Distribution of the axillary nerve to the subacromial bursa and the area around the long head of the biceps tendon

Nasu, Hisayo; Nimura, Akimoto; Yamaguchi, Kumiko; Akita, Keiichi

doi:10.1007/s00167-014-3112-4

Cited by 22 publications

(21 citation statements)

References 28 publications

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“…The estimated contribution of the AN to the totality of the shoulder joint innervation is variable. Near the quadrangular space, the main trunk gives direct articular branches to the inferior area (see also Tran et al, ) of the shoulder joint capsule, with other articular branches arising from the branch to the teres minor or appearing in the posterolateral aspect of the capsule after piercing the connective tissue of the tendon of the BB (Nasu et al, ; Eckmann et al, ). Some authors mention a single articular branch (Duparc et al, ), which they call the joint nerve (JN), while others use more general terms such as articular branch or capsular branch.…”

Section: Introduction and Aimsmentioning

confidence: 99%

Ultrasonography‐guided anterior approach for axillary nerve blockade: An anatomical study

et al. 2019

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Combined ultrasound (US)-guided blockade of the suprascapular and axillary nerves (ANs) has been proposed as an alternative to interscalene blockade for pain control in shoulder joint pathology or postsurgical care. This technique could help avoid respiratory complications and/or almost total upper limb palsy. Nowadays, the AN blockade is mostly performed using an in-plane caudal-to-cephalic approach from the posterior surface of the shoulder, reaching the nerve immediately after it exits the neurovascular quadrangular space (part of the spatium axillare). Despite precluding most respiratory complications, this approach has not made postsurgical pain relief any better than an interscalene blockade, probably because articular branches of the AN are not blocked.Cephalic-to-caudal methylene blue injections were placed in the first segment of the AN of six Thiel-embalmed cadavers using an US-guided anterior approach in order to compare the distribution with that produced by a posterior approach to the contralateral AN in the same cadaver. Another 21 formalin-fixed cadavers were bilaterally dissected to identify the articular branches of the AN.We found a good spread of the dye on the AN and a constant relationship of this nerve with the subscapularis muscle. The dye reached the musculocutaneous nerve, which also contributes to shoulder joint innervation. We describe the anatomical landmarks for an ultrasonography-guided anterior AN blockade and hypothesize that this anterior approach will provide better pain control than the posterior approach owing to complete blocking of the joint nerve. Clin. Anat. 33:488-499, 2020.

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Section: Introduction and Aimsmentioning

confidence: 99%

Ultrasonography‐guided anterior approach for axillary nerve blockade: An anatomical study

et al. 2019

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“…Shoulder pain is usually caused by the anterior, lateral, and posterior of the shoulder region as well as muscle, ligament, bursa, and capsule which constitute the shoulder joint [ 3 , 4 ]. Patients with a shoulder disorder usually complain of pain on the lateral region of the shoulder that is often caused by a bursa [ 3 , 5 ].…”

Section: Introductionmentioning

confidence: 99%

Clinical Anatomy for the Innervated Pattern and Boundary of the Subdeltoid Bursa

Seo

Kim

Jeon

et al. 2018

BioMed Research International

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The aim of this study was to accurately identify the distribution of sensory nerve branches running to bursa with mesoscopic dissection and boundaries following the injection of gelatin into the bursa. Eighteen shoulders of 11 Korean soft cadavers (average age, 65 years; age range, 43 - 88 years) were dissected. The most prominent point of greater tubercle of the humerus (GT) was used as a reference point. The horizontal line passing through GT was used as the x-axis while the vertical line passing through the GT was used as the y-axis. Average distances of the anterior, posterior, superior, and inferior from the GT were 1.9±0.6, 2.4±1.3, 2.1±0.7, and 3.2±1.5 cm, respectively. In 15 cases of 18 shoulders, the anterior branch of the axillary nerve was distributed to the subdeltoid bursa that was running posteriorly. The muscular branch of the anterior and middle parts of the deltoid was distributed to the branch of nerve that was running into the subdeltoid bursa. A branch of the posterior cord of brachial plexus was distributed to the subdeltoid bursa that was running anteriorly in three cases. Most of the branches of the axillary nerve were distributed into the posterolateral area. The branches of the posterior cord of brachial plexus were distributed in the anterolateral area. These results might be useful for preventing residual pain on the anterior shoulder region following an injection for the relief of shoulder pain.

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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%

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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Distribution of the axillary nerve to the subacromial bursa and the area around the long head of the biceps tendon

Abstract: These results would be useful to consider the cause of the shoulder pain or to prevent the residual pain after the biceps tenodesis.

Cited by 22 publications

References 28 publications

Ultrasonography‐guided anterior approach for axillary nerve blockade: An anatomical study

Ultrasonography‐guided anterior approach for axillary nerve blockade: An anatomical study

Clinical Anatomy for the Innervated Pattern and Boundary of the Subdeltoid Bursa

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

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