An osteological study of measurement of safe zone to prevent iatrogenic suprascapular nerve injury and its correlation with type of suprascapular notch


  • Hamzah M. Hafezji Department of Anatomy, Surat Municipal Institute of Medical Education and Research, Surat, Gujarat, India



Iatrogenic injury, Safe zone, Suprascapular nerve, Suprascapular notch


Background: Suprascapular nerve injury is commonly recognized as a cause of post-operative shoulder pain and rotator muscle dysfunction. The nerve may be injured during open or arthroscopic shoulder surgeries, due to its proximity to the operative field, particularly at the suprascapular and spinoglenoid notches. ‘Safe zone’ is defined as an area within which iatrogenic injury to the suprascapular nerve is likely to be avoided and it presents definitive limits. Aims of study were to identify morphometric variations of suprascapular notch (SSN), to measure distances from commonly used surgical landmarks to the possible course of suprascapular nerve so as to identify safe zone and to correlate safe zone with the type of suprascapular notch (SSN).

Methods: Total 200 dry human scapulae were obtained from Anatomy departments of three medical colleges of south Gujarat. Using digital vernier caliper, for each SSN, maximal depth (MD) and superior transverse diameters (STD) were measured and SSN classified into five types. The distances of suprascapular nerve from common surgical landmarks were measured as ‘AB’; ‘CD’ and ‘BD’ to obtain safe zone. These distances were correlated with dimension of notch. Results of the present study were compared with previous studies in different populations.

Results: The suprascapular notch was classified into five types of which Type III (MD <STD) predominate (46.5%). The mean measurements of ‘safe zone’ distances vary with type of notch and correlate with notch dimensions.

Conclusions: The precise knowledge of morphology in the shoulder girdle region (especially, variations of SSN) is particularly essential to avoid iatrogenic nerve injuries during shoulder surgeries. The measurements of ‘safe zone’ help clinicians for safe advancement during surgeries. The safe zone varies with the type of suprascapular notch.


Shishido H, Kikuchi S. Injury of the suprascapular nerve in shoulder surgery Ananatomical study. J Shoulder Elbow Surg. 2001;10:372-6.

Costouros JG, Porramatikul M, Lie DT, Warner JJP. Reversal of suprascapular neuropathy following arthroscopic repair of massive supraspinatus and infraspinatus rotator cuff tears. Arthroscopy. 2007;11:1152-61.

Shaffer BS, Conway J, Jobe FW, Kvitne RS, Tibone JE. Infraspinatus muscle-splitting incision in posterior shoulder surgery. Am J Sports Med. 1994;22:113-20.

Yoo JC, Lee YS, Ahn JH, Park JH, Kang HJ, Koh KH. Isolated suprascapular nerve injury below the spinoglenoid notch after SLAP repair. J Shoulder Elbow Surg. 2009;18:e27-9.

Asami A, Sonohata M, Morisawa K.Bilateral suprascapular nerve entrapment syndrome associated with rotator cuff tears. J Shoulder Elbow Surg. 2000;9:70-2.

Bittar ES. Arthroscopic management of massive rotator cuff tears. Arthroscopy. 2002;9:104-6.

Burkhart SS, Lo IK, Brady PC: Burkhart’s view of the shoulder a cowboy’s guide to advanced shoulder arthroscopy. Philadelphia: Lippincott, Williams & Williams. 2006:111-6,194-203.

Debeyre J, Patte D, Elmelik E. Repair of ruptures of the rotator cuff of the shoulder- with a note on advancement of the supraspinatus muscle. J Bone Joint Surg. 1980;62A:897-908.

McIIveen SJ, Duralde XA, D’alessandro DF, Bigliani LU. Isolated nerve injuriesabout the shoulder. Clin Orthop. 1994;306:54-63.

Meyer M, Graveleau N, Hardy P, Landreau P. Anatomic risks of shoulder arthroscopy portals: anatomic cadaveric study of 12 portals. Arthroscopy. 2007;23:529-36.

Neer CS. Impingement lesions. Clin Orthop. 1983;173:70-7.

Neri BR, Chan KW, Kwon YW. Management of massive and irreparablerotator cuff tears. J Shoulder Elbow Surg. 2009;18:808-18.

Warner JJP, Krushell RJ, Masquelet A, Gerber C. Anatomy and relationships of the suprascapular nerve: anatomical constraints to mobilization of the supraspinatus and infraspinatus muscles in the management of massive rotator-cuff tears. J Bone Joint Surg Am. 1992;74:36-45.

Post M, Mayer J. Suprascapular nerve entrapment, diagnosis and treatment. Clin Orthop. 1987;223:126-36.

Rengachary SS, Burr D, Lucas S, Hassanein KM, Mohn MP, Matzke H. Suprascapular entrapment neuropathy: a clinical, anatomical, and comparative study. Part 1: clinical study. Neurosurgery. 1979;5:441-6.

Rengachary SS, Burr D, Lucas S, Hassanein KM, Mohn MP, Matzke H. Suprascapular entrapment neuropathy: a clinical,anatomical, and comparative study. Part 2: anatomical study. Neurosurgery. 1979;5:447-51.

Mansat P, Cofield RH, Kersten TE, Rowland CM. Complication of rotator cuff repair.Orthop Clin North Am. 1997;28:205-13.

Zanotti RM, Carpenter JE, Blasier RB, Greenfield ML, Adler RS, Bromberg MB. The low incidence of suprascapular nerve injury after primary repair of massive rotator cuff tears. J shoulder Elbow Surg. 1997;6:258-64.

Moore KL, Dalley AF, Agur AM. Clinical oriented anatomy, 7th edn. Lippincott Williams & Wilkins, Philadelphia. P.675.

Bigliani LU, Dasley RM, McCann PD, April EW. An anatomical study of the suprascapular nerve. Arthroscopy. 1990;6:301-5.

Ekin A, Magden O, Iche C. Anatomy and relationship of the suprascapular nerve in surgery of the shoulder. In Surgery of the shoulder. Edited by Vastamäki M, Jalovaara P. New York: Elsevier. 1995:379-92.

Greiner A, Golser K, Wambacher M, Kralinger F, Sperner G. The course of the suprascapular nerve in the supraspinatus fossa and its vulnerability in muscle advancement. J Shoulder Elbow Surg. 2003,12:256-9.

Stefano G, Albino P, Stefano C, Vittorio C, Valerio A, Rita VA. Morphometry of the suprascapular notch: correlation with scapular dimensions and clinical relevance. BMC Musculoskelet Disord. 2013;14:172.

Gumina S, Albino P, Giaracuni M, Vestri AR, Ripani M, Postacchini F. The safe zone for avoiding suprascapular nerve injury during shoulder arthroscopy: An anatomical study on 500 dry scapulae. J Shoulder Elbow Surg. 2011;20(8):1317-22.

Polguj M, Jdrzejewski K.S, Podgórski M, Topo M. Correlation between morphometry of the suprascapular notch and anthropometric measurements of the scapula. Folia Morphol. 2011;70(2):109-15.

Mahdy AA, Shehab AA. Morphometric Variations of the Suprascapular Notch as a Potential Cause of Neuropathy: Anatomical Study. J Ameri Scie. 2013;9(3).

Shivaleela, Archana B, Kumar GV, Swetha, and Lakshmiprabha. Morphometric Analysis of Suprascapular Notch in Human Adult Scapulae with Clinical Relevance. RJPBCS. 2014;5(6):741-7.

Sinkeet SR, Awori KO, Odula PO, Ogeng’o JA, Mwachaka PM. The Suprascapular notch: its Morphology and distance from the glenoid cavity in a Kenyan population. Folia Morphol. 2010;69:241-5.

Vyas KK, Rajput HB, Zanzrukiya KM, Suttarwala I, Sarvaiya BJ, Shroff BD. An osseous study of suprascapular notch and various dimentions of safe zone to prevent suprascapular nerve injury. Indian Journal of Applied Basic Medical Sciences. 2013;15(20):27.

Wang H, Chen C, Wu L, Pan C, Zhang W, Li Y. Variable Morphology of the Suprascapular Notch: An Investigation and Quantitative Measurements in Chinese Population. Clinical Anatomy. 2011;24: 47-55.




How to Cite

Hafezji, H. M. (2016). An osteological study of measurement of safe zone to prevent iatrogenic suprascapular nerve injury and its correlation with type of suprascapular notch. International Journal of Research in Medical Sciences, 4(11), 5034–5040.



Original Research Articles