysis was observed in either treatment group. The incidence of a partial decrease in diaphragm movements was significantly lower in the anterior suprascapular nerve block than in the interscalene block group (1 vs. 21 patients) (P < .01). Twenty-six patients in the anterior suprascapular nerve block and 4 in the interscalene block group had less than a 25% decrease in hemidiaphrag matic movements, 30 minutes after the blockade. Pain scores were similar in the 2 groups. However, mean pain scores at 24 hours post operatively were significantly higher in the interscalene block than in the anterior suprascapular nerve block group (P < .05). Time to first pain post-block was significantly longer in the anterior suprascapular nerve block compared to the interscalene block group (677.04 ± 52.17 minutes vs. 479.2 ± 99.74 minutes, P < .05).ConclusionAnterior suprascapular nerve block and interscalene block both appear to be clinically effective in providing postoperative analgesia for patients undergoing arthroscopic shoulder surgery under general anesthesia. However, the time to first pain is significantly longer with anterior suprascapular nerve block. Pain scores at 24 hours postoperatively were significantly lower in the anterior supra scapular nerve block compared to the interscalene block group. Diaphragmatic movements after anterior suprascapular nerve block were also better preserved at both 30 minutes after the block and 24 hours after surgery.Level of evidenceLevel I, Therapeutic Study.

Dataset Information

Quantitative Ultrasonographic Analysis of Changes of the Suprascapular Nerve in the Aging Population With Shoulder Pain.

Background

Methods

Results

Conclusion

Publications

Quantitative Ultrasonographic Analysis of Changes of the Suprascapular Nerve in the Aging Population With Shoulder Pain.

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