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Neural Prolotherapy REGIONAL ANATOMY UPPER EXTREMITIES Lee Wolfer, MD, MS.

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Presentation on theme: "Neural Prolotherapy REGIONAL ANATOMY UPPER EXTREMITIES Lee Wolfer, MD, MS."— Presentation transcript:

1 Neural Prolotherapy REGIONAL ANATOMY UPPER EXTREMITIES Lee Wolfer, MD, MS

2 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

3 Dermatomal versus Regional pain Nociceptive pain Non-peptidergic Neuropathic pain Peptidergic - Nervi Nervorum

4 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.

5 THE SENSORY INNERVATION OF THE SHOULDER SUPRASCAPULAR NERVE RADIAL NERVE AXILLARY SUBSCAPULAR NERVE MUSCULOCUTANEOUS NERVE INTERMEDIATE SUPRACLAVICULAR NERVE

6 Encyclopedia Anatomica 1771 Sensocrine nerve anatomy

7 BRACHIAL PLEXUS Key UE nerves

8 Ax  SLBrC n. Rad  ILBrC n. Rad  PBrC n Rad  PABC n. Musc  LAC n. ICBr & MBrC n MAC Rad  Sup rad & digital brs Ulnar  palmar & DUC Median  palmar & digital brs

9 SUPRACLAVICULAR FOSSA Key points: Locate posterior intermediate medial CCIs

10 Proposed mechanism of ‘whiplash injury’ Neuropraxia/intussusception injury of the supraclavicular nerves

11 L Supraclavicular Nerves CCI’s Posterior Intermediate Medial

12 POSTERIOR SUPRACLAVICULAR NERVE

13 INTERMEDIATE SUPRACLAVICULAR NERVE

14 Encyclopedia Anatomica 1771 Sensocrine nerve anatomy

15 MEDIAL SUPRACLAVICULAR NERVE “Tietze syndrome” and “Costo-chondritis”

16 “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.

17 INFRASCAPULAR NERVE: INJECTION POINTS UNDER SCAPULAR SPINE, DEPTH ½ INCH CROSSED BODY ADDUCTION TEST STRESSES NERVE IN AXIAL PLANE

18 “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

19 Netter: Posterior shoulder Quadrangular space, triangular space & interval

20 AXILLARY NERVE Quadrangular space Teres minor Teres major Long head, triceps Humerus Superior lateral brachial cut n.

21 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.

22 Lower Subscapular nerve CCI to subscapularis muscle Triangular interval

23 Radial nerve “tennis elbow” CCIs: triangular entrance to LIMS Nerve test: “chicken wings” Radial nerve LIMS

24 Musculocutaneous nerve CCIs LAC BRACHIALIS ARTICULAR BR CORABRACHIALIS BICEPS

25 GREASE: WHY WE THINK DANNY ZUKO HAS GREAT HAIR OR: HOW TO TEST YOUR MUSCULOSKELETAL NERVE

26 Posterior shoulder superior lateral brachial nerve

27

28 Intercostalis nerves

29 Nerves of the arm

30 Medial brachial and antebrachial nerves “Golfers elbow” or “Throwers elbow”

31 Medial elbow with Bicipital Aponeurosis with risk of CECS

32 LEFT MEDIAL BRACHIAL AND ANTEBRACHIAL NERVES AND CCIs ME MAC ns Intercostobrachial n Medial brachial cutaneous MAC

33 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

34 Radial, Median and Ulnar palmar nerves of the left wrist “Carpal tunnel syndrome”, “OA base thumb” U M R R

35 “De Quervain syndrome” Musculocutaneous and Radial cutaneous branches R POST Br LAC


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