Neural Prolotherapy REGIONAL ANATOMY UPPER EXTREMITIES Lee Wolfer, MD, MS.
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Transcript of Neural Prolotherapy REGIONAL ANATOMY UPPER EXTREMITIES Lee Wolfer, MD, MS.
Neural Prolotherapy
REGIONAL ANATOMYUPPER EXTREMITIES
Lee Wolfer, MD, MS
NEUROBIOLOGY AND NEUROKININS
Monoaminergic SystemSerotonergic
NoradrenergicDopaminergic
Cholinergic
Glutamatergic SystemSystem controlling neural plasticity, synaptic sensitisation,
and conscious nociceptive pain through mainly NMDA receptors“20th Century CNS sensitisation”
Peptidergic SystemSystem controlling tissue homeostasis,
neurogenic inflammation peripheral non-synaptic sensitisation
and neuropathic pain
Dermatomal versus Regional painNociceptive painNon-peptidergic
Neuropathic painPeptidergic - Nervi Nervorum
Lee, MK. An evidence based approach to human dermatomes. Clin Anat, 2008
The dermatome is a fundamental concept in human anatomy and of major importance in
clinical practice.
There are significant variations in current dermatome maps in standard anatomy texts.
Our findings demonstrate that current dermatome maps are inaccurate and based on
flawed studies.
THE SENSORY INNERVATION OF THE SHOULDER
• SUPRASCAPULAR NERVE• RADIAL NERVE• AXILLARY
• SUBSCAPULAR NERVE• MUSCULOCUTANEOUS NERVE
• INTERMEDIATE SUPRACLAVICULAR NERVE
Encyclopedia Anatomica 1771Sensocrine nerve anatomy
BRACHIAL PLEXUSKey UE nerves
Ax SLBrC n.Ax SLBrC n.
Rad ILBrC n. Rad ILBrC n.
Rad PBrC n
Rad PABC n.
Musc LAC n.Musc LAC n.
ICBr & MBrC n
MAC
Rad Sup rad & digital brs
Ulnar palmar & DUC
Median palmar & digital brs
SUPRACLAVICULAR FOSSA
Key points:Locate
posteriorintermediate
medial CCIs
Proposed mechanism of ‘whiplash injury’ Neuropraxia/intussusception injury of the
supraclavicular nerves
L Supraclavicular Nerves CCI’s
Posterior
IntermediateMedial
POSTERIOR SUPRACLAVICULAR NERVE
INTERMEDIATE SUPRACLAVICULAR NERVE
Encyclopedia Anatomica 1771Sensocrine nerve anatomy
MEDIAL SUPRACLAVICULAR NERVE“Tietze syndrome” and “Costo-chondritis”
“FROZEN SHOULDER”Suprascapular Nerve Impingement
The suprascapular nerve is derived from the upper trunk of the brachial plexus from the roots of C5 and C6
The nerve supplies the supraspinatus muscle and provides articular branches to the glenohumeral and acromioclavicular joints.
It supplies sensory and sympathetic fibers to two-thirds of the shoulder capsule.
Usually there are no sensory fibers to the skin. The nerve then travels thru spinoglenoid notch under ligament to supply the infraspinatus muscle.
In about 50% of people there is another connective tissue band creating a second fibro-osseous opening for the nerve to traverse.
INFRASCAPULAR NERVE: INJECTION POINTSUNDER SCAPULAR SPINE, DEPTH ½ INCH
CROSSED BODY ADDUCTION TEST STRESSES NERVE IN AXIAL PLANE
“FROZEN SHOULDER”Suprascapular Nerve ImpingementThe suprascapular nerve is derived from the upper trunk of the brachial
plexus from the roots of C5 and C6
Right Supra-scapular Nerve
Impingement (C5,6) This illustration features a
posterior view of the deep muscles of the shoulder. The course of the supra scapular nerve is shown.
A rotator cuff tendon and ‘paralabral spinoglenoid cyst’ has trapped the infra-scapular nerve
Netter: Posterior shoulderQuadrangular space, triangular space & interval
AXILLARYNERVE
Quadrangular space
Teres minorTeres majorLong head,
tricepsHumerus
Superior lateral brachial cut n.
Axillary nerve (C5, C6)Inflammation of the Axillary
nerve trunk can be elicited in abduction and ER causing a
catching pain over the anterior Deltoid
‘Tight’ bands can be palpated in the Deltoid and Teres minor
where the Axillary nerve branches penetrate the
muscle.
Lower Subscapular
nerve CCIto subscapularis
muscle
Triangular interval
Radial nerve “tennis elbow”
CCIs:triangular interval
@ entrance to LIMS
Nerve test: “chicken wings”
Radial nerve
LIMS
Musculocutaneousnerve CCIs
LAC
BRACHIALIS
ARTICULAR BR
CORABRACHIALIS
BICEPS
GREASE: WHY WE THINK DANNY ZUKO HAS GREAT HAIR
OR:HOW TO TEST YOUR MUSCULOSKELETAL NERVE
Posterior shoulder
superiorlateral
brachial nerve
Intercostalis nerves
Nerves of the arm
Medial brachial and antebrachial
nerves“Golfers
elbow” or “Throwers
elbow”
Medial elbow with Bicipital Aponeurosis with risk of CECS
LEFT MEDIAL BRACHIAL AND ANTEBRACHIAL NERVES AND CCIs
ME
MAC ns
Intercostobrachial nMedial brachial cutaneousMAC
Left Lateral elbow (tennis elbow)Anconeus and posterior antebrachial nerves arise from the Radial nerve and the lateral antebrachial
nerve arises from the Musculocutaneous nerve
ANCONEUS
LE
O
LAC
PABCN
Radial, Median and Ulnar palmar nerves of the left wrist
“Carpal tunnel syndrome”, “OA base thumb”
U
M
RR
“De Quervain syndrome”
Musculocutaneous and Radial cutaneous branches
R
POST Br LAC