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Anatomical study of the innervation of glenohumeral and acromioclavicular joint capsules: implications for image-guided intervention
  1. John Tran1,
  2. Philip W H Peng2 and
  3. Anne M R Agur1
  1. 1 Division of Anatomy, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
  2. 2 Department of Anesthesia, Toronto Western Hospital, Wasser Pain Management Center, University of Toronto, Toronto, Ontario, Canada
  1. Correspondence to John Tran, Division of Anatomy, Department of Surgery, University of Toronto, Toronto, ON M5S 1A8, Canada; johnjt.tran{at}


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.

  • anatomy
  • joint innervation
  • shoulder joint
  • radiofrequency ablation
  • nerve blocks

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  • Presented at Interim data from this work were presented at the 2017 World Academy of Pain Medicine Ultrasonography Annual Meeting and Workshop in Miami, 13–15 January 2017; at the 2017 Study in Multidisciplinary Pain Research–International Symposium of Ultrasound in Regional Anesthesia Congress in Florence, 29 March to 1 April 2017; at the 2017 Annual Meeting of American Association of Clinical Anatomist in Minneapolis, 17–21 July 2017; and at the 2018 World Academy of Pain Medicine Ultrasonography Annual Meeting and Workshop in Toronto, 23–24 June 2018.

  • Contributors JT, PWHP and AMRA are guarantors. JT is a PhD candidate who is supervised by AMRA and PWHP. Therefore, as mandated by the School of Graduate Studies at the University of Toronto, the supervisors must be actively involved in all aspects of the research including literature search, experimental design, collecting and analyzing data, interpreting results, and manuscript preparation.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests PWHP received equipment support from Sonosite Fujifilm Canada.

  • Patient consent for publication Not required.

  • Ethics approval University of Toronto Health Sciences Research Ethics Board (#27210).

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement This is a cadaveric study and all data/findings have been reported in the manuscript.