Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on medication adherence

LIVE: Thursday 27th June 2024, 18:00-19:30 (CEST)
Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.
ADVANCED SEARCH
Log in
Top
Knee Surgery, Sports Traumatology, Arthroscopy
Published in: Knee Surgery, Sports Traumatology, Arthroscopy 12/2016

01-12-2016 | Shoulder

Anatomical study of the articular branch of the lateral pectoral nerve to the shoulder joint

Authors: Young-Seok Nam, Karnav Panchal, In-Beom Kim, Jong-Hun Ji, Min-Gyu Park, Sung-Ryeoll Park

Published in: Knee Surgery, Sports Traumatology, Arthroscopy | Issue 12/2016

Login to get access

Abstract

Purpose

The purpose of this study was to document the distribution of the articular branch of the lateral pectoral nerve (LPN) to the shoulder and to identify a suitable point for its blockade.

Methods

This study involved the dissection of 43 shoulders of 22 unembalmed cadavers (6 male and 16 female) to identify the LPN and its articular branch to the shoulder. To identify the suitable anatomical point for blocking the articular branch of the LPN, several anatomical landmarks around the shoulder were measured.

Results

The articular branch of the LPN to the shoulder was present in 29 of 43 cases (67.4 %). The appropriate point to block the articular branch of the LPN was identified at a mean distance of 1.5 cm below the clavicle, on the line connecting the closest points between the clavicle and the coracoid process, and at a mean depth of 1.0 cm from the skin.

Conclusion

The articular branch of the LPN to the shoulder, as well as the muscular and cutaneous branches of the LPN, covers a portion of the shoulder joint with suprascapular and axillary nerves. Surgeons might consider a peripheral block of the suprascapular, axillary, and LPNs to provide maximum block coverage after shoulder joint surgery.
Literature
1.
Akita K, Kawashima T, Shimokawa T, Sato K, Sato T (2002) Cutaneous nerve to the subacromial region originating from the lateral pectoral nerve. Ann Anat 184:15–19CrossRefPubMed
2.
Al-Kaisy A, McGuire G, Chan VW, Bruin G, Peng P, Miniaci A, Perlas A (1998) Analgesic effect of interscalene block using low-dose bupivacaine for outpatient arthroscopic shoulder surgery. Reg Anesth Pain Med 23:469–473CrossRefPubMed
3.
Aszmann OC, Dellon AL, Birely BT, McFarland EG (1996) Innervation of the human shoulder joint and its implications for surgery. Clin Orthop Relat Res 330:202–207CrossRef
4.
Axelsson K, Nordenson U, Johanzon E, Rawal N, Ekback G, Lidegran G, Gupta A (2003) Patient-controlled regional analgesia (PCRA) with ropivacaine after arthroscopic subacromial decompression. Acta Anaesthesiol Scand 47:993–1000CrossRefPubMed
5.
Bain GI, Rudkin G, Comley AS, Heptinstall RJ, Chittleborough M (2001) Digitally assisted acromioplasty: the effect of interscalene block on this new surgical technique. Arthroscopy 17:44–49CrossRefPubMed
6.
Benumof JL (2000) Permanent loss of cervical spinal cord function associated with interscalene block performed under general anesthesia. Anesthesiology 93:1541–1544CrossRefPubMed
7.
8.
Borgeat A, Dullenkopf A, Ekatodramis G, Nagy L (2003) Evaluation of the lateral modified approach for continuous interscalene block after shoulder surgery. Anesthesiology 99:436–442CrossRefPubMed
9.
Borgeat A, Ekatodramis G (2002) Anaesthesia for shoulder surgery. Best Pract Res Clin Anaesthesiol 16:211–225CrossRefPubMed
10.
Borgeat A, Schappi B, Biasca N, Gerber C (1997) Patient-controlled analgesia after major shoulder surgery: patient-controlled interscalene analgesia versus patient-controlled analgesia. Anesthesiology 87:1343–1347CrossRefPubMed
11.
Boss AP, Maurer T, Seiler S, Aeschbach A, Hintermann B, Strebel S (2004) Continuous subacromial bupivacaine infusion for postoperative analgesia after open acromioplasty and rotator cuff repair: preliminary results. J Shoulder Elbow Surg 13:630–634CrossRefPubMed
12.
Bowens C Jr, Sripada R (2012) Regional blockade of the shoulder: approaches and outcomes. Anesthesiol Res Pract 2012:971963PubMedPubMedCentral
13.
Checcucci G, Allegra A, Bigazzi P, Gianesello L, Ceruso M, Gritti G (2008) A new technique for regional anesthesia for arthroscopic shoulder surgery based on a suprascapular nerve block and an axillary nerve block: an evaluation of the first results. Arthroscopy 24:689–696CrossRefPubMed
14.
Coghlan JA, Forbes A, McKenzie D, Bell SN, Buchbinder R (2009) Efficacy of subacromial ropivacaine infusion for rotator cuff surgery. A randomized trial. J Bone Joint Surg Am 91:1558–1567CrossRefPubMed
15.
Cunha-Gomes D, Choudhari C, Kavarana NM (2003) Vascular compromise of the pectoralis major musculocutaneous flap in head and neck reconstruction. Ann Plast Surg 51:450–454CrossRefPubMed
16.
Fredrickson MJ, Ball CM, Dalgleish AJ (2008) Successful continuous interscalene analgesia for ambulatory shoulder surgery in a private practice setting. Reg Anesth Pain Med 33:122–128CrossRefPubMed
17.
Fredrickson MJ, Ball CM, Dalgleish AJ (2010) Analgesic effectiveness of a continuous versus single-injection interscalene block for minor arthroscopic shoulder surgery. Reg Anesth Pain Med 35:28–33CrossRefPubMed
18.
Fredrickson MJ, Kilfoyle DH (2009) Neurological complication analysis of 1000 ultrasound guided peripheral nerve blocks for elective orthopaedic surgery: a prospective study. Anaesthesia 64:836–844CrossRefPubMed
19.
Fredrickson MJ, Krishnan S, Chen CY (2010) Postoperative analgesia for shoulder surgery: a critical appraisal and review of current techniques. Anaesthesia 65:608–624CrossRefPubMed
20.
21.
Hovelacque A (1927) Anatomie des nerfs craniens et rachidiens et du système grand sympathique chez l’homme: avec 89 figures dans le texte et CXXI planches hors texte
22.
Ilfeld BM, Morey TE, Wright TW, Chidgey LK, Enneking FK (2003) Continuous interscalene brachial plexus block for postoperative pain control at home: a randomized, double-blinded, placebo-controlled study. Anesth Analg 96:1089–1095CrossRefPubMed
23.
Jerosch J, Saad M, Greig M, Filler T (2008) Suprascapular nerve block as a method of preemptive pain control in shoulder surgery. Knee Surg Sports Traumatol Arthrosc 16:602–607CrossRefPubMed
24.
Jeske HC, Kralinger F, Wambacher M, Perwanger F, Schoepf R, Oberladstaetter J, Krappinger D, Dallapozza C, Hoffmann F (2011) A randomized study of the effectiveness of suprascapular nerve block in patient satisfaction and outcome after arthroscopic subacromial decompression. Arthroscopy 27:1323–1328CrossRefPubMed
25.
Johnson D (2008) Pectoral girdle and upper limb. In: Standring S, Borley NR, Gray H (eds) Gray’s anatomy: the anatomical basis of clinical practice, 40th edn. Churchill Livingstone/Elsevier, Edinburgh, pp 777–906
26.
Kempen PM, O’Donnell J, Lawler R, Mantha V (2000) Acute respiratory insufficiency during interscalene plexus block. Anesth Analg 90:1415–1416CrossRefPubMed
27.
Klein SM, Grant SA, Greengrass RA, Nielsen KC, Speer KP, White W, Warner DS, Steele SM (2000) Interscalene brachial plexus block with a continuous catheter insertion system and a disposable infusion pump. Anesth Analg 91:1473–1478CrossRefPubMed
28.
Klepps SJ, Goldfarb C, Flatow E, Galatz LM, Yamaguchi K (2001) Anatomic evaluation of the subcoracoid pectoralis major transfer in human cadavers. J Shoulder Elbow Surg 10:453–459CrossRefPubMed
29.
Lanna M, Pastore A, Policastro C, Iacovazzo C (2012) Anesthesiological considerations in shoulder surgery. Transl Med UniSa 3:42–48PubMedPubMedCentral
30.
Laurila PA, Lopponen A, Kanga-Saarela T, Flinkkila T, Salomaki TE (2002) Interscalene brachial plexus block is superior to subacromial bursa block after arthroscopic shoulder surgery. Acta Anaesthesiol Scand 46:1031–1036CrossRefPubMed
31.
Layeeque R, Hochberg J, Siegel E, Kunkel K, Kepple J, Henry-Tillman RS, Dunlap M, Seibert J, Klimberg VS (2004) Botulinum toxin infiltration for pain control after mastectomy and expander reconstruction. Ann Surg 240:608–613PubMedPubMedCentral
32.
Lee KS (2007) Anatomic variation of the spinal origins of lateral and medial pectoral nerves. Clin Anat 20:915–918CrossRefPubMed
33.
Lee SM, Park SE, Nam YS, Han SH, Lee KJ, Kwon MJ, Ji JH, Choi SK, Park JS (2012) Analgesic effectiveness of nerve block in shoulder arthroscopy: comparison between interscalene, suprascapular and axillary nerve blocks. Knee Surg Sports Traumatol Arthrosc 20:2573–2578CrossRefPubMed
34.
Lehtipalo S, Koskinen LO, Johansson G, Kolmodin J, Biber B (1999) Continuous interscalene brachial plexus block for postoperative analgesia following shoulder surgery. Acta Anaesthesiol Scand 43:258–264CrossRefPubMed
35.
Linell EA (1921) The distribution of nerves in the upper limb, with reference to variabilities and their clinical significance. J Anat 55:79–112PubMedPubMedCentral
36.
Macchi V, Tiengo C, Porzionato A, Parenti A, Stecco C, Mazzoleni F, De Caro R (2007) Medial and lateral pectoral nerves: course and branches. Clin Anat 20:157–162CrossRefPubMed
37.
38.
Muittari PA, Nelimarkka O, Seppala T, Kanto JH, Kirvela OA (1999) Comparison of the analgesic effects of intrabursal oxycodone and bupivacaine after acromioplasty. J Clin Anesth 11:11–16CrossRefPubMed
39.
Nam YS, Jeong JJ, Han SH, Park SE, Lee SM, Kwon MJ, Ji JH, Kim KS (2011) An anatomic and clinical study of the suprascapular and axillary nerve blocks for shoulder arthroscopy. J Shoulder Elbow Surg 20:1061–1068CrossRefPubMed
40.
Neal JM, McDonald SB, Larkin KL, Polissar NL (2003) Suprascapular nerve block prolongs analgesia after nonarthroscopic shoulder surgery but does not improve outcome. Anesth Analg 96:982–986CrossRefPubMed
41.
Ozel MS, Ozel L, Toros SZ, Marur T, Yildirim Z, Erdogdu E, Kara M, Titiz IM (2011) Denervation point for neuromuscular blockade on lateral pectoral nerves: a cadaver study. Surg Radiol Anat 33:105–108CrossRefPubMed
42.
Price DJ (2007) The shoulder block: a new alternative to interscalene brachial plexus blockade for the control of postoperative shoulder pain. Anaesth Intensive Care 35:575–581PubMed
43.
Singelyn FJ, Lhotel L, Fabre B (2004) Pain relief after arthroscopic shoulder surgery: a comparison of intraarticular analgesia, suprascapular nerve block, and interscalene brachial plexus block. Anesth Analg 99:589–592CrossRefPubMed
44.
Sinha A, Higginson DW, Vickers A (1999) Use of botulinum A toxin in irreducible shoulder dislocation caused by spasm of pectoralis major. J Shoulder Elbow Surg 8:75–76CrossRefPubMed
45.
Solomon LB, Ravindranath N, Vidic B, Dym M (1997) Anatomical variant of the lateral pectoral nerve innervating the anterior portion of the deltoid muscle: a case report. Anat Rec 249:506–509CrossRefPubMed
46.
Tubbs RS, Jones VL, Loukas M, Comert A, Shoja MM, Wellons JC 3rd, Cohen-Gadol AA (2010) Anatomy and landmarks for branches of the brachial plexus: a vade mecum. Surg Radiol Anat 32:261–270CrossRefPubMed
47.
Wilson AT, Nicholson E, Burton L, Wild C (2004) Analgesia for day-case shoulder surgery. Br J Anaesth 92:414–415CrossRefPubMed
Metadata
Title
Anatomical study of the articular branch of the lateral pectoral nerve to the shoulder joint
Authors
Young-Seok Nam
Karnav Panchal
In-Beom Kim
Jong-Hun Ji
Min-Gyu Park
Sung-Ryeoll Park
Publication date
01-12-2016
Publisher
Springer Berlin Heidelberg
Published in
Knee Surgery, Sports Traumatology, Arthroscopy / Issue 12/2016
Print ISSN: 0942-2056
Electronic ISSN: 1433-7347
DOI
https://doi.org/10.1007/s00167-015-3703-8

Other articles of this Issue 12/2016

Knee Surgery, Sports Traumatology, Arthroscopy 12/2016 Go to the issue

Shoulder

Anterior shoulder instability with engaging Hill–Sachs defects: a comparison of arthroscopic Bankart repair with and without posterior capsulodesis

Shoulder

Bone mineral decreases in the calcanei in men after arthroscopic shoulder surgery: a prospective study over 5 years

Erratum

Erratum to: Efficacy of intraarticular application of ketamine or ketamine–levobupivacaine combination on post-operative pain after arthroscopic meniscectomy

Erratum

Erratum to: Evidence-based indications for hindfoot endoscopy

Shoulder

Arthroscopic management of massive rotator cuff tears: an evaluation of debridement, complete, and partial repair with and without force couple restoration

Experimental Study

Biomechanical characteristics of bioabsorbable magnesium-based (MgYREZr-alloy) interference screws with different threads