Plancher Kevin D, Luke Timothy A, Peterson Robert K, Yacoubian Stephen V
Plancher Orthopaedics & Sports Medicine, New York, New York 10128, USA.
Arthroscopy. 2007 Sep;23(9):991-8. doi: 10.1016/j.arthro.2007.03.098.
The purpose of this study was to determine the pressure exerted on the suprascapular nerve by compression of the spinoglenoid ligament during glenohumeral range of motion. In addition, a 2-portal technique was described to arthroscopically visualize and safely release the spinoglenoid ligament while visualizing the suprascapular nerve, artery, and vein.
Ten cadaveric shoulders were used for visual observation of variation in the position and tension of the spinoglenoid ligament. In 15 additional shoulders, a transducer was used to sense the pressure changes and was recorded in voltage. Pressure changes created by the spinoglenoid ligament on the distal suprascapular nerve in the scapular tunnel during glenohumeral motion were recorded.
Internal rotation, rather than external rotation, in any position of the shoulder created a visual increase of tension in the spinoglenoid ligament. Increased pressure readings were noted with internal rotation and with 90 degrees of abduction, full abduction, and full adduction of the shoulder. The suprascapular nerve occupying the space created by the spinoglenoid ligament experiences an increased pressure during glenohumeral range of motion and positions that mimic overhead throwing. The dynamic nature of the ligament with its insertion on the posterior capsule required a new minimally invasive technique for its release that can be safe and straightforward.
The spinoglenoid ligament was affected by the position of the glenohumeral joint. These changes in pressure in combination with repetitive shoulder movement are likely components that cause repeated trauma or compression on the distal suprascapular nerve created by a scapular tunnel syndrome. The surgical technique provides a treatment option when conservative treatment fails in the patient with posterior shoulder pain.
The spinoglenoid ligament was affected by the position of the shoulder, with the most pressure noted with the arm in full adduction and internal rotation. This pressure can be treated with arthroscopic release.
本研究的目的是确定在盂肱关节活动范围内，肩胛下肌上盂肱韧带受压时对肩胛上神经施加的压力。此外，还描述了一种双切口技术，用于在关节镜下可视化并安全地松解肩胛下肌上盂肱韧带，同时观察肩胛上神经、动脉和静脉。
使用10具尸体肩部进行肩胛下肌上盂肱韧带位置和张力变化的视觉观察。在另外15具肩部中，使用传感器感应压力变化并以电压形式记录。记录在盂肱关节活动期间，肩胛下肌上盂肱韧带在肩胛隧道内对肩胛上神经远端产生的压力变化。
在肩部的任何位置，内旋而非外旋会使肩胛下肌上盂肱韧带的张力明显增加。在内旋以及肩部外展90度、完全外展和完全内收时，压力读数增加。在盂肱关节活动范围以及模拟过头投掷的位置时，占据肩胛下肌上盂肱韧带所形成空间的肩胛上神经会受到更大压力。由于该韧带附着于后关节囊的动态特性，需要一种新的微创技术来安全、直接地进行松解。
肩胛下肌上盂肱韧带受盂肱关节位置的影响。这些压力变化与重复性肩部运动相结合，可能是导致肩胛隧道综合征对肩胛上神经远端造成反复创伤或压迫的因素。当保守治疗对后肩部疼痛患者无效时，该手术技术提供了一种治疗选择。
肩胛下肌上盂肱韧带受肩部位置影响，当手臂完全内收和内旋时压力最大。这种压力可通过关节镜松解进行治疗。
