Departamento de Anatomía, Histología y Neurociencia, Universidad Autónoma de Madrid, Calle Arzobispo Morcillo, 4, 28029 Madrid, Spain; Division of Pathology, General Hospital of La Palma (HGLP) Buenavista de Arriba s/n PC48713 La Palma, Canary Islands, Spain.; MoMaRC Morphological Madrid Research Center, Calle Arzobispo Morcillo, 4, 28029 Madrid, Spain.
MoMaRC Morphological Madrid Research Center, Calle Arzobispo Morcillo, 4, 28029 Madrid, Spain; Division of Rheumatology, Medical-geriatric Department, University Hospital AOU Careggi, Largo Piero Palagi, 1, 50139 Florence, Italy.
Ann Anat. 2022 Jan;239:151814. doi: 10.1016/j.aanat.2021.151814. Epub 2021 Sep 16.
Shoulder pain is a highly prevalent condition, often resulting in major life limitations, and requiring effective treatments. In this work, we explore the anatomical basis of a proposed approach to the regional anesthesia of the shoulder through a single injection under the subscapularis muscle. Bilateral experimental injections in shoulders from body donors (Radiolar ® and Methylene-Blue) under the subscapular muscle (n = 11) and cadaveric systematic dissections of other 35 shoulders from body donors were performed. Injectate spread was then qualitatively assessed. Long axis of permeable foramina in the anterior aspect of the shoulder joint capsule was measured in centimeters using a digital caliper. More than 40% of specimens had at least one permeable space (Weitbrech and/or Rouvière foramina) communicating the subscapular bursa and the articular space. We further demonstrate that an ultrasonography-guided injection under the subscapularis muscle allows the spread of the injectate through the anterior, inferior and posterodorsal walls of the articular capsule, the subacromial bursa, and the bicipital groove, as well as into the articular space for some injections. The odds of accidental intraarticular injection decrease when injecting with low volumes. This anatomical study provides a detailed description of foramina between glenohumeral ligaments. Furthermore, the data shown in this work supports, as a proof of concept, a safe alternative for rapid and specific blockade of terminal sensory branches innervating the shoulder joint capsule.
肩部疼痛是一种高发疾病，常导致严重的生活受限，并需要有效的治疗。在这项工作中，我们通过在肩胛下肌下进行单次注射，探索了一种针对肩部区域麻醉的新方法的解剖学基础。在尸体捐赠者的肩部进行双侧实验性注射（Radiolar ® 和亚甲蓝）（n=11），并对其他 35 名尸体捐赠者的肩部进行了尸体系统解剖。然后定性评估了注射剂的扩散情况。使用数字卡尺测量肩关节囊前侧的可渗透孔的长轴，以厘米为单位。超过 40%的标本至少有一个可渗透的空间（Weitbrech 和/或 Rouvière 孔），将肩胛下囊和关节腔连通。我们进一步证明，肩胛下肌下的超声引导注射可使注射剂通过关节囊的前、下和后背部、肩峰下囊和二头肌沟扩散，并在一些注射中进入关节腔。当注射量较低时，意外关节内注射的可能性会降低。这项解剖学研究详细描述了肩盂和肱盂韧带之间的孔。此外，本工作中的数据支持了一种安全的替代方案，作为一种概念验证，可以快速和特异性地阻断支配肩关节囊的终末感觉分支。
