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Anatomical study of the innervation of glenohumeral and acromioclavicular joint capsules: implications for image-guided intervention.
Reg Anesth Pain Med. 2019 Jan 11 [Online ahead of print]RA

Abstract

BACKGROUND AND OBJECTIVES

In 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.

METHODS

Fifteen 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.

RESULTS

In 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.

CONCLUSIONS

The 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.

Authors+Show Affiliations

Division of Anatomy, Department of Surgery, University of Toronto, Toronto, Ontario, Canada johnjt.tran@mail.utoronto.ca.Department of Anesthesia, Toronto Western Hospital, Wasser Pain Management Center, University of Toronto, Toronto, Ontario, Canada.Division of Anatomy, Department of Surgery, University of Toronto, Toronto, Ontario, Canada.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

30635516

Citation

Tran, John, et al. "Anatomical Study of the Innervation of Glenohumeral and Acromioclavicular Joint Capsules: Implications for Image-guided Intervention." Regional Anesthesia and Pain Medicine, 2019.
Tran J, Peng PWH, Agur AMR. Anatomical study of the innervation of glenohumeral and acromioclavicular joint capsules: implications for image-guided intervention. Reg Anesth Pain Med. 2019.
Tran, J., Peng, P. W. H., & Agur, A. M. R. (2019). Anatomical study of the innervation of glenohumeral and acromioclavicular joint capsules: implications for image-guided intervention. Regional Anesthesia and Pain Medicine. https://doi.org/10.1136/rapm-2018-100152
Tran J, Peng PWH, Agur AMR. Anatomical Study of the Innervation of Glenohumeral and Acromioclavicular Joint Capsules: Implications for Image-guided Intervention. Reg Anesth Pain Med. 2019 Jan 11; PubMed PMID: 30635516.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Anatomical study of the innervation of glenohumeral and acromioclavicular joint capsules: implications for image-guided intervention. AU - Tran,John, AU - Peng,Philip W H, AU - Agur,Anne M R, Y1 - 2019/01/11/ PY - 2018/10/03/received PY - 2018/11/29/revised PY - 2018/12/10/accepted PY - 2019/1/13/entrez PY - 2019/1/13/pubmed PY - 2019/1/13/medline KW - anatomy KW - joint innervation KW - nerve blocks KW - radiofrequency ablation KW - shoulder joint JF - Regional anesthesia and pain medicine JO - Reg Anesth Pain Med N2 - BACKGROUND AND OBJECTIVES: In 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. METHODS: Fifteen 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. RESULTS: In 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. CONCLUSIONS: The 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. SN - 1532-8651 UR - https://www.unboundmedicine.com/medline/citation/30635516/Anatomical_study_of_the_innervation_of_glenohumeral_and_acromioclavicular_joint_capsules:_implications_for_image_guided_intervention_ DB - PRIME DP - Unbound Medicine ER -
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