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Gregor Antoniadis, Hans-Peter Richter, Stefan Rath, Veit Braun and Gerald Moese

of the first SN lesion reported by Bernhardt in 1886. Kopell and Thompson 48 were the first to describe SN entrapment (SNE) at the suprascapular notch in 1959. In 1982, Aiello, et al. , 2 described SNE at the spinoglenoid notch. The current report deals with 28 consecutive cases of SNE in 27 patients over a 10-year period. Suprascapular Nerve Entrapment Anatomical Review The SN originates in the upper trunk of the brachial plexus, which is formed by the C-5 and C-6 roots. It runs through the suprascapular notch, which is covered by the superior

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Thomas Kretschmer, Gregor Antoniadis, Veit Braun, Stefan A. Rath and Hans-Peter Richter

radial nerve. As a result, a small skin incision was recommended instead of percutaneous placement of wires. Because commonly performed operative procedures undergo constant changes in method, typical iatrogenic lesions can change as well. When shoulder rests were used to support patients who were operated on while in the Trendelenburg position in former days, patients frequently suffered from brachial plexus damage. 2 With the use of slings for maintaining limbs in the lithotomy position, a greater likelihood of damaging the common peroneal nerve was noted. 2

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Julia A. Kandenwein, Thomas Kretschmer, Martin Engelhardt, Hans-Peter Richter and Gregor Antoniadis

T he treatment of traction or stretch injury to the brachial plexus has changed in the last four decades. Prior to 1970, conservative therapy including intensive physiotherapy was generally recommended. Surgical exploration and repair of brachial plexus injuries were not performed because of poor results. After Millesi 20 and Narakas 24, 25 obtained good results using microsurgical techniques, a more aggressive approach was generally followed. Later, Kline and Judice 17 and Hudson and Tranmer 10 revealed support for surgical treatment through

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Ralph W. Koenig, Maria T. Pedro, Christian P. G. Heinen, Thomas Schmidt, Hans-Peter Richter, Gregor Antoniadis and Thomas Kretschmer

under examination. In general, the highest frequency possible should be used for examination. Superficially located nerves such as the median nerve should be examined with transducers of 15–18 MHz, whereas deep nerves such as the sciatic nerve or the brachial plexus are better examined with 9–12 MHz transducers. Ultrasonography of Normal Peripheral Nerves Fornage 15 was the first to systematically examine the appearance of peripheral nerves under high-resolution ultrasonography. Silvestri and colleagues 37 subsequently described the normal internal

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Maria Teresa Pedro, Gregor Antoniadis, Angelika Scheuerle, Mirko Pham, Christian Rainer Wirtz and Ralph W. Koenig

1 , Patient 11), who had a slowly growing mass in his lower leg, had minimal neurological deficit. The tumor arose from the tibial nerve. The second patient, who had a brachial plexus tumor ( Table 1 , Patient 12), suffered from pain radiating into his left upper arm under strain ( Fig. 7A–F ). FIG. 7. Patient 12. Coronal T1-weighted Gd-enhanced MR image (A) of the brachial plexus showing an irregular cystic tumor mass of the posterior division and iHRU image (B) (17–5 MHz) showing the corresponding cystic hypoechoic to hyperechoic formation; the nerve