Innervation patterns of the inferior glenohumeral ligament: Anatomical and biomechanical relevance

Abstract

Although the Inferior Glenohumeral Ligament (IGHL) has a well known mechanical and proprioceptive relevance in shoulder stability, the interrelation of the ligament's anatomical disposition/innervation has not actually been described previously. The purpose of the study was to determine the IGHL innervation patterns and relate them to dislocation. Forty-five embalmed and 16 fresh-frozen human cadaveric shoulders were studied. Masson's Trichrome staining detailed the intraligamentous nerve fiber arrangements. The effect on the articular nerves of an anteroinferior dislocation of the shoulder joint and the position of 60 degrees abduction and 45 degrees external rotation was studied dynamically. The axillary nerve provided IGHL innervation in 95.08% of the cases. We saw two distinct innervation patterns originating from the axillary nerve. In Type 1, one or two collaterals diverged later from the main trunk to enter the ligament. Type 2 showed innervation to the ligament provided by the posterior branch for three to four neural branches. In both cases, these branches enter the ligament near the glenoid rim and at the 7 o'clock position (right shoulder). The radial nerve (Type 3 innervation pattern) provided IGHL innervation in 3.28% of the cases. Microscopic analysis revealed wavy intraligamentous neural branches. The articular branches relaxed and separated from the capsule at the apprehension position and stayed intact after dislocation. These results showed a special predisposition to avoid possible denervation and suggested that the neural arch probably remains unaffected after most dislocations. Knowledge of the neural anatomy of the shoulder will clearly help in avoiding its injury in surgical procedures.

Nerves of the Upper Extremity

“…The axillary nerve most commonly bifurcates into the anterior and posterior branches within or posterior to the quadrangular space in 55% (Gelber et al 2006), 87% (Uz et al 2007), and 100% (Tubbs et al 2005) of specimens. Uz et al (2007) found the point of bifurcation proximal to the quadrangular space in 13%, whereas Gelber et al (2006) found this arrangement in 38% of specimens.…”

“…Uz et al (2007) found the point of bifurcation proximal to the quadrangular space in 13%, whereas Gelber et al (2006) found this arrangement in 38% of specimens.…”

“…The axillary nerve may be the origin for the lower subscapular nerve, as was found in 55% of specimens (Kerr 1918); branches to the lower margin of the subscapularis muscle; a branch to teres major; a branch to the coracobrachialis (Duparc et al 1997); or the origin of the thoracodorsal nerve (Gelber et al 2006).…”

“…The axillary nerve provides sensory branches to the glenohumeral joint that have been found to arise from multiple locations along the axillary nerve, although there is considerable variation between observations amongst authors (Duparc et al 1997;Gelber et al 2006;Uz et al 2007). There are commonly multiple articular branches from the axillary nerve to the shoulder capsule (Table 91.8).…”

“…Duparc et al (1997) noted that multiple articular branches from the axillary nerve to the joint capsule fixated the nerve, which may predispose the axillary nerve to injury. The radial, suprascapular, and subscapular nerves may also provide articular branches to the glenohumeral joint (Gardner 1948b;Gelber et al 2006). …”