Southwest Shoulder, Elbow and Hand Center, Tucson, AZ, USA.
J Shoulder Elbow Surg. 2013 Jan;22(1):108-14. doi: 10.1016/j.jse.2011.12.005. Epub 2012 Apr 20.
The purpose of this study was to describe the complex anatomy surrounding the teres minor muscle.
Thirty-one cadaveric human shoulders were dissected. Qualitative fascial and neurovascular anatomy were described. Location of motor nerves to teres minor were measured in reference to local anatomy.
Fascial anatomy of the posterior shoulder had 2 distinct and equally common variants, 1 of which demonstrated a stout, inflexible fascial compartment enveloping the teres minor muscle. The other had a continuous fascia enveloping both the infraspinatus and teres minor muscles. In both variants, the primary nerve to teres minor traveled around a fascial sling, becoming sub-fascial at an average of 44 mm (range, 25-68) medial to the teres minor's insertion. The nerve took its most angulated course as it entered the fascial sling. Smaller accessory innervation of teres minor began, on average, 30 mm (range, 15-48) medial to the muscle's lateral insertion. None of the accessory motor nerves coursed deep to the fascial sling nor to the distinct teres minor fascial compartment.
A stout fascial sling may be the potential site of greatest compression and tethering of the primary motor nerve to teres minor. Additional lateral accessory motor nerves to teres minor remained extra-fascial and took a less angulated path. Half of the shoulders demonstrated a separate teres minor fascial compartment. An improved understanding of the fascial anatomy and innervation pattern of the teres minor muscle may help clinicians who treat patients with symptomatic isolated teres minor muscle atrophy.
本研究旨在描述小圆肌周围复杂的解剖结构。
对 31 具尸体人肩进行解剖。描述了筋膜和神经血管的解剖结构。测量了支配小圆肌的运动神经在局部解剖学上的位置。
后肩的筋膜解剖有 2 种明显且同样常见的变异,其中 1 种显示出坚固、僵硬的筋膜隔室包裹着小圆肌。另一种有连续的筋膜包裹着冈下肌和小圆肌。在这两种变异中,小圆肌的主要神经绕过筋膜吊带,在距小圆肌插入点内侧平均 44 毫米(范围 25-68)处成为亚筋膜。神经在进入筋膜吊带时呈最弯曲的走向。较小的小圆肌辅助神经支配,平均在肌肉外侧插入点内侧 30 毫米(范围 15-48)处开始。没有辅助运动神经在筋膜吊带深部或在明显的小圆肌筋膜隔室内走行。
坚固的筋膜吊带可能是小圆肌主要运动神经受压和束缚的潜在部位。额外的小圆肌外侧辅助运动神经仍然位于筋膜外,且走行的角度较小。一半的肩膀显示出单独的小圆肌筋膜隔室。对小圆肌肌肉筋膜解剖和神经支配模式的更好理解可能有助于治疗有症状的孤立性小圆肌萎缩的临床医生。