NEURAL PROLOTHERAPY
REGIONAL ANATOMY
UPPER EXTREMITIES
Lecture by: M.K. Sastry
Program Director,
Post Graduate Studies and PhD Program
Dermatomal versus Regional pain
Nociceptive pain Neuropathic pain
Non-peptidergic Peptidergic - Nervi Nervorum
THE SENSORY INNERVATION OF
THE SHOULDER
Suprascapular Nerve.
Radial Nerve.
Axillary.
Subscapular Nerve.
THE SENSORY INNERVATION OF
THE SHOULDER
Musculocutaneous Nerve.
Intermediate Supraclavicular Nerve.
Encyclopedia Anatomica
1771
Sensocrine nerve anatomy
BRACHIAL PLEXUS
Key UE nerves
Ax SLBrC n.
Ax SLBrC n.
Rad PBrC n
Rad ILBrC n. Rad ILBrC n.
ICBr
& Rad PABC n.
Musc LAC MBr
MA Musc LAC
n. C
Cn n.
Ulnar Rad Sup rad &
palmar digital brs
& DUC
Median
palmar &
digital brs
SUPRACLAVICULAR
FOSSA
Key points:
Locate
posterior
intermediate
medial
CCIs
Proposed mechanism of ‘whiplash injury’
Neuropraxia / intussusception injury of
the supraclavicular nerves
L Supraclavicular Nerves CCI’s
Posterior
Medial Intermediate
POSTERIOR SUPRACLAVICULAR NERVE
INTERMEDIATE SUPRACLAVICULAR NERVE
Encyclopedia Anatomica 1771
Sensocrine 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.
“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
It supplies sensory and
sympathetic fibers to
two-thirds of the
shoulder capsule.
“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
Usually there are no
sensory fibers to the
skin. The nerve then
travels thru spino-
glenoid notch under
ligament to supply the
infra-spinatus muscle.
“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
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 POINTS
UNDER SCAPULAR SPINE, DEPTH ½ INCH
CROSSED BODY ADDUCTION TEST STRESSES NERVE
IN AXIAL PLANE
“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
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.
“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
A rotator cuff tendon and
‘paralabral spinoglenoid
cyst’ has trapped the infra-
scapular nerve
Netter: Posterior shoulder
Quadrangular space, triangular space & interval
AXILLARY
NERVE
Quadrangular
space
Teres minor
Teres major
Long head,
triceps
Humerus
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 CCI
to subscapularis
muscle
Triangular
interval
Radial nerve
“tennis elbow”
CCIs:
Radial nerve
triangular
interval
@ entrance to
LIMS
LIMS
Nerve test:
“chicken wings”
CORABRACHIALIS
BICEPS Musculocutaneous
BRACHIAL nerve
IS
ARTICULAR BR CCIs
LAC
Posterior
shoulder
superior
lateral
brachial
nerve
Intercostalis nerves
Nerves of the
arm
Medial
brachial and
antebrachia
l nerves
“Golfers
elbow” or
“Throwers
elbow”
Medial elbow with
Bicipital Aponeurosis with risk of CECS
LEFT MEDIAL BRACHIAL AND
ANTEBRACHIAL NERVES AND CCIs
MAC ns
Inter-costobrachial n ME
Medial brachial cutaneous
MAC
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
LA
C
L
PABC E
N O
ANCONEU
S
Radial, Median and Ulnar palmar nerves of
the left wrist
“Carpal tunnel syndrome”, “OA base thumb”
M R
R
“De Quervain
syndrome”
Musculocutaneous and
POST Br LAC
Radial cutaneous branches
R
Thank You
