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肩部神经卡压综合征的基础:一项探索影响肩胛上神经横截面积因素的超声研究

Basis of Shoulder Nerve Entrapment Syndrome: An Ultrasonographic Study Exploring Factors Influencing Cross-Sectional Area of the Suprascapular Nerve.

作者信息

Wu Wei-Ting, Chang Ke-Vin, Mezian Kamal, Naňka Ondřej, Lin Chih-Peng, Özçakar Levent

机构信息

Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Bei-Hu Branch and National Taiwan University College of Medicine, Taipei, Taiwan.

Department of Rehabilitation Medicine, First Faculty of Medicine, Charles University in Prague, Prague, Czechia.

出版信息

Front Neurol. 2018 Oct 23;9:902. doi: 10.3389/fneur.2018.00902. eCollection 2018.


DOI:10.3389/fneur.2018.00902
PMID:30405524
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC6205983/
Abstract

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.

摘要

由于神经的形状和大小变化是卡压性神经病常见的超声检查结果,神经横截面积(CSA)的测量成为区分正常与病变的最常用指标。最近,更多的超声研究致力于测量肩胛上切迹的形状和肩胛上神经的直径。鉴于肩胛上神经对各种肩部疾病至关重要,本研究旨在确定不同水平肩胛上神经大小的正常值,并探讨参与者特征对CSA测量的潜在影响。本研究采用横断面设计,调查从锁骨上区域至肩胛下切迹的肩胛上神经的CSA值。我们采用神经内膜内和神经内膜外方法,在超声成像上量化颈神经根(C5和C6)和肩胛上神经的CSA。对不同年龄和性别组的神经大小进行单因素比较。进行多因素分析以分析参与者特征对神经CSA的影响。进行重复测量方差分析,以检查肩胛上神经从起始部至冈下肌窝的CSA节段变化。我们的研究纳入了60名健康成年人的120个肩部,有三个主要发现:(1)神经内膜内方法在CSA测量方面比神经内膜外方法更可靠,因为其评分者内和评分者间可靠性更高;(2)女性的颈神经根和肩胛上神经最近端节段的尺寸较小;(3)使用神经内膜外方法,肩胛上神经在其远侧分支处的CSA大于锁骨中线近端部分。总之,神经内膜内方法在神经CSA评估方面具有更好的可靠性,但量化肩胛上神经远侧部分的大小需要神经内膜外方法。在评估最近端神经节段时应考虑CSA值的性别差异。使用神经内膜外方法时,肩胛上神经远侧段的估计值会大于其近端部分,且节段差异不应被误解为病变。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/765a/6205983/67562078afd0/fneur-09-00902-g0007.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/765a/6205983/313107826abb/fneur-09-00902-g0001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/765a/6205983/e90686b206b7/fneur-09-00902-g0002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/765a/6205983/e5098157bdff/fneur-09-00902-g0003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/765a/6205983/a3ee361cb14a/fneur-09-00902-g0004.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/765a/6205983/6100c90272cb/fneur-09-00902-g0005.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/765a/6205983/a42724278b5a/fneur-09-00902-g0006.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/765a/6205983/67562078afd0/fneur-09-00902-g0007.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/765a/6205983/313107826abb/fneur-09-00902-g0001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/765a/6205983/e90686b206b7/fneur-09-00902-g0002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/765a/6205983/e5098157bdff/fneur-09-00902-g0003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/765a/6205983/a3ee361cb14a/fneur-09-00902-g0004.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/765a/6205983/6100c90272cb/fneur-09-00902-g0005.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/765a/6205983/a42724278b5a/fneur-09-00902-g0006.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/765a/6205983/67562078afd0/fneur-09-00902-g0007.jpg

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[4]
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本文引用的文献

[1]
A Cadaver Study Investigating Structures Encountered by the Needle During a Retroclavicular Approach to Infraclavicular Brachial Plexus Block.

Reg Anesth Pain Med. 2018-10

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The Influence of Suprascapular Notch Shape on the Visualization of Structures in the Suprascapular Notch Region: Studies Based on a New Four-Stage Ultrasonographic Protocol.

Biomed Res Int. 2017-12-20

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Accuracy of Ultrasonography for the Diagnosis of Carpal Tunnel Syndrome: A Systematic Review and Meta-Analysis.

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Clin Neurophysiol. 2017-8

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Pain Physician. 2016

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Am J Phys Med Rehabil. 2016-11

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Can Quantification of Biceps Peritendinous Effusion Predict Rotator Cuff Pathologies?: A Retrospective Analysis of 1352 Shoulder Ultrasound.

Am J Phys Med Rehabil. 2016-3

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Comparison of the Effectiveness of Suprascapular Nerve Block With Physical Therapy, Placebo, and Intra-Articular Injection in Management of Chronic Shoulder Pain: A Meta-Analysis of Randomized Controlled Trials.

Arch Phys Med Rehabil. 2016-8

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