Presentation on theme: "Neural Prolotherapy REGIONAL ANATOMY UPPER EXTREMITIES Lee Wolfer, MD, MS."— Presentation transcript:
Neural Prolotherapy REGIONAL ANATOMY UPPER EXTREMITIES Lee Wolfer, MD, MS
NEUROBIOLOGY AND NEUROKININS Monoaminergic System Serotonergic Noradrenergic Dopaminergic Cholinergic Glutamatergic System System controlling neural plasticity, synaptic sensitisation, and conscious nociceptive pain through mainly NMDA receptors “20 th Century CNS sensitisation” Peptidergic System System controlling tissue homeostasis, neurogenic inflammation peripheral non-synaptic sensitisation and neuropathic pain
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
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 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. 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
GREASE: WHY WE THINK DANNY ZUKO HAS GREAT HAIR OR: HOW TO TEST YOUR MUSCULOSKELETAL NERVE
Posterior shoulder superior lateral brachial nerve
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 n 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 ANCONEUS LE O LAC PABCN
Radial, Median and Ulnar palmar nerves of the left wrist “Carpal tunnel syndrome”, “OA base thumb” U M R R
“De Quervain syndrome” Musculocutaneous and Radial cutaneous branches R POST Br LAC