Permeable spaces between glenohumeral ligaments as potential gateways for rapid regional anesthesia of the shoulder
| Autor: | Isabel Pérez-Santos, Emilio González-Arnay, Elena Bañón-Boulet, Clotilde Rivier-Julien, Manuel Barrueco-Fernández, Felice Galluccio, Mario Fajardo-Pérez, Ece Yamak-Altinpulluk, Lorena Jiménez-Sánchez, Marilina Susana Olea, Sebastián Merlano-Castellanos, Ana Sofia Teles |
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| Jazyk: | angličtina |
| Rok vydání: | 2022 |
| Předmět: |
musculoskeletal diseases
Shoulder Chondrotoxicity Shoulders Glenohumeral joint Block Regional anesthesia Shoulder joint Anesthesia Conduction Bicipital groove Ultrasound Cadaver medicine Humans Pain Management Articular capsule of the knee joint Ligaments Shoulder Joint business.industry Innervation Subscapularis muscle General Medicine Anatomy Bursa Synovial musculoskeletal system Bupivacaine Glenohumeral ligaments medicine.anatomical_structure Axillary Nerve Joint Ligaments Articular Capsuloligamentous Complex business Subacromial bursa Cadaveric spasm Developmental Biology |
| Popis: | Shoulder pain is a highly prevalent condition, often resulting in major life limitations, and requiring effective treatments. In this work, we explore the anatomical basis of a proposed approach to the regional anesthesia of the shoulder through a single injection under the subscapularis muscle. Bilateral experimental injections in shoulders from body donors (Radiolar (R) and Methylene-Blue) under the subscapular muscle (n = 11) and cadaveric systematic dissections of other 35 shoulders from body donors were performed. Injectate spread was then qualitatively assessed. Long axis of permeable foramina in the anterior aspect of the shoulder joint capsule was measured in centimeters using a digital caliper. More than 40% of specimens had at least one permeable space (Weitbrech and/or Rouviere foramina) communicating the subscapular bursa and the articular space. We further demonstrate that an ultrasonography-guided injection under the subscapularis muscle allows the spread of the injectate through the anterior, inferior and posterodorsal walls of the articular capsule, the subacromial bursa, and the bicipital groove, as well as into the articular space for some injections. The odds of accidental intraarticular injection decrease when injecting with low volumes. This anatomical study provides a detailed description of foramina between glenohumeral ligaments. Furthermore, the data shown in this work supports, as a proof of concept, a safe alternative for rapid and specific blockade of terminal sensory branches innervating the shoulder joint capsule. (c) 2021 Elsevier GmbH. All rights reserved. |
| Databáze: | OpenAIRE |
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