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Original Article
Quantitative analysis of the distal, lateral, and posterior articular branches of the axillary nerve to the shoulder: implications for intervention
  1. Brittany Bickelhaupt1,
  2. Maxim S Eckmann2,
  3. Caroline Brennick1 and
  4. Omid B Rahimi3
  1. 1Rehabilitation, University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
  2. 2Anesthesiology, University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
  3. 3Cellular and Structural Biology, University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
  1. Correspondence to Dr Brittany Bickelhaupt, Rehabilitation, University of Texas Health Science Center at San Antonio, San Antonio, TX 78229, USA; bickelhaupt{at}uthscsa.edu

Abstract

Introduction The terminal sensory branches innervating the shoulder joint are potential therapeutic targets for the treatment of shoulder pain. This cadaveric study investigated in detail the anatomic pathway of the posterior terminal sensory branch of the axillary nerve (AN) and its relationship to nearby anatomic structures for applications, such as nerve block or ablation of the shoulder joint.

Methods For this study, nine shoulders were dissected. Following dissection, methylene blue was used to stain the pathway of the terminal sensory branches of the AN to provide a visual relationship to the nearby bony structures. A transparent grid was overlaid on the humeral head to provide further detailed information regarding the innervation to the shoulder joint.

Results Eight of the nine shoulders displayed terminal sensory branches of the AN. The terminal sensory branches of the AN innervated the posterolateral head of the humerus and shoulder capsule and were deep and distal to the motor branches innervating the deltoid muscle and teres minor muscle. All terminal branches dissected innervated the shoulder capsule at the posteroinferior-lateral aspect of the greater tuberosity of the humerus. All specimens displayed innervation to the shoulder joint in the lateral most 25% and inferior most 37.5% before methylene blue staining.

Conclusion The terminal sensory branches of the AN consistently innervate the inferior and lateral aspects of the posterior humeral head and shoulder capsule. These nerves are easily accessible and would provide a practical target for nerve block or ablation to relieve shoulder pain without compromising motor integrity.

  • upper extremity
  • acute pain
  • interventional pain management
  • radiofrequency ablation
  • anatomy

https://doi.org/10.1136/rapm-2019-100560

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    Footnotes

    • Contributors BB and MSE designed the study. BB and CB performed the cadaveric dissections, data collection, and analysis. MSE supervised the data acquisition quality and manuscript editing. BB wrote the manuscript with input from MSE. OBR provided supplies for cadaveric dissections and oversaw anatomic lab procedures.

    • Funding Cadaver specimens were funded by Avanos Medical, Inc., and provided by the University of Texas Health San Antonio Department of Cell Systems and Anatomy and the Body Donation Program.

    • Competing interests None declared.

    • Patient consent for publication Not required.

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

    • Data availability statement All data relevant to the study are included in the article or uploaded as supplementary information.