Case series of 18 scapula fractures examining whether residual shoulder disability comes from suprascapular nerve injury at the scapular notch. It asks how often type III fractures involve the notch and how best to image it. The study also tests EMG for confirming nerve injury.
When a scapula fracture involves the superior lateral angle (DeCoulx type III), think about the suprascapular nerve at the notch. The key trap is imaging: standard AP and lateral views hide the notch behind the scapular spine, so the fracture and the nerve risk get missed. This paper showed the notch was seen on only 3 of 18 conventional films but on all 7 with a caudally angled AP view.
Remember the anatomy that makes this matter: the suprascapular nerve (C4-C6) runs under the transverse scapular ligament and drives the supraspinatus and infraspinatus, so notch injury shows up as supraspinatus weakness. When you see reduced supraspinatus strength after a notch fracture, get an EMG to confirm nerve injury, and consider decompression if it is proven.
This is a small case series, so it establishes the association and the imaging pearl, not the true incidence of nerve injury.
Case series of 18 scapula fractures examining whether residual shoulder disability comes from suprascapular nerve injury at the scapular notch. It asks how often type III fractures involve the notch and how best to image it. The study also tests EMG for confirming nerve injury.
When a scapula fracture involves the superior lateral angle (DeCoulx type III), think about the suprascapular nerve at the notch. The key trap is imaging: standard AP and lateral views hide the notch behind the scapular spine, so the fracture and the nerve risk get missed. This paper showed the notch was seen on only 3 of 18 conventional films but on all 7 with a caudally angled AP view.
Remember the anatomy that makes this matter: the suprascapular nerve (C4-C6) runs under the transverse scapular ligament and drives the supraspinatus and infraspinatus, so notch injury shows up as supraspinatus weakness. When you see reduced supraspinatus strength after a notch fracture, get an EMG to confirm nerve injury, and consider decompression if it is proven.
This is a small case series, so it establishes the association and the imaging pearl, not the true incidence of nerve injury.