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肩胛上神经评估与管理。

The Evaluation and Management of Suprascapular Neuropathy.

机构信息

From the Division of Sports Medicine, NYU Langone Orthopedics. New York, NY.

出版信息

J Am Acad Orthop Surg. 2020 Aug 1;28(15):617-627. doi: 10.5435/JAAOS-D-19-00526.

Abstract

Suprascapular neuropathy is a potential source of shoulder pain and functional limitation that can present secondary to various etiologies including entrapment or compression. Cystic lesions arising from a labral or capsular tear can compress the nerve along its course over the scapula. Nerve traction is theorized to arise from chronic overhead athletics or due to a retracted rotator cuff tear. The diagnosis of suprascapular neuropathy is based on a combination of a detailed history, a comprehensive physical examination, imaging, and electrodiagnostic studies. Although the anatomic course and variations in bony constraint are well understood, the role of surgical treatment in cases of suprascapular neuropathy is less clear. Recent reviews on the topic have shed light on the outcomes after the treatment of suprascapular neuropathy because of compression, showing that surgical release can improve return to play in well-indicated patients. The incidence of compressive neuropathy is quite high in the overhead athletic cohort, but most patients do not show clinically relevant deficiencies in function. Surgical release is therefore not routinely recommended unless patients with pain or deficits in strength fail appropriate nonsurgical treatment.

摘要

肩胛上神经病变是肩部疼痛和功能受限的一个潜在原因,可能由多种病因引起,包括卡压或压迫。盂唇或肩袖撕裂引起的囊性病变可在肩胛上沿神经走行压迫神经。神经牵拉理论上源于慢性过顶运动或回缩性肩袖撕裂。肩胛上神经病变的诊断基于详细的病史、全面的体格检查、影像学和电诊断研究。尽管神经的解剖路径和骨骼限制的变化已经得到很好的理解,但在肩胛上神经病变的情况下,手术治疗的作用还不太清楚。最近关于这个主题的综述阐明了因压迫导致的肩胛上神经病变的治疗结果,表明手术松解可以改善有适应证的患者重返运动的能力。在过顶运动人群中,压迫性神经病的发生率相当高,但大多数患者的功能没有明显的临床缺陷。因此,除非疼痛或力量缺陷的患者对非手术治疗无效,否则通常不推荐手术松解。

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