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