Collin Philippe, Treseder Tom, Lädermann Alexandre, Benkalfate Tewfik, Mourtada Reda, Courage Olivier, Favard Luc
Saint-Grégoire Private Hospital Center, Saint-Grégoire, France.
Royal Melbourne Hospital, Parkville, Melbourne, VIC, Australia.
J Shoulder Elbow Surg. 2014 Jan;23(1):28-34. doi: 10.1016/j.jse.2013.07.039. Epub 2013 Sep 30.
An association between massive rotator cuff tear (RCT) and suprascapular nerve neuropathy has previously been suggested. The anatomic course of the suprascapular nerve is relatively fixed along its passage. Thus, injury to the nerve by trauma, compression, and iatrogenic reasons is well documented. However, the association between retraction of the RCT and development of neuropathy of the suprascapular nerve remains unclear. We aimed to prospectively evaluate the suprascapular nerve for preoperative neurodiagnostic abnormalities in shoulders with massive RCT.
A prospective study was performed in 2 centers. Fifty patients with retracted tears of both supraspinatus and infraspinatus were evaluated. This was confirmed with preoperative computed tomography arthrography, and the fatty infiltration of the affected muscles was graded. Forty-nine preoperative electromyograms were performed in a standardized fashion and the results analyzed twice.
Of 49 shoulders, 6 (12%) had neurologic lesions noted on electromyography: 1 suprascapular nerve neuropathy, 1 radicular lesion of the C5 root, 1 affected electromyogram in the context of a previous stroke, and 3 cases of partial axillary nerve palsy with a history of shoulder dislocation. No difference or diminution of the latency or amplitude of the electromyographic curve was found in the cases that presented significant fatty infiltration.
This study did not detect a suprascapular lesion in the majority of cases of massive RCT. With a low association of neuropathy with massive RCT, we find no evidence to support the routine practice of suprascapular nerve release when RCT repair is performed.
先前已有研究表明巨大肩袖撕裂（RCT）与肩胛上神经病变之间存在关联。肩胛上神经的解剖行程在其走行过程中相对固定。因此，创伤、压迫和医源性原因导致的该神经损伤已有充分记录。然而，RCT的回缩与肩胛上神经病变发展之间的关联仍不明确。我们旨在前瞻性评估巨大RCT患者肩部术前神经诊断异常情况的肩胛上神经。
在2个中心进行了一项前瞻性研究。对50例冈上肌和冈下肌均有回缩性撕裂的患者进行了评估。术前通过计算机断层扫描关节造影术予以证实，并对患侧肌肉的脂肪浸润情况进行分级。以标准化方式进行了49例术前肌电图检查，并对结果进行了两次分析。
在49例肩部病例中，6例（12%）在肌电图检查中发现有神经病变：1例肩胛上神经病变，1例C5神经根性病变，1例既往中风背景下的异常肌电图，以及3例有肩关节脱位病史的部分腋神经麻痹病例。在出现明显脂肪浸润的病例中，未发现肌电图曲线潜伏期或波幅有差异或降低情况。
本研究在大多数巨大RCT病例中未检测到肩胛上神经病变。鉴于神经病变与巨大RCT的关联较低，我们没有证据支持在进行RCT修复时常规进行肩胛上神经松解术。
