Neurological Problems around shoulder
Suprascapular Nerve (C5,6 ) Injury
Compression
due to Ganglion , Labral tears
Above spinoglenoid notch - Supra/infra-scapular muscles
Below spinoglenoid notch with infracspinatus muscle
Clinical features
Lateral shoulder pain
Wasting of supraspinatus /infraspinatus muscles
Loss of abduction and external rotation
Management
EMGs
NCS
Treatment
Trapezius muscle splitting approach
decompress notch
arthroscopic debridement of notch
Long Thoracic Nerve (C5-7 )
Neuorolysis
Pectoralis Major transfer
Spinal Accessory Nerve Injury
Mx
Non-operative after more than 12 months with good compensation
Options - Neurolysis ,direct repair with nerve grafting , muscle transfer ,scapulothoracic fusion
Thoracic Outlet Syndrome
Causes
Cervical rib, anomalous scalenius
Types
Neurogenic - Upper Plexus Type
Lower Plexus Type
Vascular
sites of compression
as plexus passes over first rib
under clavicle by subclavian tendon
underneath coracoid process
Provocative
Adson , Wright ,Roos
Investigations
Plain radiographs of Chest and Spine
CT- for suspected bony anomaly
MRI - for cervical pathology , tumor or radiation plexitis
Doppler arteriography /Venography
EMG and NCS
Treatment
Physiotherapy
Ist rib resection , release or excision of scalene anterior and middle muscles
via transaxillary or supraclavicular approach
Venous thrombolysis or arterial thrombectomy and vascular reconstruction
Compression
due to Ganglion , Labral tears
Above spinoglenoid notch - Supra/infra-scapular muscles
Below spinoglenoid notch with infracspinatus muscle
Clinical features
Lateral shoulder pain
Wasting of supraspinatus /infraspinatus muscles
Loss of abduction and external rotation
Management
EMGs
NCS
Treatment
Trapezius muscle splitting approach
decompress notch
arthroscopic debridement of notch
Long Thoracic Nerve (C5-7 )
Neuorolysis
Pectoralis Major transfer
Spinal Accessory Nerve Injury
Mx
Non-operative after more than 12 months with good compensation
Options - Neurolysis ,direct repair with nerve grafting , muscle transfer ,scapulothoracic fusion
Thoracic Outlet Syndrome
Causes
Cervical rib, anomalous scalenius
Types
Neurogenic - Upper Plexus Type
Lower Plexus Type
Vascular
sites of compression
as plexus passes over first rib
under clavicle by subclavian tendon
underneath coracoid process
Provocative
Adson , Wright ,Roos
Investigations
Plain radiographs of Chest and Spine
CT- for suspected bony anomaly
MRI - for cervical pathology , tumor or radiation plexitis
Doppler arteriography /Venography
EMG and NCS
Treatment
Physiotherapy
Ist rib resection , release or excision of scalene anterior and middle muscles
via transaxillary or supraclavicular approach
Venous thrombolysis or arterial thrombectomy and vascular reconstruction
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