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Intramuscular innervation of the subscapularis muscle and its clinical implication for the BoNT injection: An anatomical study using the modified Sihler's staining

Authors
 Tae‐Hyeon Cho  ;  Hyun‐Jin Kwon  ;  You‐Jin Choi  ;  Jehoon O  ;  Sung‐Yoon Won  ;  Hun‐Mu Yang 
Citation
 Clinical Anatomy, Vol.32(1) : 110-116, 2019 
Journal Title
 Clinical Anatomy 
ISSN
 0897-3806 
Issue Date
2019
Keywords
botulinum toxins ; injections ; muscle spasticity ; rotator cuff
Abstract
Shoulder pain is commonly associated with spasticity of the rotator cuff muscles including the subscapularis (SSC). The aim of this study was to elucidate the intramuscular innervation pattern of the SSC using the modified Sihler's staining technique to facilitate the targeting of botulinum neurotoxin (BoNT) injections to alleviate shoulder spasticity. Ten SSC specimens (mean age, 81.5 years) were used in this study. Modified Sihler's staining was used to clarify the muscle and to stain the intramuscular nerves. Their extramuscular and intramuscular innervation patterns were examined. The upper subscapular, lower subscapular, thoracodorsal, and axillary nerves (USN, LSN, TDN, and AXN) innervated the SSC in 100%, 80%, 20%, and 40% of specimens, respectively. There was an anastomosis between the USN and LSN in the central portion of the SSC in more than half of the cases. The USN innervated the overall portion of the muscle. In contrast, the additional branches from the TDN and AXN innervated the inferior SSC portion. The superficial branches of the USN were mostly distributed in the superior SSC portion while the deep branches were distributed in the inferior portion. As a major intramuscular nerve within the SSC, the USN should be targeted by a BoNT injection. Regarding the USN distribution, the aim should be to spread the BoNT injectate within the central SSC portion. For supplementary injection to the AXN, the lateral approach would be more appropriate than alternatives. A physician performing a BoNT injection should consider the intramuscular innervation of the SSC portion.
Full Text
https://onlinelibrary.wiley.com/doi/full/10.1002/ca.23303
DOI
10.1002/ca.23303
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Anatomy (해부학교실) > 1. Journal Papers
2. College of Dentistry (치과대학) > Dept. of Oral Biology (구강생물학교실) > 1. Journal Papers
Yonsei Authors
Kwon, Hyun-Jin(권현진) ORCID logo https://orcid.org/0000-0001-7752-6172
Yang, Hun Mu(양헌무) ORCID logo https://orcid.org/0000-0003-1954-0114
O, Jehoon(오제훈) ORCID logo https://orcid.org/0000-0003-4351-3183
Cho, Tae-Hyeon(조태현) ORCID logo https://orcid.org/0000-0001-7230-620X
Choi, You Jin(최유진) ORCID logo https://orcid.org/0000-0003-3701-2200
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URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/167317
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