From the Departments of *Anesthesiology and †Rehabilitation, University of Texas Health Science Center at San Antonio, San Antonio; ‡Department of Anesthesia, Baylor Scott and White Health, Temple; and §Cellular and Structural Biology, University of Texas Health Science Center at San Antonio, San Antonio, TX.
Reg Anesth Pain Med. 2017 Sep/Oct;42(5):564-570. doi: 10.1097/AAP.0000000000000652.
This cadaveric study investigated the anatomic relationships of the articular branches of the suprascapular (SN), axillary (AN), and lateral pectoral nerves (LPN), which are potential targets for shoulder analgesia.
Sixteen embalmed cadavers and 1 unembalmed cadaver, including 33 shoulders total, were dissected. Following dissections, fluoroscopic images were taken to propose an anatomical landmark to be used in shoulder articular branch blockade.
Thirty-three shoulders from 17 total cadavers were studied. In a series of 16 shoulders, 16 (100%) of 16 had an intact SN branch innervating the posterior head of the humerus and shoulder capsule. Suprascapular sensory branches coursed laterally from the spinoglenoid notch then toward the glenohumeral joint capsule posteriorly. Axillary nerve articular branches innervated the posterolateral head of the humerus and shoulder capsule in the same 16 (100%) of 16 shoulders. The AN gave branches ascending circumferentially from the quadrangular space to the posterolateral humerus, deep to the deltoid, and inserting at the inferior portion of the posterior joint capsule. In 4 previously dissected and 17 distinct shoulders, intact LPNs could be identified in 14 (67%) of 21 specimens. Of these, 12 (86%) of 14 had articular branches innervating the anterior shoulder joint, and 14 (100%) of 14 LPN articular branches were adjacent to acromial branches of the thoracoacromial blood vessels over the superior aspect of the coracoid process.
Articular branches from the SN, AN, and LPN were identified. Articular branches of the SN and AN insert into the capsule overlying the glenohumeral joint posteriorly. Articular branches of the LPN exist and innervate a portion of the anterior shoulder joint.
本尸体研究调查了肩胛上（SN）、腋（AN）和外侧胸（LPN）神经关节支的解剖关系，这些神经支是肩部镇痛的潜在靶点。
共解剖了 16 具防腐尸体和 1 具非防腐尸体，共计 33 个肩部。解剖后，拍摄了荧光透视图像，提出了一种用于肩部关节支阻滞的解剖学标志。
研究了来自 17 具尸体的 33 个肩部。在一系列 16 个肩部中，16（100%）个肩部均有完整的 SN 分支支配肱骨头后和肩囊。肩胛上感觉支从肩胛冈下切迹外侧走行，然后向后走向盂肱关节囊。腋神经关节支在 16（100%）个肩部中支配肱骨头后外侧和肩囊。AN 发出的分支从四方形空间向肱骨头后外侧呈环形上升，位于三角肌深面，插入关节囊后下部。在之前解剖的 4 个和 17 个不同的肩部中，在 14（67%）个标本中可以识别到完整的 LPN。其中，12（86%）个有分支支配前肩关节，14（100%）个 LPN 关节支位于喙突上方肩峰支的胸肩峰血管上方。
发现了来自 SN、AN 和 LPN 的关节支。SN 和 AN 的关节支插入盂肱关节后上方的关节囊。LPN 的关节支存在并支配前肩关节的一部分。
