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Sonoanatomy and an ultrasound scanning protocol of the intramuscular innervation pattern of the infraspinatus muscle
  1. Hyung-Jin Lee1,
  2. Ji-Hyun Lee2,
  3. Kyu-Ho Yi2,3 and
  4. Hee-Jin Kim2,4
  1. 1Catholic Institute for Applied Anatomy, Department of Anatomy, College of Medicine, The Catholic University of Korea, Seoul, Korea
  2. 2Division in Anatomy and Developmental Biology, Department of Oral Biology, Human Identification Research Institute, BK21 FOUR Project, Yonsei University College of Dentistry, Seoul, Korea
  3. 3COVID-19 Division, Wonju City Public Health Center, Wonju, Korea
  4. 4Department of Materials Science & Engineering, Yonsei University College of Engineering, Seodaemun-gu, Korea
  1. Correspondence to Dr Hee-Jin Kim, Division in Anatomy and Developmental Biology, Department of Oral Biology, Human Identification Research Institute, BK21 FOUR Project, Yonsei University College of Dentistry, Seoul 03722, Korea (the Republic of); hjk776{at}yuhs.ac

Abstract

Introduction Botulinum neurotoxin injection is a valuable treatment method for patients with myofascial pain syndrome in the infraspinatus muscle. However, there is no botulinum neurotoxin injection guideline, and the most appropriate injection site based on topographical anatomic information for this injection to effectively treat myofascial pain syndrome in the infraspinatus muscle is unclear. The purpose of this study was to evaluate the intramuscular nerve terminal of the infraspinatus muscle and to suggest the most efficient botulinum neurotoxin injection sites.

Methods This study used 5 formalin-embalmed and 10 fresh frozen cadavers with a mean age of 78.9 years. Sihler’s staining was applied to evaluate the intramuscular nerve terminal of the infraspinatus muscle. The ultrasound scanning of the infraspinatus muscle was performed based on the surface landmarks and internal structures near the scapular region.

Results The intramuscular nerve terminal was mostly observed in the medial third area of the infraspinatus muscle. The deltoid tubercle, inferior angle, and acromion of the scapula are useful as surface landmarks to scan the infraspinatus muscle.

Discussion The proposed injection sites based on the intramuscular nerve terminal and surface landmarks can be regarded as accurate locations to reach the cluster area of the intramuscular nerve terminal and each compartment of the infraspinatus muscle to manage the myofascial pain syndrome in the infraspinatus muscle.

  • Pain Management
  • Anesthesia, Local
  • Nerve Block

https://doi.org/10.1136/rapm-2022-103682

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    Footnotes

    • H-JL and J-HL contributed equally.

    • Contributors H-JL and J-HL (these authors contribute equllay to this work): conceptualization, dissection, experimemt, validation, writing and editing of the original manuscript. K-HY: experiment, validation and visualization. H-JK: project administration, conceptualization, supervision, and critical revision of the manuscript for intellectual content. All authors have read and agreed to the publication of this manuscript. H-JK is responsible for the overall content as guarantor. All authors have read and agreed to the publication of this manuscript.

    • Funding The authors sincerely thank those who donated their bodies to science so that anatomical research could be performed. This research was supported by Basic Science Research Program through the National Research Foundation of Korea (NRF) funded by the Ministry of Education (2022R1I1A1A01069499). This work was supported by the National Research Foundation of Korea (NRF) grant funded by the Korean government (MSIP) (NRF NRF-2019R1C1C1010776). The authors thank Soowan Kim from Johns Hopkins University and Shihyun Kim from Boston University for their revision of the English translation of this manuscript.

    • Competing interests None declared.

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

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.