2004 Volume 28 Issue 3 Pages 569-572
We used a trapezius-splitting surgical approach when we performed an operation on the suprascapular notch. We reported on the safety and usefulness of this approach. To elucidate the safe limits for musclesplitting incisions of the trapezius muscles,5bodies (10 cadaver shoulders) were studied (2 males / 3 females, age: 54∼82, the average: 78). To evaluate the usefulness of this approach, we investigated the operative findings in 3 cases of suprascapular nerve palsy with a trapezius-splitting. The spinal accessory nerve was found to run a vertical course medial and parallel to the vertebral border of the scapula. Three to six nerve branches also ran a vertical course lying between 35% and 48% of the distance from the vertebral spinous processes to the acromion. The most lateral branch lay on average at 45% distance and never beyond 50%. In 3 cases of the trapezius-splitting surgical approach, we could get excellent exposure of the suprascapular vessels / nerve, which gave us a good view for the operation. No case had a spinal accessory nerve injury after the operation. To split the muscle in the direction of the fibers is useful for getting excellent exposure, and it made the operation easy. However, splitting of the muscle has a risk of injury to the neurovascular structures. There are a number of reports about the position of the axillary nerve in the deltoid. Comparing this to that, there have been few reports about the position of the accessory nerve in the trapezius. From this examination, we concluded that the trapezius-splitting surgical approach for decompression of the suprascapular nerve is safe and useful when it is done in the lateral 50% of the muscle.
