scholarly journals Cadaveric evaluation of the feasibility of glenohumeral joint denervation

2021 ◽  
Vol 8 (1) ◽  
Author(s):  
Amr M. Aly
Keyword(s):  
Muscle Weakness ◽  
Shoulder Joint ◽  
Glenohumeral Joint ◽  
Axillary Nerve ◽  
Low Risk ◽  
Dorsal Approach ◽  
Articular Branch ◽  
Pectoral Nerve ◽  
Teres Minor

Abstract Purpose To assess the feasibility of total shoulder denervation through two proposed incisions. Methods Total shoulder denervation was performed through an extended delta-pectoral approach and a transverse dorsal approach at the spine of the scapula. The study involved six cadavers. Course and number of articular branches from the lateral pectoral, axillary and supra-scapular nerve were documented. Results All shoulder joint articular branches were accessible through the proposed anterior and posterior approaches. The articular branch of the lateral pectoral nerve and supra scapular nerve were present in all the specimen. Axillary nerve articular branches were variable in number but when present anteriorly were proximal to the deltoid muscular branches and posteriorly proximal to the muscular branches to the teres minor. Conclusion Total glenohumeral denervation was feasible through our proposed anterior and posterior approaches. Enhanced knowledge of articular nerve branches could provide interventional targets for joint and ligament pain, with low risk of muscle weakness.

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

2019 ◽  
Vol 44 (4) ◽  
pp. 452-458 ◽  
Author(s):  
John Tran ◽  
Philip W H Peng ◽  
Anne M R Agur
Keyword(s):  
Soft Tissue ◽  
Shoulder Joint ◽  
Joint Pain ◽  
Acromioclavicular Joint ◽  
Axillary Nerve ◽  
Image Guided ◽  
Bony Landmarks ◽  
Pectoral Nerve ◽  
Image Guided Intervention ◽  
Frequency Map

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.

Anatomical study of the articular branch of the lateral pectoral nerve to the shoulder joint

2015 ◽  
Vol 24 (12) ◽  
pp. 3820-3827 ◽  
Author(s):  
Young-Seok Nam ◽  
Karnav Panchal ◽  
In-Beom Kim ◽  
Jong-Hun Ji ◽  
Min-Gyu Park ◽  
...  
Keyword(s):  
Shoulder Joint ◽  
Anatomical Study ◽  
Articular Branch ◽  
Pectoral Nerve

scholarly journals SÍNDROME DEL ESPACIO CUADRILÁTERO: ¿INFRECUENTE O INSOSPECHADO? Quadrilateral space syndrome: infrequent or unsuspected?

2016 ◽  
Vol 8 (2) ◽  
pp. 87-92
Author(s):  
Lucas M. Gutierrez ◽  
Matias Cullari ◽  
Maximiliano Ranaletta ◽  
Ignacio Tanoira ◽  
César Gomez ◽  
...  
Keyword(s):  
Clinical Presentation ◽  
Matched Control ◽  
External Rotation ◽  
Axillary Nerve ◽  
Control Group ◽  
Vascular Compression ◽  
Resonance Imaging ◽  
Diagnostic Protocol ◽  
Magnetic Resonance Imaging Mri ◽  
Teres Minor

Introducción: El síndrome del espacio cuadrilátero (QSS) es un cuadro clínico causado por la compresión nerviosa y/o vascular a nivel del espacio axilar lateral. La prevalencia de este síndrome se desconoce y se cree que es baja, sin embargo, formas de presentación incompleta podrían llevar a que el mismo sea subdiagnosticado. Objetivo: Describir un protocolo diagnóstico utilizado en una serie de casos consecutivos de pacientes con omalgia inespecífica y sospecha de QSS. Materiales y Métodos: De manera prospectiva se evaluaron 10 pacientes con omalgia agravada con la rotación externa forzada, uno de ellos con síntomas bilaterales. Se realizó electromiografía (EMG) de deltoides y redondo menor bilaterales, con estudios de conducción nerviosa. Los valores se compararon con el hombro sano, y con un grupo control. El diagnóstico se confirmó mediante resonancia magnética nuclear (RMN). Resultados: El EMG mostró en todos los casos atrapamiento con compromiso axonal de la rama para el redondo menor, con preservación de la inervación del deltoides. La RMN mostró en los 11 hombros afectados atrofia selectiva del redondo menor. Conclusión: El QSS en sus formas incompletas suele ser subdiagnosticado, siendo necesario mantener un alto índice de sospecha clínica frente a un cuadro de omalgia inespecífica. Palabras Claves: espacio cuadrilátero, omalgia, electromiografía, redondo menor, nervio axilar. Introduction: The quadrilateral space syndrome (QSS) has clinical features caused by a nervous and /or vascular compression at the lateral axillary space. The prevalence of this syndrome is unknown but it is believed to be low. Nevertheless, some cases with an incomplete clinical presentation might be misdiagnosed. Purpose: To describe a diagnostic protocol used in a series of consecutive cases of patients with non-specific omalgia and suspected QSS. Materials and Methods: Ten patients of both genders suffering shoulder pain aggravated by forced external rotation were prospectively evaluated.  One of them had bilateral symptoms. Evaluation included clinical examination, electromyography (EMG) and nerve conduction studies of the deltoid and teres minor bilaterally. The results were compared with an age-matched control group. Diagnosis was confirmed by magnetic resonance imaging (MRI). Results: The EMG showed in all the cases a selective entrapment of the branch for the teres minor, with preservation of the innervation of the deltoid. The RMN showed in the 11 affected shoulders selective atrophy of the teres minor. Conclusion: Incomplete presentations of the QSS are usually underdiagnosed, making it necessary to maintain a high index of clinical suspicion in front of any non-specific omalgia case. Key words: quadrilateral space, omalgia, electromyography, teres minor, axillary nerve.

scholarly journals Stress Distribution Patterns Across the Shoulder Joint in Gymnasts: A Computed Tomography Osteoabsorptiometry Study

2020 ◽  
Vol 8 (11) ◽  
pp. 232596712096210
Author(s):  
Daisuke Momma ◽  
Wataru Iwamoto ◽  
Kaori Endo ◽  
Kazuki Sato ◽  
Norimasa Iwasaki
Keyword(s):  
Bone Density ◽  
Stress Distribution ◽  
Distribution Pattern ◽  
Subchondral Bone ◽  
Shoulder Joint ◽  
Glenohumeral Joint ◽  
Articular Surface ◽  
Articular Surfaces ◽  
Subchondral Bone Density ◽  
Collegiate Gymnasts

Background: The distribution pattern of subchondral bone density is an indicator of stress distribution over a joint surface under long-term physiologic loading. The biomechanical characteristics of the articular surfaces of the shoulder joint in gymnasts can be determined by measuring this distribution pattern. Purpose: To evaluate the distribution of subchondral bone density across the shoulder joint in male collegiate gymnasts and to determine the effects of gymnastic activities on its articular surfaces under long-term loading conditions using computed tomography osteoabsorptiometry (CTOAM). Study Design: Descriptive laboratory study. Methods: CT image data were obtained from both shoulders of 12 asymptomatic male collegiate gymnasts (gymnast group; mean age, 19.4 years; range, 18-22 years) and 10 male collegiate volunteers (control group; mean age, 20.2 years; range, 18-22 years). The distribution pattern of subchondral bone density across the articular surfaces of each shoulder joint was assessed by CTOAM. Quantitative analysis was performed of the locations and percentages of high-density areas on the articular surface. Results: Stress distribution patterns over the articular surfaces differed between the gymnasts and the controls. In the gymnasts, high-density areas were detected on the posterosuperior articular surface of the humeral head and the anterosuperior and/or posterosuperior articular surface of the glenoid. Mean bone density was greater in the gymnasts than in the controls ( P < .0001). Conclusion: Stress distribution over the articular surfaces of the shoulder joint was affected by gymnastic activities. Stress was concentrated over the superior part of the glenohumeral joint in male collegiate gymnasts. Clinical Relevance: The present findings suggest that gymnastic activities increase stress to the articular surfaces of the superior glenohumeral joint. This supports the notion that mechanical conditions play a crucial role in the origin of disorders particular to gymnastic activities.

scholarly journals Sonoarthrographic examination of posterior labrocapsular structures of the shoulder joint

2020 ◽  
Vol 93 (1106) ◽  
pp. 20190886
Author(s):  
Hayri Ogul ◽  
Nurmuhammet Tas ◽  
Mutlu Ay ◽  
Mehmet Kose ◽  
Mecit Kantarci
Keyword(s):  
Shoulder Joint ◽  
Glenohumeral Joint ◽  
Imaging Modality ◽  
Mr Arthrography ◽  
Labral Tear ◽  
Labral Tears ◽  
Significant Difference ◽  
Arthroscopic Examination ◽  
Synovial Folds ◽  
Direct Mr Arthrography

Objective: To describe the posterior labral lesions and labrocapsular abnormalities of the shoulder on sonoarthrography and to compare these findings with MR arthrography results. Methods: 82 shoulders were initially evaluated with ultrasonography and MRI and then were examined with sonoarthrography and MR arthrography following intraarticular injection of diluted gadolinium solution. The ultrasonography images were prospectively evaluated for the presence of posterior labral tear, sublabral cleft, and posterior capsular abnormalities by two radiologists. The diagnostic accuracy of sonoarthrography in the detection of posterior labral tears and posterior labrocapsular variants was compared with that of MR arthrography. Results: In sonoarthrographic examinations of 82 shoulders, 5 and 6 posterior labral tears were identified by Observer 1 and 2, respectively. Moreover, 6 and 7 posterior sublabral clefts, and 2 and 3 posterior synovial folds were identified by Observer 1 and 2, respectively. All the 82 patients were examined with MR arthrography; however, only 14 patients underwent arthroscopic examination. No significant difference was found among the 82 patients with regard to age, gender, and the prevalence of posterior labral tear, posterior labral cleft, and posterior synovial fold (p > 0.05). Interobserver variability showed substantial agreement between the sonoarthrographic and MR arthrographic results of the posterior labrocapsular structures (κ = 0.71, p < 0.05). Conclusion: Posterior labral tears and posterior synovial folds of the shoulder joint can be evaluated non-invasively by sonoarthrography. Advances in knowledge: Variations and pathologies of posterior labrocapsular structures of the glenohumeral joint are relatively uncommon. Direct (MR) arthrography is the gold-standard imaging modality to evaluate of posterior labrocapsular abnormalities of the glenohumeral joint. Sonoarthrography of the glenohumeral joint may be utilized in clinical practice in patients with contraindications to (MRI).

The 7-o'clock Posteroinferior Portal for Shoulder Arthroscopy

2002 ◽  
Vol 30 (5) ◽  
pp. 693-696 ◽  
Author(s):  
Philip A. Davidson ◽  
Dennis W. Rivenburgh
Keyword(s):  
Glenohumeral Joint ◽  
Shoulder Arthroscopy ◽  
Suprascapular Nerve ◽  
Skin Incision ◽  
Axillary Nerve ◽  
Anatomic Study ◽  
Effective Technique ◽  
Alternative Approach ◽  
Flexion Extension ◽  
Differential Distance

Background: Access to the inferior glenohumeral joint of the shoulder is very limited through the traditional 2- or 3-o'clock anterior portals. Hypothesis: The 7-o'clock posteroinferior portal offers an excellent alternative approach. Study Design: Descriptive anatomic study. Methods: Six paired cadaveric shoulders were used to arthroscopically develop and test a 7-o'clock posteroinferior portal. The distances between the portal and the subscapular and axillary nerves were measured with the arm in six different positions, combining flexion, extension, abduction, and adduction. Results: The distance from the 7-o'clock posteroinferior portal to the axillary nerve was 39 ± 4 mm and to the suprascapular nerve was 28 ± 2 mm. There was no statistically significant nerve-to-portal differential distance when the arm was placed in flexion, extension, abduction, or adduction. The inside-to-outside technique produced a 7-o'clock posteroinferior portal approximately 5 mm further from both the axillary and suprascapular nerves than did the outside-to-inside method. The angle of divergence from the 7-o'clock posterior portal skin incision to the axillary nerve was 47° and to the suprascapular nerve was 33°. Conclusions: The 7-o'clock portal affords safe, direct working access to the inferior capsular recess of the glenohumeral joint. Clinical Relevance: The 7-o'clock portal is a safe and effective technique for use by shoulder surgeons.

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