Cadaveric Study of the Articular Branches of the Shoulder Joint

Eckmann, Maxim; Bickelhaupt, Brittany; Fehl, Jacob; Benfield, Jonathan A.; Curley, Jonathan; Rahimi, Ohmid; Nagpal, Ameet S.

doi:10.1097/aap.0000000000000652

Cited by 67 publications

(44 citation statements)

References 21 publications

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“…Gardner7 was the first to report the innervation of GHJ from all four articular branches (SSN, AN, LPN and NS) 7. More recently, Nasu et al 14 found an articular branch terminating in the transverse humeral ligament that originated from the anterior division of AN,14 and Eckmann et al 16 found additional articular branches from SSN that coursed along the superior border of the spine of scapula to supply the posterosuperior GHJ capsule 16. However, in the current study, branches of the musculocutaeneous nerve reported by Wrete (1948) were not found 8…”

Section: Discussionmentioning

confidence: 99%

“…The key landmarks identified include the coracoid process, midpoint between the suprascapular and spinoglenoid notches, rim of the anterior glenoid fossa, and acromial branch of the thoracoacromial artery. In previous studies, Nam et al 15 reported the course of the articular branch from LPN in relation to the coracoid process and coracoclavicular ligament,15 and Eckmann et al 16 related the articular branches of SSN, LPN and AN to the spine of scapula, thoracoacromial artery and head of humerus, respectively 16…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Anatomical study of the innervation of glenohumeral and acromioclavicular joint capsules: implications for image-guided intervention

Tran

Peng

Agur

2019

Regional Anesthesia &Amp; Pain Medicine

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Background and objectivesIn 2011, chronic shoulder joint pain was reported by 18.7 million Americans. Image-guided radiofrequency ablation has emerged as an alternative intervention to manage chronic shoulder joint pain. To optimize the effectiveness of shoulder denervation, it requires a detailed understanding of the nerve supply to the glenohumeral and acromioclavicular joints relative to landmarks visible with image guidance. The purpose of this cadaveric study was to determine the origin, course, relationships to bony landmarks, and frequency of articular branches innervating the glenohumeral and acromioclavicular joints.MethodsFifteen cadaveric specimens were meticulously dissected. The origin, course, and termination of articular branches supplying the glenohumeral and acromioclavicular joints were documented. The frequency of each branch was determined and used to generate a frequency map that included their relationships to bony and soft tissue landmarks.ResultsIn all specimens, the posterosuperior quadrant of the glenohumeral joint was supplied by suprascapular nerve; posteroinferior by posterior division of axillary nerve; anterosuperior by superior nerve to subscapularis; and anteroinferior by main trunk of axillary nerve. Less frequent innervation was found from lateral pectoral nerve and posterior cord. The acromioclavicular joint was found to be innervated by the lateral pectoral and acromial branch of suprascapular nerves in all specimens. Bony and soft tissue landmarks were identified to localize each nerve.ConclusionsThe frequency map of the articular branches supplying the glenohumeral and acromioclavicular joints, as well as their relationship to bony and soft tissue landmarks, provide an anatomical foundation to develop novel shoulder denervation and perioperative pain management protocols.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Anatomical study of the innervation of glenohumeral and acromioclavicular joint capsules: implications for image-guided intervention

Tran

Peng

Agur

2019

Regional Anesthesia &Amp; Pain Medicine

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“…Alternative regional analgesic techniques to interscalene brachial plexus block target the peripheral nerves that innervate the shoulder and may have a better side-effect profile [13]. The suprascapular and axillary nerves provide sensory innervation to most of the glenohumeral joint [14][15][16]. Therefore, a combined suprascapular and axillary nerve block is a valid alternative to interscalene brachial plexus block [4] with less impact on respiratory function [17][18][19][20][21][22] and hand-grip strength [23].…”

Section: Introductionmentioning

confidence: 99%

“…15 MHz, X-Porte, Fujifilm SonositeVR, Inc., Bothell, WA, USA) was applied to the side of the neck in a transverse plane to visualise the brachial plexus. The probe was then moved distally in order to identify the emergence of the suprascapular nerve from the superior trunk.…”

mentioning

confidence: 99%

Hemidiaphragmatic paralysis following ultrasound‐guided anterior vs. posterior suprascapular nerve block: a double‐blind, randomised control trial

et al. 2020

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Summary Interscalene brachial plexus block provides analgesia for shoulder surgery but is associated with hemidiaphragmatic paralysis. Before considering a combined suprascapular and axillary nerve block as an alternative to interscalene brachial plexus block, evaluation of the incidence of diaphragmatic dysfunction according to the approach to the suprascapular nerve is necessary. We randomly allocated 84 patients undergoing arthroscopic shoulder surgery to an anterior or a posterior approach to the suprascapular nerve block combined with an axillary nerve block using 10 ml ropivacaine 0.375% for each nerve. The primary outcome was the incidence of hemidiaphragmatic paralysis diagnosed by ultrasound. Secondary outcomes included: characterisation of the hemidiaphragmatic paralysis over time; numeric rating scale pain scores; oral morphine equivalent consumption; and patient satisfaction. The incidence of hemidiaphragmatic paralysis was 40% (n = 17) vs. 2% (n = 1) in the anterior and posterior groups, respectively (p < 0.001). In one third of patients with hemidiaphragmatic paralysis, it persisted beyond the eighth hour. The median (interquartile range [range]) oral morphine equivalent consumption was significantly higher in the posterior approach when compared with the anterior approach, whether in the recovery area (20 [5–31 (0–60)] mg vs. 7.5 [0–14 (0–52)] mg, respectively; p = 0.004) or during the first 24 h (82 [61–127 (12–360) mg] vs. 58 [30–86 (0–160)] mg, respectively; p = 0.01). Patient satisfaction was comparable between groups (p = 0.6). Compared with the anterior approach, diaphragmatic function is best preserved with the posterior needle approach to the suprascapular nerve block.

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“…More exact targeting may now be possible in light of this detailed mapping, as depicted in Figure 4 of the study of Eckmann et al 2 Their anatomical work shows us where sensory nerves can be safely targeted by dividing potential sites into zones. The sought-after clinical benefit of this precision involves avoidance of disrupting motor nerves, as well as sensory pathways not implicated in the patient's pain syndrome.…”

mentioning

confidence: 99%

Precise Anatomical Targeting

Nowrouz

Huntoon

2017

Regional Anesthesia and Pain Medicine

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Cadaveric Study of the Articular Branches of the Shoulder Joint

Abstract: Articular branches from the SN, AN, and LPN were identified. Articular branches of the SN and AN insert into the capsule overlying the glenohumeral joint posteriorly. Articular branches of the LPN exist and innervate a portion of the anterior shoulder joint.

Cited by 67 publications

References 21 publications

Anatomical study of the innervation of glenohumeral and acromioclavicular joint capsules: implications for image-guided intervention

Anatomical study of the innervation of glenohumeral and acromioclavicular joint capsules: implications for image-guided intervention

Hemidiaphragmatic paralysis following ultrasound‐guided anterior vs. posterior suprascapular nerve block: a double‐blind, randomised control trial

Precise Anatomical Targeting

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