Abstract
Purpose
To report atypical anatomical variation of an osseous suprascapular canal, and to elaborate on its clinical significance as a potential anatomical factor that could obscure a direct posterior surgical approach and suprascapular nerve block.
Methods
Osteological observational study of the scapula with emphasis on the suprascapular space. The pool of investigated sample size was collectively 768 specimens composed of 529 adult dry scapulae (240 paired, 289 un-paired), 54 children dry scapulae, 135 wet scapulae observed during cadaveric dissections, 47 retrospective 3D CT reconstructions, and 3 retrospective full sequence shoulder MRI. The two reported cases came from the 240 (120 skeleton) observed paired scapulae. Furthermore, the osseous suprascapular canal was examined by X-rays and its internal path was exposed by CT sections. A narrative review was conducted to investigate any relevant reports on the subject matter.
Results
Two left dry bone scapulae with unilateral osseous suprascapular canal were found. The incidence of this atypical morphology of an osseous canal is probably five cases reported in three studies including this cases study.
Conclusions
The reported cases aid in explaining additional possible anatomical factors that could lead to below threshold anesthetic effect in posterior suprascapular nerve block procedures. Therefore, it is more practical to visualize the suprascapular canal by some imaging method before attempting to blindly access the suprascapular nerve in nerve block or posterior surgical approach due to the rare potential existence of an ossified barrier hindering the procedure.
Level of evidence
V Basic Science Research.
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Acknowledgements
The authors would like to acknowledge and thank Marek Jantač (Department of Anthropology, National Museum, Prague) for performing the radiographs; Martin Horák (Department of Radiology, Hospital Na Homolce, Prague) for creating the CT scans; Carl V. L. Olson (Department of Anatomy, Second Faculty of Medicine, Charles University, Prague) for his help in taking the specimens photos; Radovan Hudák (Department of Anatomy and Department of Orthopedics, Second Faculty of Medicine, Charles University, Prague) for his help with access to retrospective images; Aimilia Theodorakioglou, Sayed Mehdi Sadat and Michal Benes (Department of Anatomy, Second Faculty of Medicine, Charles University, Prague) for their help with the specimens observations. The authors sincerely thank those who donated their bodies to science so that anatomical research could be performed. Results from such research can potentially increase mankind's overall knowledge that can then improve patient care. Therefore, these donors and their families deserve our highest gratitude.
Funding
This work was supported by The Grant Agency of Charles University (GAUK No. 1720119), and the Ministry of Culture of the Czech Republic (DKRVO 2019–2023/7.I.d, 00023272).
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AA-R: principle researcher, conceptualization, methodology, investigation, visualization, project administration, funding acquisition, writing—original draft. SS: formal analysis. JC: resources, funding acquisition. JV: resources. PV: resources, supervision, visualization. DK: supervision, validation, writing—review and editing. All authors have read and approved the manuscript.
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The ethical and legal access to specimens was approved for research and education purposes by the Institutional Review Board (IRB) The Ethics Committee of the University Hospital Motol and Second Faculty of Medicine, Charles University, in Prague, Czech Republic [Reference ID no. EK-353/19].
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Al-Redouan, A., Salavova, S., Cvrček, J. et al. Osseous suprascapular canal: rare variant that would hinder suprascapular nerve block and posterior surgical approach. Surg Radiol Anat 44, 1507–1511 (2022). https://doi.org/10.1007/s00276-022-03045-z
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DOI: https://doi.org/10.1007/s00276-022-03045-z