Wu Wei-Ting, Chen Lan-Rong, Chang Hsiang-Chi, Chang Ke-Vin, Özçakar Levent
Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Bei-Hu Branch, Taipei, Taiwan.
Department of Physical Medicine and Rehabilitation, Cheng Hsin General Hospital, Taipei, Taiwan.
Front Bioeng Biotechnol. 2021 Feb 19;9:640747. doi: 10.3389/fbioe.2021.640747. eCollection 2021.
Older people are vulnerable to painful shoulder syndromes, the majority of which are derived from degenerative rotator cuff pathologies. The suprascapular nerve (SSN) is closely related to the rotator cuff complex, and its role in shoulder pain has recently been highlighted. This study aimed to explore the differences in SSN among older people with and without shoulder pain, and to investigate the potential factors influencing the nerve size using ultrasound (US) imaging.
Participants aged ≥60 years were enrolled in the study. A systematic and bilateral US examination of the rotator cuff tendons was performed. The SSN was examined from its origin in the brachial plexus to the spinoglenoid notch of the infraspinatus fossa. The association between the nerve's cross-sectional area (CSA) and rotator cuff lesions was analyzed using the generalized estimation equation.
Among the 94 participants, 45 (with bilaterally asymptomatic shoulders) were classified into the control group, whereas 49 (with at least one-sided shoulder pain) were classified into the group with shoulder pain. The average CSAs of the SSN at the level of the brachial plexus, supraspinatus fossa, and infraspinatus fossa were comparable between the patients in the control group and those with shoulder pain. There was a higher prevalence of rotator cuff lesions and enlarged distal SSNs in the painful shoulders than in the asymptomatic shoulders of patients with unilateral involvement. A full-thickness tear of the supraspinatus tendon was associated with swelling of the SSN in the supraspinatus fossa (β coefficient = 4.068 mm, < 0.001).
In the older population, full-thickness tears of the supraspinatus tendon are independently associated with enlargement of the distal SSN. In cases with large rotator cuff tendon tears with poor response to conservative treatments, possible SSN entrapment should be considered and managed accordingly.
老年人易患肩部疼痛综合征，其中大多数源于退行性肩袖病变。肩胛上神经（SSN）与肩袖复合体密切相关，其在肩部疼痛中的作用最近受到关注。本研究旨在探讨有或无肩部疼痛的老年人肩胛上神经的差异，并利用超声（US）成像研究影响神经大小的潜在因素。
纳入年龄≥60岁的参与者。对肩袖肌腱进行系统的双侧超声检查。检查肩胛上神经从臂丛神经起始处至冈下肌窝的肩胛下切迹。使用广义估计方程分析神经横截面积（CSA）与肩袖损伤之间的关联。
94名参与者中，45名（双侧肩部无症状）被归入对照组，而49名（至少一侧肩部疼痛）被归入肩部疼痛组。对照组患者与肩部疼痛患者在臂丛神经、冈上肌窝和冈下肌窝水平的肩胛上神经平均CSA相当。单侧受累患者中，疼痛肩部的肩袖损伤和远端肩胛上神经增粗的患病率高于无症状肩部。冈上肌腱全层撕裂与冈上肌窝内肩胛上神经肿胀相关（β系数 = 4.068 mm，< 0.001）。
在老年人群中，冈上肌腱全层撕裂与远端肩胛上神经增粗独立相关。对于肩袖肌腱大撕裂且保守治疗反应不佳的病例，应考虑并相应处理可能的肩胛上神经卡压。
