Anat Cell Biol.  2023 Sep;56(3):322-327. 10.5115/acb.23.087.

Intramuscular neural distribution of the teres minor muscle using Sihler’s stain: application to botulinum neurotoxin injection

• Yi KH
• Kim SB
• Lee K
• Hu H
• Lee JH
• Lee HJ

• KMID: 2546328
• DOI: http://doi.org/10.5115/acb.23.087

Abstract

The aim of this study was to elucidate the intramuscular arborization of the teres minor muslce for effective botulinum neurotoxin injection. Twelve specimens from 6 adult Korean cadavers (3 males and 3 females, age ranging from 66 to 78 years) were used in the study. The reference line between the 2/3 point of the axillary border of the scapula (0/5), where the muscle originates ant the insertion point of the greater tubercle of the humerus (5/5). The most intramuscular neural distribution was located on 1/5–3/5 of the muscle. The tendinous portion was observed in the 3/5–5/5. The result suggests the botulinum neurotoxin should be delivered in the 1/5–3/5 area of the teres minor muscle.

Keyword

Teres minor muscle; Sihler’s method; Botulinum neurotoxin; Trigger point injection; Intramuscular neural distribution

Figure

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  Fig. 1 The teres minor muscle has been revealed after removing posterior deltoid and dissected with surrounding muscles of infraspinatus, teres major, and long head of triceps brachii.

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  Fig. 2 The teres minor muscle was harvested from the 2/3 point of the axillary border of the scapula (0/5), where the muscle originates, and the insertion point of the greater tubercle of the humerus (5/5). The arborization patterns in the muscles were elucidated with respect to the horizontal length of the muscle with 5 divisions.

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  Fig. 3 A specimen of Sihler’s stained teres minor muscle with enlarged panels of intramuscular arborizations. The intramuscular pattern and nerve entry points are revealed by dissection and staining.

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  Fig. 4 A different example of Sihler’s stained teres minor muscle is demonstrated, showing larger sections of internal branching. By dissecting and staining, the nerve entry points and internal pattern of the muscle can be observed.

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  Fig. 5 The teres minor muscles had the largest arborization patterns (shaded in blue), in the located on 1/5–3/5. The tendinous portion was observed in the 3/5–5/5. The needles in the photograph show ideal injection areas along the teres minor muscle where the largest arborization was observed.

Reference

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