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Diagnostic block and radiofrequency ablation of the acromial branches of the lateral pectoral and suprascapular nerves for shoulder pain: a 3D cadaveric study
  1. John Tran1,
  2. Philip Peng2,
  3. Anne Agur1 and
  4. Nimish Mittal3
  1. 1 Division of Anatomy, Department of Surgery, University of Toronto Faculty of Medicine, Toronto, Canada
  2. 2 Department of Anesthesia and Pain Medicine, Toronto Western Hospital, Toronto, Canada
  3. 3 Physical Medicine and Rehabilitation, University Health Network, Toronto, Canada
  1. Correspondence to Dr John Tran, Division of Anatomy, Department of Surgery, University of Toronto Faculty of Medicine, Toronto, Canada; johnjt.tran{at}mail.utoronto.ca

Abstract

Background and objectives Acromial branches of the lateral pectoral and suprascapular nerves have been proposed as targets for diagnostic block and radiofrequency ablation to treat superior shoulder pain; however, the nerve capture rates of these procedures have not been investigated. The objectives of this study were to use dissection and 3D modeling technology to determine the course of these acromial branches, relative to anatomical landmarks, and to evaluate nerve capture rates using ultrasound-guided dye injection and lesion simulation.

Methods Ultrasound-guided dye injections, targeting the superior surface of coracoid process and floor of supraspinous fossa, were performed (n=5). Furthermore, needles targeting the superior and posterior surfaces of the coracoid process were placed under ultrasound guidance to simulate needle electrode position (n=5). Specimens were dissected, digitized, and modeled to determine capture rates of acromial branches of lateral pectoral and suprascapular nerves.

Results The course of acromial branches of lateral pectoral and suprascapular nerves were documented. Dye spread capture rates: acromial branches of lateral pectoral and suprascapular nerves were captured in all specimens. Lesion simulation capture rates: (1) when targeting superior surface of coracoid process, the entire acromial branch of lateral pectoral nerve was captured in all specimens and (2) when targeting posterior surface of coracoid process, the acromioclavicular and bursal branches of acromial branch of suprascapular nerve were captured in all specimens; coracoclavicular branch was captured in 3/5 specimens.

Conclusions This study supports the anatomical feasibility of ultrasound-guided targeting of the acromial branches of lateral pectoral and suprascapular nerves. Further clinical investigation is required.

  • chronic pain
  • pain management
  • nerve block
  • ultrasonography
  • upper extremity

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Footnotes

  • Contributors JT, PP, AA, and NM contributed to the experimental design, data acquisition, analysis of data, drafting, and revising the manuscript critically for important intellectual content.

  • 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 PP received equipment support from Sonosite Fujifilm Canada. AA is an Anatomy Faculty with Allergan Academy of Excellence.

  • Patient consent for publication Not required.

  • Ethics approval This cadaveric study includes nonidentifiable dissection images and the use was approved by the University of Toronto Health Sciences Research Ethics Board (#27210).

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

  • Data availability statement This is a cadaveric study and all data relevant to this study are included in the article or uploaded as supplementary information.

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