Sonoanatomy and an ultrasound scanning protocol of the intramuscular innervation pattern of the infraspinatus muscle.

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.

Anatomical structure and nerve branching pattern of the human infraspinatus muscle.

The function of the infraspinatus muscle, critical to rotator cuff function, is dependent upon the muscle's structure and innervation pattern. The morphology of the infraspinatus muscle has been inconsistently described in the literature. Additionally, the branching pattern of the suprascapular nerve in the infraspinous fossa has not been addressed in the literature. The purposes of this study were to determine: the arrangement of the infraspinatus muscle bellies; the branching patterns of the suprascapular nerve to the infraspinatus muscle; if the infraspinatus muscle was composed the neuromuscular compartments. Forty-eight infraspinatus muscles from 24 embalmed cadavers were studied using standard dissection techniques to determine morphological characteristics and innervation patterns. Results demonstrated that the infraspinatus muscles were comprised of three separate muscular partitions with each partition residing in a thin fascial compartment but all residing deep to the posterior scapular fascia. A first order suprascapular nerve branch was present in 91.6% of superior, 100% of middle, and 70.8% of inferior partitions. A first order nerve was present in all 3 muscular compartments of the same infraspinatus muscle in 62.5% of cases. Second order nerve branches were present in 8.3% of superior, 0% of middle, and 29.2% of inferior partitions. These findings help to determine a more complete and accurate understanding of the structure of the infraspinatus muscle. A better understanding of its structure could lead to a better understanding of the function of the muscle. Such information will enable more effective rehabilitation strategies for injuries involving the infraspinatus component of the rotator cuff.

Why does my shoulder hurt? A review of the neuroanatomical and biochemical basis of shoulder pain.

If a patient asks 'why does my shoulder hurt?' the conversation will quickly turn to scientific theory and sometimes unsubstantiated conjecture. Frequently, the clinician becomes aware of the limits of the scientific basis of their explanation, demonstrating the incompleteness of our understanding of the nature of shoulder pain. This review takes a systematic approach to help answer fundamental questions relating to shoulder pain, with a view to providing insights into future research and novel methods for treating shoulder pain. We shall explore the roles of (1) the peripheral receptors, (2) peripheral pain processing or 'nociception', (3) the spinal cord, (4) the brain, (5) the location of receptors in the shoulder and (6) the neural anatomy of the shoulder. We also consider how these factors might contribute to the variability in the clinical presentation, the diagnosis and the treatment of shoulder pain. In this way we aim to provide an overview of the component parts of the peripheral pain detection system and central pain processing mechanisms in shoulder pain that interact to produce clinical pain.