Background

Afferent innervation of shoulder joints plays a fundamental role in nociception and mechanoception and its alteration result in shoulder´s disease that course with pain and functional disability.

Methods

Joints shoulder from healthy subjects (n = 20) and with chronic pain shoulder syndromes (n = 17) were analyzed using immunohistochemistry for S100 protein to identify nerve structures (nerve fibers and sensory corpuscles), coupled with a quantification of the sensory formations. Sensory nerve formations were quantified in 13 distinct areas in healthy joint shoulder and in the available equivalent areas in the pathological joints. Statistical analyses were conducted to assess differences between healthy shoulder and pathological shoulder joint (p< 0.05).

Results

All analyzed structures, i.e., glenohumeral capsule, acromioclavicular capsule, the extraarticular structures (subcoracoid region and subacromio-subdeltoid bursa) and intraarticular structures (biceps brachii tendon and labrum articulare) are variably innervated except the extrinsic coracoacromial ligament, which was aneural. The afferent innervation of healthy human shoulder joints consists of free nerve endings, simple lamellar corpuscles and Ruffini’s corpuscles. Occasionally, Golgi-Mazzoni’s and Pacinian corpuscles were found. However, the relative density of each one varied among joints and/or the different zones within the same joint. As a rule, the upper half and anterior half of healthy glenohumeral capsules have a higher innervation compared to the lower and posterior respectably. On the other hand, in joints from subjects suffering chronic shoulder pain, a reduced innervation was found, involving more the corpuscles than free nerve endings.

Conclusions

Our findings report a global innervation map of the human shoulder joints, especially the glenohumeral one, and this knowledge might be of interest for arthroscopic surgeons allowing to develop more selective and unhurt treatments, controlling the pain, and avoiding the loss of afferent innervation after surgical procedures. To the light of our results the postero-inferior glenohumeral capsular region seems to be the more adequate to be a surgical portal (surgical access area) to prevent nerve lesions.

中文翻译：

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健康和慢性肩痛综合征中人体肩关节的感觉神经支配

背景

肩关节的传入神经支配在伤害感受和机械感受中起着重要作用，其改变会导致伴有疼痛和功能障碍的肩部疾病。

方法

使用 S100 蛋白的免疫组织化学分析健康受试者 (n = 20) 和患有慢性肩痛综合征 (n = 17 )的肩关节，以识别神经结构（神经纤维和感觉小体），并对感觉形成进行量化。对健康肩关节的 13 个不同区域和病理关节中可用的等效区域的感觉神经结构进行了量化。进行统计分析以评估健康肩关节和病理肩关节之间的差异（p<0.05）。

结果

所有分析的结构，即盂肱关节囊、肩锁关节囊、关节外结构（喙突下区域和肩峰下三角肌下囊）和关节内结构（肱二头肌腱和唇关节），除了外在的喙肩韧带是无神经的外，均受到​​不同程度的神经支配。健康人肩关节的传入神经支配由游离神经末梢、简单板层小体和鲁菲尼小体组成。偶尔会发现高尔基-马佐尼小体和帕西尼亚小体。然而，每种物质的相对密度在关节和/或同一关节内的不同区域之间有所不同。一般来说，健康盂肱关节囊的上半部和前半部分别比下半部和后部具有更高的神经支配。另一方面，在患有慢性肩痛的受试者的关节中，发现神经支配减少，涉及的小体多于游离神经末梢。

结论

我们的研究结果报告了人类肩关节的整体神经支配图，尤其是盂肱关节，这一知识可能会引起关节镜外科医生的兴趣，从而开发出更具选择性和无损伤的治疗方法，控制疼痛，并避免手术后传入神经支配的丧失程序。根据我们的结果，后下盂肱囊区域似乎更适合作为手术入口（手术进入区域）来预防神经损伤。