• The Journal of Korean Orthopaedic Ultrasound Society
• /
• v.7 no.1
• /
• pp.67-75
• /
• 2014

There are several kinds of regional nerve blockades, such as interscalene brachial plexus block, C5 root block, suprascapular nerve block, and axillary nerve block, which can be applied for anesthesia and postoperative pain control after shoulder surgeries. These regional nerve blockades have shown good results, but high failure rate and serious complications, such as phrenic nerve palsy, pneumothorax, and nerve injury, still remain. Ultrasound-guided intervention can increase the success rate of nerve blockades and reduce complications. We described the method of ultrasound-guided intervention for the regional nerve blockades around shoulder.

• Clinics in Shoulder and Elbow
• /
• v.26 no.2
• /
• pp.131-139
• /
• 2023

Background: Massive rotator cuff tears (RCTs) are complicated by muscle atrophy, fibrosis, and intramuscular fatty degeneration, which are associated with postoperative tendon-to-bone healing failure and poor clinical outcomes. We evaluated muscle and enthesis changes in large tears with or without suprascapular nerve (SN) injury in a rat model. Methods: Sixty-two adult Sprague-Dawley rats were divided into SN injury (+) and SN injury (-) groups (n=31 each), comprising tendon (supraspinatus [SSP]/infraspinatus [ISP]) and nerve resection and tendon resection only cases, respectively. Muscle weight measurement, histological evaluation, and biomechanical testing were performed 4, 8, and 12 weeks postoperatively. Ultrastructural analysis with block face imaging was performed 8 weeks postoperatively. Results: SSP/ISP muscles in the SN injury (+) group appeared atrophic, with increased fatty tissue and decreased muscle weight, compared to those in the control and SN injury (-) groups. Immunoreactivity was only positive in the SN injury (+) group. Myofibril arrangement irregularity and mitochondrial swelling severity, along with number of fatty cells, were higher in the SN injury (+) group than in the SN injury (-) group. The bone-tendon junction enthesis was firm in the SN injury (-) group; this was atrophic and thinner in the SN injury (+) group, with decreased cell density and immature fibrocartilage. Mechanically, the tendon-bone insertion was significantly weaker in the SN injury (+) group than in the control and SN injury (+) groups. Conclusions: In clinical settings, SN injury may cause severe fatty changes and inhibition of postoperative tendon healing in large RCTs. Level of evidence: Level Basic research, controlled laboratory study.

• Journal of Korean Neurosurgical Society
• /
• v.67 no.5
• /
• pp.568-577
• /
• 2024

Objective : Post-stroke shoulder pain (PSSP) is a common complication that limits the range of motion (ROM) of the shoulder, the patient's rehabilitation and in turn, affects the patients' quality of life (QoL). Several treatment modalities such as sling, positioning, strapping, functional electrical stimulation, and nerve block have been suggested in literatures, however none of the treatments had long-term effects for PSSP. In this study, the authors evaluated clinical efficacy of pulsed radiofrequency (PRF) neuromodulation on the suprascapular nerve for PSSP, and suggested it as a potential treatment with long-term effect. Methods : This retrospective case series was conducted at a single center, a private practice institution. From 2013 to 2021, 13 patients with PSSP underwent PRF neuromodulation of the suprascapular nerve. The primary outcome measure was the Visual analog scale (VAS) score. The secondary outcome measurements included the shoulder ROM, Disability assessment scale (DAS), modified Ashworth scale, modified Rankin scale (mRS), and EuroQol-5 dimension-3L questionnaire (EQ-5D-3L) scores. These parameters were evaluated before PRF modulation, immediately after PRF modulation, and every 3 months until the final follow-up visit. Results : Six men and seven women were enrolled, and all patients were followed-up for a minimum of 12 months. The mean VAS score was 7.07 points before PRF neuromodulation and 2.38 points immediately post-procedure. Shoulder ROM for abduction and flexion, DAS for pain, mRS, and EQ-5D-3L demonstrated marked improvement. No complications were reported. Conclusion : PRF neuromodulation of the suprascapular nerve is an effective modality in patients with PSSP, and has long-term effect of pain relief, improvement of QoL.

• The Academic Congress of Korean Shoulder and Elbow Society
• /
• 2009.03a
• /
• pp.206-206
• /
• 2009

• Anatomy and Cell Biology
• /
• v.56 no.4
• /
• pp.482-493
• /
• 2023

Understanding the anatomy of suprascapular area helps the clinicians and surgeons in management of any disability at the shoulder region. This work aimed to clear the different morphological and morphometrical types of suprascapular notch (SSN). Unknown 120 dry human scapulae of both sides and 60 formalin-embalmed cadaveric upper limbs (40 males and 20 females) were used in the present study. Three main morphological forms of SSN were reported: J, U, and V-shaped. J-shaped notch showed the highest incidence followed by U-shaped then V-shaped one. Morphometrically, type (III) notch was the most prevalent in both dry bones and cadavers, while the incidence of type (II) was the lowest form. Also, the measurements of superior transverse diameter, middle transverse diameter and vertical dimension of the different types of the notch showed no side or sex significant difference. The suprascapular foramen with ossified superior transverse scapular ligament (STSL) was seen in 5.8% of dry bones and 10% of cadaveric specimens. Fan and band-shaped ossified transverse scapular ligaments were reported. Absence of SSN was seen in 10.8% of dry bones, 7.5% of male and 10% of female specimens with left side predominance. V-shaped, absence, and ossified STSL were considered as predisposing factors of suprascapular nerve entrapment syndrome. Knowledge of the morphology and morphometric parameters of SSN is of great clinical significance for anatomists, radiologists, physiotherapists, orthopedics and neurosurgeons to perform good diagnosis and best planning for surgical or arthroscopic interventions within the shoulder region.

• Clinics in Shoulder and Elbow
• /
• v.22 no.4
• /
• pp.210-215
• /
• 2019

Background: This study was undertaken to evaluate early clinical outcomes of ultrasound-guided suprascapular nerve block (SSNB) using a proximal approach, as compared with subacromial steroid injection (SA). Methods: This retrospective study included a consecutive series of 40 patients of SSNB and 20 patients receiving SA, from August 2017 to August 2018. The visual analogue scale (VAS), American Shoulder Elbow Surgeon's score (ASES), University of California, Los Angeles score (UCLA), the 36 health survey questionnaire mental component summary (SF36-MCS), physical component summary (PCS), and range of motion (forward elevation, external rotation, and internal rotation) were assessed for clinical evaluations. Results: Compared with the baseline, VAS, and ranges of motion in the SSNB group significantly improved at the 4-week follow-up (VAS scores improved from $6.7{\pm}1.6$ to $4.3{\pm}2.4$, p<0.001; all ranges of motion p<0.05), while other variables showed no statistically significant differences. All clinical variables were significantly improved in the SA group (p<0.05). However, all clinical scores at the 4-week follow-up showed no significant difference between groups. Conclusions: Ultrasound-guided SSNB using proximal approach provides significant pain relief at 4-weeks after treatment, with statistically significant difference when compared with SA, suggesting that SSNB using proximal approach is a potentially useful option in managing shoulder pain. However, in the current study, it was less effective in improving shoulder function and health-related quality of life, compared with SA.

• The Korean Journal of Pain
• /
• v.5 no.2
• /
• pp.239-248
• /
• 1992

Two hundred sisty five patients who complained of neck pain with stiffness and pain of the suprascapular area were studied. In most cases the anatomical locations of pain were in the levator scapulae muscles or trapezius muscles. Hyperactivity of dorsal scapular nerve or spinal accessory nerve which innervate those muscles was thought to be responsible for these pains. The hyperactivity of the nerves may be due to the spasm of the sternocleidomastoid muscle and the scalenus medius muscle which the nerves meet during their courses to the levator scapulae or trapezius muscles. Therefore, spasmolytic treatment on the scalenus medius provided effective relief for neck or shoulder pain.

• Journal of the Korean Arthroscopy Society
• /
• v.13 no.2
• /
• pp.132-137
• /
• 2009

• The Korean Journal of Pain
• /
• v.7 no.1
• /
• pp.84-87
• /
• 1994

Retrospective analysis, of 1,734 patients treated for nerve block from October 1991 to March 1994. Largest percentage of patients were in the 50 year old range, with a distribution of 44.9% male and 55.1% female. Treatments were for ailments of: Low Back Pain 17.3%, Multiple Contusion 10.5%, and Cancer 10%. Most common nerve block was epidural block 38.6%, followed by stellate ganglion block 38.4%, intercostal block 5.4%, and suprascapular nerve block 5.2%. Nerve block under fluorscopic guide were as follows: facet joint block 34.1%, lumbar sympathetic ganglion block 13.6%, and celiac plexus block 12.9%.

• The Korean Journal of Pain
• /
• v.25 no.3
• /
• pp.168-172
• /
• 2012

Background: The aim of the study was to investigate the feasibility of fluoroscopy-guided anterior approach for suprascapular nerve block (SSNB). Methods: Twenty patients with chronic shoulder pain were included in the study. All of the nerve blocks were performed with patients in a supine position. Fluoroscopy was tilted medially to obtain the best view of the scapular notch (medial angle) and caudally to put the base of coracoid process and scapular spine on same line (caudal angle). SSNB was performed by introducing a 100-mm, 21-gauge needle to the scapular notch with tunnel view technique. Following negative aspiration, 1.0 ml of contrast was injected to confirm the scapular notch, and 1 % mepivacaine 2 ml was slowly injected. The success of SSNB was assessed by numerical rating scale (NRS) before and after the block. Results: The average NRS was decreased from $4.8{\pm}0.6$ to $0.6{\pm}0.5$ after the procedure (P < 0.05). The best view of the scapular notch was obtained in a medial angle of $15.1{\pm}2.2$ ($11-19^{\circ}$) and a caudal angle of $15.4{\pm}1.7^{\circ}$ ($12-18^{\circ}$). The average distance from the skin to the scapular notch was $5.8{\pm}0.6$ cm. None of the complications such as pneumothorax, intravascular injection, and hematoma formation was found except one case of partial brachial plexus block. Conclusions: SSNB by fluoroscopy-guided anterior approach is a feasible technique. The advantage of using a fluoroscopy resulted in an effective block with a small dose of local anesthetics by an accurate placement of a tip of needle in the scapular notch while avoiding pneumothorax.