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Groove in the superior border of the scapula, for the suprascapular nerve to pass through
The suprascapular notch (or scapular notch ) is a notch in the superior border of the
scapula , just medial to the base of the
coracoid process .
[1] It is converted into the
suprascapular canal by the
suprascapular ligament .
[2]
Structure
This notch is converted into a
foramen by the
suprascapular ligament , and serves for the passage of the
suprascapular nerve .
[2] The suprascapular vessels vary in number as well as in their course as they run at the suprascapular notch site. The
suprascapular artery pass above the
suprascapular ligament in most cases. The
suprascapular vein may pass through the suprascapular notch or it may instead pass superior to the
suprascapular ligament .
[3]
[1]
Types
Two main classification systems exist; others are modified approaches of the same principle.
Typing based on subjective observation of the suprascapular notch shape.
Introduced by
Hrdicka 1942 and modified by
Rengachary et al. 1979
There are six basic types of scapular notch:
Type I: Notch is absent. The superior border forms a wide depression from the medial angle to the coracoid process.
Type II: Notch is a blunted V-shape occupying the middle third of the superior border.
Type III: Notch is U-shaped with nearly parallel margins.
Type IV: Notch is V-shaped and very small. A shallow groove is frequently formed for the suprascapular nerve adjacent to the notch.
Type V: Notch is minimal and U-shaped with a partially ossified ligament.
Type VI: Notch is a
foramen as the ligament is completely ossified.
[4]
Typing based on parametric measurements of depth to upper width ratio of the suprascapular notch
Introduced by
Natsis et al. 2007 and modified by
Polguj et al. 2011
There are five basic types of scapular notch:
Type I: Depth larger than upper width.
Type II: Depth equal to upper width.
Type III: Depth is smaller than upper width.
Type IV: Notch is a
foramen .
Type V: Discrete notch.
The second method of suprascapular notch typing yields more practical approach in clinical diagnosis of the
suprascapular nerve entrapment .
[5]
Clinical significance
As the suprascapular nerve passes through the suprascapular notch, it is a common site of entrapment for the nerve.
[1]
[6]
[7]
Suprascapular notch
stenosis is a narrowing of the notch internal space that can potentially compress the suprascapular nerve leading to
suprascapular nerve entrapment .
Al-Redouan et al. 2020 predicted the morphological pattern of the suprascapular notch
stenosis revealing higher incidence in the discrete notch (Type V according to the parametric measurements typing system). There are two main suprascapular
stenosis patterns:
[5]
Vertical stenosis. Treated surgically by cutting the
suprascapular ligament (ligamentectomy).
Horizontal stenosis. Treated surgically by trimming the notch borders (
osteoplasty ).
The suprascapular nerve predictably passes through the suprascapular notch, so it is a good place for a local
nerve block of the entire nerve.
[8]
[9]
Additional images
Left scapula. Suprascapular notch shown in red.
Animation. Suprascapular notch shown in red.
Left
scapula .
Dorsal surface . (Sup. notch visible at top center.)
Costal surface of left scapula. Suprascapular notch labeled at top center.
See also
References
^
a
b
c Al-Redouan, Azzat; Holding, Keiv; Kachlik, David (2021).
" "Suprascapular canal": Anatomical and topographical description and its clinical implication in entrapment syndrome" . Annals of Anatomy . 233 : 151593.
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10.1016/j.aanat.2020.151593 .
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32898658 .
^
a
b Nathan, Jay K.; McGillicuddy, John E. (2015-01-01), Tubbs, R. Shane; Rizk, Elias; Shoja, Mohammadali M.; Loukas, Marios (eds.),
"Chapter 38 - Anatomy of the Ventral Rami, Upper Trunk, and Its Divisions and Branches" , Nerves and Nerve Injuries , San Diego: Academic Press, pp. 527–535,
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^ Polguj, Michał; Rożniecki, Jacek; Sibiński, Marcin; Grzegorzewski, Andrzej; Majos, Agata; Topol, Mirosław (2015).
"The variable morphology of suprascapular nerve and vessels at suprascapular notch: a proposal for classification and its potential clinical implications" . Knee Surg Sports Traumatol Arthrosc . 23 (5): 1542–1548.
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10.1007/s00167-014-2937-1 .
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^
a
b Al-Redouan, Azzat; Hudak, Radovan; Nanka, Ondrej; Kachlik, David (2020).
"The morphological stenosis pattern of the suprascapular notch is revealed yielding higher incidence in the discrete type and elucidating the inevitability of osteoplasty in horizontally oriented stenosis" . Knee Surg Sports Traumatol Arthrosc . 29 (7): 2272–2280.
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^ Preston, David C.; Shapiro, Barbara E. (2013-01-01), Preston, David C.; Shapiro, Barbara E. (eds.),
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^ Bouche, P. (2013-01-01), Said, Gérard; Krarup, Christian (eds.),
"Chapter 19 - Compression and entrapment neuropathies" , Handbook of Clinical Neurology , Peripheral Nerve Disorders, 115 , Elsevier: 311–366,
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^ Wilkinson, Laura J.
"Defunct DOI" . Crossref .
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^ Molloy, Robert E. (2005-01-01), Benzon, Honorio T.; Raja, Srinivasa N.; Molloy, Robert E.; Liu, Spencer S. (eds.),
"Chapter 75 - Truncal Blocks: Intercostal, Paravertebral, Interpleural, Suprascapular, Ilioinguinal, and Iliohypogastric Nerve Blocks" , Essentials of Pain Medicine and Regional Anesthesia (Second Edition) , Philadelphia: Churchill Livingstone, pp. 636–644,
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This article incorporates text in the
public domain from
page 204 of the 20th edition of
Gray's Anatomy (1918)
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