Demirhan M, Imhoff A B, Debski R E, Patel P R, Fu F H, Woo S L
Department of Orthopaedic Surgery, University of Pittsburgh, PA 15213, USA.
J Shoulder Elbow Surg. 1998 May-Jun;7(3):238-43. doi: 10.1016/s1058-2746(98)90051-9.
Entrapment of the suprascapular nerve by the inferior transverse scapular ligament or spinoglenoid ligament (SGL) has been discussed frequently in the literature, but it has not been well documented anatomically. Therefore the mechanism of entrapment is not well understood. When isolated atrophy and denervation of the infraspinatus muscle have been noted, compression of the muscle's motor branch at the spinoglenoid notch has been implicated. This anatomic and morphologic study investigates the role of the SGL in entrapment neuropathy of the infraspinatus. We used 23 shoulders from 19 cadavers, 5 women (8 shoulders) and 14 men (15 shoulders), with a mean age of 67.9 (54 to 78) years. The presence or absence of the SGL was noted. The length, width, and orientation of the SGL; size and shape of the tunnel to the infraspinatus fossa; and distance of the notch to the posterior glenoid rim were determined. The SGL was present in 14 (60.8%) shoulders, 5 (36%) women and 9 (64%) men. The SGL was wider at the superior entrance of the tunnel and fanned and twisted toward the inferior aspect. In all specimens the SGL fibers inserted into the posterior shoulder capsule. The mean length for the upper part of the SGL was 17.5 +/- 2.6 mm in men and 15.8 +/- 1.8 mm in women, and the lower part was 14.1 +/- 2.4 mm and 12.9 +/- 1.8 mm, respectively. The widths of the SGL at the origin of the scapular spine were 12.2 +/- 3.9 mm for men and 10.4 +/- 2.7 mm for women, whereas the insertion site widths were 15.8 +/- 2.2 mm for men, and 16.1 +/- 3.8 mm for women. The midportion width of the SGL was 6.8 +/- 1.9 mm in men and 5.8 +/- 2.1 mm in women. During cross-body adduction and internal rotation of the glenohumeral joint, the interaction of the SGL and the posterior capsule resulted in a tightening of the SGL. The suprascapular nerve moved laterally and stretched underneath the SGL in this position.
肩胛下横韧带或肩胛冈下韧带（SGL）卡压肩胛上神经的情况在文献中已有频繁讨论，但在解剖学上尚未得到充分记录。因此，卡压机制尚未完全明确。当发现冈下肌出现孤立性萎缩和失神经支配时，人们认为是其运动支在肩胛冈下切迹处受到了压迫。本解剖学和形态学研究旨在探讨肩胛冈下韧带在冈下肌卡压性神经病变中的作用。我们使用了来自19具尸体的23个肩部标本，其中女性5例（8个肩部），男性14例（15个肩部），平均年龄为67.9岁（54至78岁）。记录肩胛冈下韧带的有无。测定肩胛冈下韧带的长度、宽度和走向；通向冈下窝的隧道的大小和形状；以及切迹到关节盂后缘的距离。14个（60.8%）肩部存在肩胛冈下韧带，其中女性5个（36%），男性9个（64%）。肩胛冈下韧带在隧道的上入口处较宽，向下呈扇形展开并扭转。在所有标本中，肩胛冈下韧带纤维均插入后肩囊。肩胛冈下韧带上部的平均长度男性为17.5±2.6毫米，女性为15.8±1.8毫米，下部平均长度男性为14.1±2.4毫米，女性为12.9±1.8毫米。肩胛冈下韧带在肩胛冈起点处的宽度男性为12.2±3.9毫米，女性为10.4±2.7毫米，而在插入点处的宽度男性为15.8±2.2毫米，女性为16.1±3.8毫米。肩胛冈下韧带中部的宽度男性为6.8±1.9毫米，女性为5.8±2.1毫米。在盂肱关节进行体侧内收和内旋时，肩胛冈下韧带与后囊的相互作用导致肩胛冈下韧带收紧。在此位置，肩胛上神经向外侧移动并在肩胛冈下韧带下方伸展。
