Introduction Can be caused by suprascapular notch entrapment weakness of both supraspinatus and infraspinatus spinoglenoid notch entrapment weakness of infraspinatus only Anatomy Suprascapular nerve (C5,C6) emerges off superior trunk (C5,C6) of brachial plexus travels across posterior triangle of neck to scapula innervates supraspinatus infraspinatus Suprascapular ligament arises from medial base of coracoid and overlies suprascapular notch suprascapular artery runs above suprascapular nerve runs below Spinoglenoid ligament arises near spinoglenoid notch overlies distal suprascapular nerve Suprascapular notch entrapment Introduction proximal compression of suprascapular nerve in the suprascapular notch leads to weakness of both supraspinatus and infraspinatus Pathoanatomy compression can be from ganglion cyst (often associated with labral tears) transverse scapular ligament entrapment fracture callus Presentation symptoms deep, diffuse, posterolateral shoulder pain physical exam pain with palpation of suprascapular notch weakness of supraspinatus weakness seen with shoulder abduction to 90 degree, 30 degrees forward flexion, and with internal rotation (Jobe test positive) weakness of infraspinatus weakness to external rotation with elbow at side atrophy along the posterior scapula Evaluation MRI important to identify a compressive mass with associated cyst EMG/NCV diagnostic Treatment nonoperative activity modification and organized shoulder rehab program indications no structural lesion seen on MRI technique rehab should be performed for a minimum of 6 months operative surgical nerve decompression at suprascapular notch indications structural lesion seen on MRI (cyst) failure of extended nonoperative management (~ 1 year) Spinoglenoid notch entrapment Introduction distal compression of suprascapular nerve affects infraspinatus only Pathoanatomy compression can be due to posterior labral tears causing a cyst spinoglenoid ligament spinoglenoid notch ganglion traction injury (seen in 45% of volley ball players) transglenoid fixation lies 1.5cm medial to glenoid labrum Presentation symptoms deep, diffuse, posterolateral shoulder pain physical exam infraspinatus weakness weakness to external rotation with elbow at side infraspinatus atrophy along the posterior scapula supraspinatus strength is normal Evaluation MRI important to identify posterior labral lesions with associated cyst EMG/NCV diagnostic Treatment nonoperative activity modification and organized shoulder rehab program indications no structural lesion seen on MRI technique posterior shoulder capsule stretching operative labral repair with or without arthroscopic cyst decompression indications labral lesion with associated cyst seen on MRI spinoglenoid ligament release with nerve decompression indications no structural lesion seen on MRI and failure of extended nonoperative management (~ 1 year) technique posterior approach commonly utilized decompress nerve in spinoglenoid notch
Technique Guide CPT Codes: 64708 Neuroplasty, major peripheral nerve, arm or leg, open; other than specified Technique guide are not considered high yield topics for orthopaedic standardized exams including the ABOS, EBOT and RC. Suprascapular Nerve Decompression (Suprascapular Notch) Orthobullets Team Shoulder & Elbow - Suprascapular Neuropathy Technique Guide CPT Codes: 64708 Neuroplasty, major peripheral nerve, arm or leg, open; other than specified Technique guide are not considered high yield topics for orthopaedic standardized exams including the ABOS, EBOT and RC. Suprascapular Nerve Decompression (Spinoglenoid Notch) Orthobullets Team Shoulder & Elbow - Suprascapular Neuropathy
QUESTIONS 1 of 20 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 Previous Next Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK (OBQ13.42) Figure A and B are MRI images of a 42-year-old male with symptoms of right shoulder neuropathy. If this patient has an abnormality detected on EMG and nerve conduction testing, which of the following nerves is most likely to be involved? Tested Concept QID: 4677 FIGURES: A B Type & Select Correct Answer 1 Subscapular nerve 6% (273/4629) 2 Axillary nerve 3% (150/4629) 3 Musculocutaneous nerve 1% (68/4629) 4 Suprascapular nerve 88% (4091/4629) 5 Long thoracic nerve 1% (24/4629) L 2 Question Complexity B Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 4 Review tested concept (OBQ12.24) A 22-year-old right-handed semi-professional baseball player complains of right shoulder pain and progressive weakness. He denies any traumatic events. His exam is noted to have a normal "empty can" and "belly press" tests. Resisted external rotation with the arm at the side does exhibit weakness. His MRI images are shown in figure A and B. What is the most likely cause of his symptoms? Tested Concept QID: 4384 FIGURES: A B Type & Select Correct Answer 1 Suprascapular nerve entrapment at the suprascapular notch 11% (702/6141) 2 Suprascapular nerve entrapment at the spinoglenoid notch 83% (5079/6141) 3 Axillary nerve entrapment in the posterior triangle 2% (138/6141) 4 Axillary nerve entrapment in the axillary pouch 1% (53/6141) 5 Axillary nerve entrapment at near inferior neck of glenoid 2% (105/6141) L 2 Question Complexity A Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 2 Review tested concept Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK (OBQ11.179) A 44-year-old male presents with a 2 month history of posterior shoulder pain. He is noted to have normal forward flexion and abduction strength and isolated weakness on shoulder external rotation. He has slight atrophy of his periscapular area. He has no numbness or paraesthesias. Which pathology would best explain his symptoms? Tested Concept QID: 3602 Type & Select Correct Answer 1 Cranial nerve XI palsy 1% (29/4223) 2 Spinoglenoid notch cyst 77% (3272/4223) 3 Axillary nerve palsy 1% (58/4223) 4 Suprascapular notch cyst 19% (801/4223) 5 Parsonage-Turner Syndrome 1% (46/4223) L 2 Question Complexity B Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 2 Review tested concept Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK (OBQ10.168) A 29-year-old male volleyball player presents with a one year history of right shoulder weakness and deep aching pain. He denies any history of trauma or prior shoulder problems. A clinical photograph and representative sagittal MRI image are shown in Figures A and B respectively. He is diagnosed with a ganglion cyst of the shoulder. Based on the images provided, where is the cyst located? Tested Concept QID: 3261 FIGURES: A B Type & Select Correct Answer 1 Suprascapular notch 7% (160/2370) 2 Spinoglenoid notch 81% (1910/2370) 3 Quadrangular space 5% (122/2370) 4 Subscapular recess 6% (141/2370) 5 Triangular interval 1% (25/2370) L 1 Question Complexity A Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 2 Review tested concept Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK This is an AAOS Self Assessment Exam (SAE) question. Orthobullets was not involved in the editorial process and does not have the ability to alter the question. If you prefer to hide SAE questions, simply turn them off in your Learning Goals. (SAE07SM.89) A 22-year-old volleyball player reports the insidious onset of superior and posterior shoulder pain. Radiographs are normal. An MRI scan is shown in Figure 25. What is the most specific physical examination finding? Tested Concept QID: 8751 FIGURES: A Type & Select Correct Answer 1 Positive impingement sign 11% (38/341) 2 Positive apprehension 16% (54/341) 3 Positive active compression 14% (47/341) 4 Weakness of external rotation 49% (167/341) 5 Weakness of abduction 10% (34/341) L 4 Question Complexity D Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 4 Review tested concept This is an AAOS Self Assessment Exam (SAE) question. Orthobullets was not involved in the editorial process and does not have the ability to alter the question. If you prefer to hide SAE questions, simply turn them off in your Learning Goals. (SAE07SM.51) A 22-year-old professional baseball catcher has posterior shoulder pain and severe external rotation weakness with the arm in adduction. Radiographs are normal. MRI scans are shown in Figures 15a through 15c. Management should consist of Tested Concept QID: 8713 FIGURES: A B C Type & Select Correct Answer 1 aspiration and steroid injection. 13% (42/327) 2 rest. 4% (12/327) 3 acromioplasty. 1% (3/327) 4 arthroscopic repair and decompression. 73% (240/327) 5 rehabilitation. 9% (29/327) L 3 Question Complexity E Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 4 Review tested concept (SBQ07SM.51) A 34-year-old competitive weightlifter presents with increasing pain during bench pressing. Despite modifications in his workout, he is unable to compete. His physical exam demonstrates weakness in external rotation. Radiographs are unremarkable. His MRI findings are seen in Figure A. Treatment should include which of the following? Tested Concept QID: 1436 FIGURES: A Type & Select Correct Answer 1 Refrain from weightlifting for a minimum of 6 weeks 4% (91/2073) 2 Physical therapy with rotator cuff strengthening 7% (155/2073) 3 Suprascapular cyst decompression 6% (128/2073) 4 Infraspinatus rotator cuff repair and acromioplasty 4% (73/2073) 5 Spinoglenoid cyst decompression with posterior labral repair 78% (1616/2073) L 2 Question Complexity B Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 5 Review tested concept (OBQ07.107) A patient with shoulder pain and weakness has an MRI showing a cyst in the suprascapular notch. Which of the following muscles is most likely to show weakness? Tested Concept QID: 768 Type & Select Correct Answer 1 Deltoid 0% (4/2085) 2 Supraspinatus 4% (90/2085) 3 Supraspinatus and infraspinatus 86% (1785/2085) 4 Infraspinatus 9% (194/2085) 5 Teres minor 0% (10/2085) L 1 Question Complexity A Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 3 Review tested concept (OBQ05.131) A 24-year-old avid volleyball player has noted gradual onset of shoulder fatigue and weakness limiting his game. Radiographs done by his primary care physician were normal and he has failed to improve with 6 weeks of physical therapy. Given the MRI image shown in Figure A, this patients physical exam may reveal weakness with which of the following actions? Tested Concept QID: 1017 FIGURES: A Type & Select Correct Answer 1 Adduction 1% (17/2256) 2 Internal rotation 1% (33/2256) 3 Abduction and external rotation 54% (1210/2256) 4 Abduction 12% (261/2256) 5 External rotation 32% (712/2256) L 2 Question Complexity D Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 3 Review tested concept (OBQ05.15) A 21-year-old collegiate volleyball player is noted to have weakness in external rotation and isolated atrophy of the infraspinatus on physical examination as seen in Figure A. An axial MRI image is shown in Figure B. This clinical condition is most likely caused by compression of the: Tested Concept QID: 52 FIGURES: A B Type & Select Correct Answer 1 Axillary nerve at the triangular space 0% (2/667) 2 Suprascapular nerve in the suprascapular notch 9% (62/667) 3 Axillary nerve in the quadrangular space 2% (12/667) 4 Suprascapular nerve in the spinoglenoid notch 88% (585/667) 5 Long thoracic nerve anterior to the scalenus and the first rib and posterior to the clavicle 1% (4/667) L 1 Question Complexity A Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 4 Review tested concept (OBQ05.202) A patient is scheduled to undergo arthroscopy for a SLAP tear of his shoulder. Based on the sagittal images of the right shoulder MRI shown in Figure A, what additional physical exam finding is the patient likely to display? Tested Concept QID: 1088 FIGURES: A Type & Select Correct Answer 1 Weakness in forward elevation 4% (34/884) 2 Weakness in internal rotation 10% (92/884) 3 Weakness in external rotation 80% (709/884) 4 Positive impingement maneuver 4% (33/884) 5 Scapular winging 1% (11/884) L 2 Question Complexity A Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 3 Review tested concept (OBQ04.127) A 25-year-old volleyball player has recurrent right shoulder pain. On exam she has right shoulder weakness to external rotation with her arm at her side and atrophy below the scapular spine. There is no external rotation lag sign. Jobe drop arm and hornblower's tests are negative. The O'Brien's active compression test is positive. What will most likely be found on MRI of her shoulder? Tested Concept QID: 1232 Type & Select Correct Answer 1 Partial articular sided tear of the infraspinatus 4% (91/2323) 2 Partial articular sided tear of the supraspinatus 1% (31/2323) 3 Full thickness tear of the infraspinatus 5% (112/2323) 4 Inferior labral tear with quadrangular space cyst 3% (59/2323) 5 SLAP tear and spinoglenoid notch cyst 87% (2013/2323) L 1 Question Complexity C Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 5 Review tested concept
All Videos (10) Podcasts (1) Login to View Community Videos Login to View Community Videos SLAP with Spinoglenoid Cyst - Joo Han, Oh M.D., Ph.D. Shoulder & Elbow - Suprascapular Neuropathy 12/21/2020 46 views 0.0 (0) Login to View Community Videos Login to View Community Videos Arthroscopic Decompression of Spinoglenoid Notch Cyst & SLAP Repair Through a Single Working Portal Shoulder & Elbow - Suprascapular Neuropathy 12/16/2020 22 views 0.0 (0) Login to View Community Videos Login to View Community Videos 2018 Winter SKS Meeting: Shoulder, Knee, & Sports Medicine Suprascapular Neuropathy - Laurent Lafosse, MD (2.19, 2018 Winter SKS) Laurent Lafosse Shoulder & Elbow - Suprascapular Neuropathy B 7/16/2018 376 views 4.0 (4) Shoulder & Elbow⎪Suprascapular Neuropathy Team Orthobullets (5) Shoulder & Elbow - Suprascapular Neuropathy Listen Now 11:57 min 10/15/2019 131 plays 5.0 (1) See More See Less
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