Innervation of the Posterior Hip Capsule: A Cadaveric Study

Abstract

Objective Recent studies of hip anatomy have turned to the posterior hip capsule to better understand the anatomic location of the posterior capsular sensory branches and identify nerves with potential for neural blockade. Current literature has shown the posterior hip capsule is primarily supplied by branches from the sciatic nerve, nerve to quadratus femoris, and superior gluteal nerve (1, 2). This cadaveric study investigated the gross anatomy of the posterior hip, while also identifying potential targets for hip analgesia, with emphasis on the superior gluteal nerve and nerve to quadratus femoris. Design Cadaveric study. Setting University of Texas Health San Antonio Anatomy Lab Methods 10 total cadavers (18 hips total), were posteriorly dissected identifying nerve to quadratus femoris, superior gluteal nerve, and sciatic nerve. Nerves were labeled with radio-opaque markers. Following the dissections, fluoroscopic images were obtained as sequential angles to identify neural anatomy and help expand anatomic knowledge for interventional pain procedures. Results The posterior hip capsule was supplied by the sciatic nerve in 1/16 hips, the nerve to quadratus femoris in 15/18 hips, and the superior gluteal nerve in 6/18 hips. Conclusions The nerve to quadratus femoris reliably innervates the posterior hip joint. Both the sciatic nerve and superior gluteal nerve may have small articular branches that may be involved in posterior hip innervation, but not this is not seen commonly. The results of this study may elucidate novel therapeutic targets for treatment of chronic refractory hip pain (i.e., the nerve to quadratus femoris).

Bloqueo PENG para prótesis de cadera

“…El bloqueo del nervio femoral, el del compartimento de la fascia ilíaca y el femoral 3 en 1, se usan con regularidad debido a su capacidad para reducir el dolor posoperatorio, el consumo de opioides y los efectos adversos relacionados con éstos [7], [8], [29], [30]. Los estudios anatómicos han demostrado que las ramas articulares del nervio obturador y femoral, que inervan la cápsula anterior de la cadera, pueden no bloquearse de manera óptima con estas técnicas [31], [32].…”

A Preliminary Analysis of a Modified Anterior Approach to Hip Pericapsular Neurolysis for Inoperable Hip Fracture Using the IDEAL Framework

“…For the remaining 30% patients who responded suboptimally to anterior neurolysis, one of the postulations is the contribution and sensitization of the posterior hip capsule as supported by our recent case series on posterior hip pericapsular neurolysis [ 12 ]. Anatomically, this is explained by the presence of nociceptors in the superoposterior labrum, which is predominantly innervated by the nerve to the quadratus femoris with contributions from the superior gluteal and sciatic nerves [ 14 , 15 , 16 ]. The concept of silent nociceptor activation secondary to fracture hip can explain the augmented pain intensity over posterior hip capsule [ 17 , 18 ].…”

Pericapsular Nerve Group (PENG) Block - An Evidence Based Discussion

“…4 The posterior capsule is innervated most commonly by the nerve to the quadratus femoris, while small articular branches from the sciatic nerve and superior gluteal nerves may also be seen. 5 The anterior capsule, which contains most of the sensory innervation of the joint and has been identified as the main source of the majority of postoperative hip pain, is the target of the PENG block. 3,4 Short et al 4 further demonstrated that 'high' sensory articular branches of the FN, originating cranially to the inguinal ligament, play a greater role in the innervation of the anterior hip capsule than previously thought.…”