Anatomical Considerations of the Lateral Femoral Cutaneous Nerve Related to Nerve Conduction Study

OBJECTIVE: Lateral femoral cutaneous nerve (LFCN) conduction study is an objective measure for the diagnosis of meralgia paresthetica. Sensory nerve action potential of LFCN is not frequently evoked because of anatomical variations around inguinal area. The purpose of this study is to support the diagnosis of meralgia paresthetica by considering anatomical variations of LFCN in Korean adult cadavers. METHOD: Eighteen lower limbs of total nine adult cadavers were studied. Men were five and women were four. The points that LFCN or the main branch of LFCN met the imaginary line from anterior superior iliac spine (ASIS) to pubic tubercle and to lateral border of patella were recorded, respectively and distances from ASIS to those points were measured. RESULTS: The distance from ASIS to the point that LFCN or the main branch of LFCN met the imaginary line from ASIS to pubic tubercle and to lateral border of patella was respectivlely 1.36+/-0.68 cm (minimal 0.2, maximal 3.0) and 10.74+/-5.68 (minimal 3.3, maximal 20.1) cm. There was no significant distance difference between men and women. CONCLUSION: This study showed anatomic variations of LFCN around ASIS and femoral part. This knowledge may help LFCN conduction study for the diagnosis of meralgia paresthetica.

Suggestion of Safer and Easier Technique of Suprascapular Nerve Block based on Cadaver Study

OBJECTIVE: To suggest a safer and easier technique of suprascapular nerve block by assessing anatomical relationship of the suprascapular notch from a view point of surface anatomy. METHOD: Fourteen shoulders of seven cadavers were dissected in prone position. The scapular notch was exposed and the articular branch of suprascapular nerve was observed. The length and depth of spine, height and relative position of scapular notch were measured for all of the specimen. RESULTS: The length of the spine was 11.45+/-0.72 cm. The injection point was measured as relative position of scapular notch on the spine. The ratio between distance from medial border of the spine to injection point and from the injection point to posterior angle of acromion was 1.89+/-0.2: 1. The depth of the spine, which was defined as the shortest vertical distance from the injection point to the scapula was 2.69+/-0.43 cm, and the vertical distance from this contact point to the base of the scapular notch, e.g. the height of the scapular notch, was 1.18+/-0.1 cm. CONCLUSION: We expect we could perform suprascapular nerve block easily and safely with suggested surface landmarks and measured data in this study.

The Success Rate of Posterior Approach Glenohumeral Injection in Patients with Adhesive Capsulitis

OBJECTIVE: Accuracy of injection in patient with adhesive capsulitis may significantly affect the clinical outcome. The purpose of this study was to evaluate the success rate of posterior approach glenohumeral injection in patients with adhesive capsulitis. METHOD: Twenty-two patients who were clinically diagnosed with adhesive capsulitis were enrolled. They had sustained pain and limitation of motion in shoulder in spite of medication and physical therapy for at least 2 months and no history of trauma. Patients were received by a posterior approach glenohumeral injection of 2 ml radiographic contrast. Radiograph of the shoulder joint was taken immediately after the injection to determine success of the intra-articular injection. RESULTS: 5 of the 22 procedures (22.7%) were judged to be accurately placed and in the others the contrast media was observed in the muscular and subcutaneous tissues. CONCLUSION: This study showed that posterior approach glenohumeral injection in adhesive capsulitis was a difficult procedure. The low success rate of posterior approach glenohumeral injection in adhesive capsulitis would lead to repetitive injection and side-effect of corticosteroid. We consider fluoroscopy-guided intra-articular injection in adhesive capsulitis rather than posterior approach glenohumeral injection to increase the accuracy of intra-articular injection.