Friend Jikol, Francis Sarah, McCulloch Jane, Ecker Jeff, Breidahl William, McMenamin Paul
School of Anatomy and Human Biology, The University of Western Australia, 35 Stirling Highway, Crawley (Perth), WA, 6009, Australia.
Surg Radiol Anat. 2010 Mar;32(3):243-9. doi: 10.1007/s00276-009-0605-9. Epub 2009 Dec 18.
Teres minor atrophy occurs either in isolation, associated with other rotator cuff muscle pathologies or in quadrilateral space syndrome. In the latter condition, compression of the axillary nerve is the likely cause; however, the anatomy of the nerve to teres minor and how this may relate to isolated teres minor atrophy have not been extensively investigated. In light of the significance of teres minor atrophy in shoulder pathology, we performed a combined radiological and anatomical study of teres minor and its nerve supply.
Cadaveric dissection of nine shoulder specimens from eight cadavers was performed to investigate the anatomical variability in course, length and branching pattern of both the teres minor nerve and the axillary nerve. Radiological imaging and reports were analysed on all shoulder magnetic resonance images performed over a 1-week period at four radiology clinic locations in an attempt to identify the incidence of isolated teres minor atrophy and review teres minor atrophy in association with other shoulder pathology. Finally, we studied a case of isolated teres minor atrophy identified during a routine undergraduate dissection class.
Considerable anatomical variation was noticed in cadaver dissections in the nerve(s) supplying teres minor muscle revealing several various points where it may be vulnerable to impingement or injury at along its course. Analysis of 61 shoulder MR images revealed two patients with shoulder complaints that had isolated teres minor atrophy. Case-based study of these two male patients revealed other associated shoulder injury but the presentation was markedly different and clinically distinct from quadrilateral space syndrome.
Isolated teres minor atrophy is a relatively common shoulder pathology which appears to be clinically distinct from other syndromes with rotator cuff muscle atrophy including quadrilateral space syndrome. The exact aetiology is unknown but cadaveric dissection in this study suggests the considerable anatomical variation in both the origin and length of teres minor nerve(s) increase the risk of impingement and subsequent isolated teres minor atrophy.
小圆肌萎缩可单独出现，与其他肩袖肌病变相关，或发生于四边孔综合征。在后者的情况下，腋神经受压可能是原因；然而，支配小圆肌的神经解剖结构以及这与孤立性小圆肌萎缩的关系尚未得到广泛研究。鉴于小圆肌萎缩在肩部病理学中的重要性，我们对小圆肌及其神经供应进行了放射学和解剖学联合研究。
对来自8具尸体的9个肩部标本进行尸体解剖，以研究小圆肌神经和腋神经在走行、长度和分支模式上的解剖变异。对在四个放射科诊所地点在1周内进行的所有肩部磁共振成像的放射学影像和报告进行分析，试图确定孤立性小圆肌萎缩的发生率，并回顾与其他肩部病变相关的小圆肌萎缩情况。最后，我们研究了一例在本科常规解剖课上发现的孤立性小圆肌萎缩病例。
在尸体解剖中发现，供应小圆肌的神经存在相当大的解剖变异，揭示了在其走行过程中可能易受撞击或损伤的几个不同点。对61例肩部磁共振图像的分析显示，有2例肩部不适患者存在孤立性小圆肌萎缩。对这两名男性患者的病例研究显示存在其他相关的肩部损伤，但表现明显不同，在临床上与四边孔综合征有明显区别。
孤立性小圆肌萎缩是一种相对常见的肩部病变，在临床上似乎与包括四边孔综合征在内的其他肩袖肌萎缩综合征不同。确切病因尚不清楚，但本研究中的尸体解剖表明，小圆肌神经的起源和长度存在相当大的解剖变异，增加了撞击和随后发生孤立性小圆肌萎缩的风险。
