Online Article
Sensory innervation of the human shoulder joint: the three bridges to break

https://doi.org/10.1016/j.jse.2020.07.017Get rights and content

Background

Painful shoulders create a substantial socioeconomic burden and significant diagnostic challenge for shoulder surgeons. Consensus with respect to the anatomic location of sensory nerve branches is lacking. The aim of this literature review was to establish consensus with respect to the anatomic features of the articular branches (ABs) (1) innervating the shoulder joint and (2) the distribution of sensory receptors about its capsule and bursae.

Materials and methods

Four electronic databases were queried, between January 1945 and June 2019. Thirty original articles providing a detailed description of the distribution of sensory receptors about the shoulder joint capsule (13) and its ABs (22) were reviewed.

Results

The suprascapular, lateral pectoral, axillary, and lower subscapular nerves were found to provide ABs to the shoulder joint. The highest density of nociceptors was found in the subacromial bursa. The highest density of mechanoreceptors was identified within the insertion of the glenohumeral ligaments. The most frequently identified innervation pattern comprised 3 nerve bridges (consisting of ABs from suprascapular, axillary, and lateral pectoral nerves) connecting the trigger and the identified pain generator areas rich in nociceptors.

Conclusion

Current literature supports the presence of a common sensory innervation pattern for the human shoulder joint. Anatomic studies have demonstrated that the most common parent nerves supplying ABs to the shoulder joint are the suprascapular, lateral pectoral, and axillary nerves. Further studies are needed to assess both the safety and efficacy of selective denervation of the painful shoulders, while limiting the loss of proprioceptive function.

Section snippets

Materials and methods

The aim of this study was to collect and review international literature describing the ABs of the shoulder joint, as well as the sensory branches to its capsule, ligaments, and bursae. A literature search was performed using 5 different databases: Ovid Medline, Ovid Embase, Scopus, Web of Science, and Cochrane. Articles from 1945 to 2019 were included, and the search was performed using the Medical Subject Headings and keywords. The search was limited to English language literature. The

Quality of studies

Our electronic search yielded a total of 876 studies. After applying inclusion and exclusion criteria, articles underwent full-text evaluation. A total of 13 articles related to shoulder sensory receptors and 22 related to ABs were included in the review. A summary of the search strategy is outlined in Figure 1.

Sensory receptors

Sensory receptors include mechanoreceptors (Ruffini, Pacinian, and Golgi corpuscles) and nociceptors (free nerves endings). Both types were found in the shoulder joint capsule, its

Discussion

The present literature reviewed summarized all described ABs innervating the shoulder joint. The resulting frequency map of AB and sensory receptors provided an anatomical basis with which to design targeted denervation (Table II, Figs. 2 and 3).

There were several identifiable limitations of the reviewed literature. Providing a complete and detailed description of shoulder innervation has long been a challenge to the anatomist. For this reason, few studies have comprehensively described the

Conclusion

The SSN, LPN, AN, and LSN were found to supply ABs to the shoulder joint. The highest density of nociceptors and mechanoreceptors was identified in SAB and anterior GH capsule/ligaments, respectively. Further studies are needed to assess both the safety and efficacy of selective denervation of the PS, while limiting the loss of proprioceptive function.

Disclaimer

Figure 2, Figure 4 were funded by Arthrex, Inc. (Naples, FL, USA). The authors, their immediate families, and any research foundations with which they are affiliated have not received any financial payments or other benefits from any commercial entity related to the subject of this article.

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