In a material consisting of 18 patients with scapula fractures, the scapular notch was involved in two cases. In one of these cases injury of the suprascapular nerve function was proved. The value of X-ray examination with projections visualizing the scapular notch is pointed out. EMG examination in selected cases with the combination of reduced supraspinatus muscle function and a fracture of the scapular notch is recommended in order to diagnose injury of the suprascapular nerve.
The essential considerations to be taken for the design of a composite elasto-dynamic intervertebral disc prosthesis (IDP) are discussed, and a disc implant, supposedly satisfying the demands for surgical and biomechanical applicability and biocompatibility, are outlined. The suggested IDP implant is composed of an elastic kernel, covered in a two-components telescoping shell, situated in a polymer slit-tube fundament, after preparation fixed to the respective vertebral bodies of the respective motion segment with bone cement. The approach to a lumbar motion segment is suggested to be by way of an abdominal and retroperitoneal incision and exploration.
Block of the suprascapular nerve in the treatment of shoulder pain has been suggested by Bonica 1953, Gordh 1969, Moore 1962, and others.The nerve innervates the two spinatus muscles, parts of the shoulder joint capsule, and also the acromioclavicular joint. The nerve passes the suprascapular notch. Using a thin lumbar puncture needle, 10–15 ml of 1% mepivacaine (Carbocain®) without adrenaline is slowly deposited into and through the notch.Pain relief has been obtained within a few minutes in ten of the twelve patients. Pain was troublesome in two patients, one with a subclavicular dislocation. A reduction technique, using traction of the arm along the neck of the scapula in simultaneous manipulation of the head of the humerus, was successful in all patients.If anaesthesia is necessary at all, if one of the other methods is unsuitable or contra‐indicated, the suprascapular nerve block is suggested as an alternative to general anaesthesia or supraclavicular plexus anaesthesia.ZUSAMMENFASSUNGBlockade des N.suprascapularis wurde zur Behandlung von Schulterschmerzen von Bonica (1953), Gordh (1969), Moore (1962) und anderen vorgeschlagen.Der Nerv innerviert die beiden Mm.spinati, Teile des Schultergelenks, sowie das Acromioclaviculargelenk. Der Nerv zieht durch die supra‐scapuläre Kerbe. Mittels einer dünnen Lumbal‐punkturnadel werden 10‐15 ml einer 1 %igen Mepivacain ‐ (Carbocain®)‐Lösung ohne Adrenalin langsam in und durch die Kerbe deponiert.Shmerzleichterung wurde innerhalb weniger Minuten bei 10 von 12 Patienten erzielt. Bei zwei Patienten, einer davon mit subclaviculärer Dislokation, war der Schmerz besonders störend. Eine Technik des Einrenkens, bei der Zug am Arm entlang dem Hals der Scapula bei gleichzeitigen Manipulationen am Humeruskopf angewandt wurde, war bei allen Patienten erfolgreich.Falls überhaupt eine Anaesthesie notwendig ist und eine der anderen Methoden sich als ungeeignet oder kontraindiziert erweisen sollte, wird die Blockade des N.suprascapularis als Alternativmethode zur Allgemeinnarkose oder supraclaviculären Plexusanaesthesie vorgeschlagen.
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