Body Surface Localization And Anatomy Research In Tenderness Points On Shoulder Soft Tissue

1. Objectivea) Studies on the tenderness points of common shoulder soft tissue injury in distribution rule, anatomy foundation, the sign of osseous surface as well as the acupuncture points and the tenderness points relevance and the clinical significance, expected in clinical diagnosis & treatment, especially to provide an anatomical basis for body surface localization.b) Studies on scapular spine, acromial angle, scapular notch anatomical characteristics, anatomical morphology, localization and its clinical significance, to provide an anatomical basis of the diagnosis and treatment of shoulder disorder.c) Studies on the alignment character of suprascapular nerve to provide an anatomical basis for the diagnosis and treatment of suprascapular nerve compression syndrome, providing anatomical basis of clinical diagnosis and treatment of shoulder pain and suprascapular nerve injury.2. Materials & Methodsa) Clinical research:To study the shoulder tenderness points distribution rule and the body surface localization in 90 cases shoulder-strain patients by local finger pressing examination, performing subacromial impingement test and assessing the pain with visual analogue scale (VAS).b) Clinical research:To study and compare the shoulder tenderness points body surface localization distribution and the relationship between the acupuncture points in 90 cases shoulder-strain patients.c) Basic research:To study the anatomical characteristic of shape, course, localizing method, in view of clinical significance of scapular spine and acromial angle on 200 adults dry scapulas.d) Basic research:To study the shape of scapular notches, course, and the anatomical classification of locating methods marked by acromial angle on 200 adults dry scapulas.e) Anatomic research:To observe the function of alignment of suprascapular nerve with its nearby neighboring structure in 7 adult anti-corrosive and 1 adult fresh cadavers.3. Results1.1 Shoulder strain soft tissue tenderness points are mainly located in the upper trapezius, infraspinatus muscle, subacromion, coracoid process, intertubercular groove of humerus, the space between coracoid process and lesser tuberosity of humerus, lesser tuberosity of humerus and lateral border of scapula etc. The most tenderness points are found at upper trapezius, infraspinatus, coracoid process, lesser tuberosity of humerus and subacromion etc. Subacromial lesions have subacromial impingement pain;1.2 Shoulder soft tissue tenderness points of distribution and body surface localization have a certain correspondence with acupuncture points; the acupoints JianJing (GB21); NaoShu (SJ10); JianLiao (SJ14); TianZong (SI11) and JianYu (LI15) are corresponding to the local anatomical structure. To determinate the shoulder tenderness points depends on the basic of the corresponding shoulder surface anatomical knowledge and understanding of correlative anatomy;1.3 The scapular spine is superficial and constant in shape. The average length of scapular spine and basement are (118.67±5.06)mm and (82.04±5.58)mm. The average width and height of eminence on scapular spine are (12.92±3.79)mm and (18.34±3.99)mm. The acromial angles are mostly obtuse, protrude significantly, in constant location and are classified into three types. The average angle is (119.9±8.53)°; C-type accounting for 68.00% and the average angle is (124.6±6.49)°; L-type accounting for 22.50% and the average angle is (104.8±5.54)°; Double-angle-type accounting for 9.50%.1.4 The shapes of scapular notches are classified as type U, type large arc, type V, type O and type incomplete ossification and the most common is type U (52.50%). The average width and depth of scapular notches is (10.52±4.27)mm and (6.12±2.24)mm. The distance of acromial angle and vertical intersection point of scapular notch to spine of scapula is (43.12±4.82)mm. The average depth is (31.42±4.01)mm from the intersection point to the scapular notch.1.5 Suprascapular nerve aligns with the scapula bone surface, which issues 2 or 3 medial branch nerves into the supraspinatus muscle. The main trunk continues to go around the glenoid notch and down into the infraspinatus fossa. The medial muscular branches issues 3 or 4 nerves into the infraspinatus muscle. 4. Conclusions4.1 All kinds of shoulder soft tissue strain injury have their tenderness points distribution rules, and certain correlations with some acupuncture points. The shoulder surface osseous signs and the corresponding topographic anatomical structures as the soft tissue tenderness point locating, can be accurately and vastly located are advantages. Coracoid process, spine of scapula, the angle of acromion, intertubercular groove of humerus, etc have an important role in determining the tenderness points of shoulder soft tissue. To understand the tenderness points of shoulder soft tissue distribution and the anatomical basis for disease diagnosis and treatment of shoulder disorders has an important clinical significance.4.2 Of the shoulder pain is significantly, but no clear shoulder tenderness points, particularly in restricted mobility of shoulder abduction, subacromial impingement test must be performed to clear the pain from the subacromial organizational structure, or from other soft tissue lesions in the shoulder. Subacromial impingement pain can be used to determine the presence of subacromial lesions.4.3 The shoulder surface anatomical landmarks are an important anatomical basis for tenderness points, Anatomical tenderness points and tenderness acupoints have a certain correlation. These tenderness points are well corresponding in general, JianJing (GB21) corresponding upper part of trapezius muscle, TianZong (SI11) corresponding infraspinatus muscle, JianYu (LI15) corresponding subacromial, NaoShu (SJ10) corresponding lateral edge of the scapula. In clinical, the shoulder surface anatomical basis should be combined with the theory of meridian points to determine tenderness points.4.4 Superior border of scapular spine and angle of acromial are constant in shape and its superficial, clear positioning, can be easy to understand, and used as the locating sign for the diagnosis and treatment of shoulder diseases. Scapular notch is located by the method of moving about 4 cm from an acromial angle to the medial along spine of scapula and then turning forward about 3 cm, where the best position for steroid injection treatment of suprascapular nerve entrapment syndrome. However, the use of needle-knife treatment of this syndrome must be familiar with the local anatomy, clear signs of bone, and an expertise in know well the locating and operating of facilities like the needle-knife, otherwise, it can damage the below blood vessels and nerves easily.3.1 Suprascapular nerve entrapment syndrome is the department compression of suprascapular nerve in suprascapular notch, causing the paralysis and atrophy of supraspinatus, infraspinatus muscle; as well as a series of symptoms of shoulder pain and movement limitation, which is one of reason of shoulder pain. Suprascapular nerve located in scapular area takes an important place of complex anatomy in this region. It is the anatomical basis of shoulder pain caused by suprascapular nerve entrapment and or injury.