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Lateral Pectoral Nerve Identification through Ultrasound-Guided Methylene Blue Injection during Selective Peripheral Neurectomy for Shoulder Spasticity: Proposal for a New Procedure

1
Neuro-Orthopedic Unit, Sol et Salus Hospital, 47922 Rimini, Italy
2
Department of Neuroscience, Mental Health and Sensory Organs (NESMOS), Sapienza University of Rome, 00189 Rome, Italy
3
Gait and Motion Analysis Laboratory, Sol et Salus Hospital, 47992 Rimini, Italy
4
Department of Women, Child, General and Specialistic Surgery, University of Campania “L. Vanvitelli”, 80138 Naples, Italy
5
Section of Human Anatomy, Department of Mental and Physical Health and Preventive Medicine, University of Campania “Luigi Vanvitelli”, Via Luciano Armanni, 5, 80138 Naples, Italy
*
Author to whom correspondence should be addressed.
J. Pers. Med. 2024, 14(1), 116; https://doi.org/10.3390/jpm14010116
Submission received: 9 November 2023 / Revised: 12 January 2024 / Accepted: 17 January 2024 / Published: 20 January 2024
(This article belongs to the Special Issue Interventional Radiology: Towards Personalized Medicine)

Abstract

Internally rotated and adducted shoulder is a common posture in upper limb spasticity. Selective peripheral neurectomy is a useful and viable surgical technique to ameliorate spasticity, and the lateral pectoral nerve (LPN) could be a potential good target to manage shoulder spasticity presenting with internal rotation. However, there are some limitations related to this procedure, such as potential anatomical variability and the necessity of intraoperative surgical exploration to identify the target nerve requiring wide surgical incisions. This could result in higher post-surgical discomfort for the patient. Therefore, the aim of our study was to describe a modification of the traditional selective peripheral neurectomy procedure of the LPN through the perioperative ultrasound-guided marking of the target nerve with methylene blue. The details of the localization and marking procedure are described, as well as the surgical technique of peripheral selective neurectomy and the potential advantages in terms of nerve localization, surgical precision and patients’ post-surgical discomfort. We suggest that the proposed modified procedure could be a valid technique to address some current limitations and move the surgical treatment of spasticity toward increasingly tailored management due to the ease of nerve identification, the possibility of handling potential anatomical variability and the resulting smaller surgical incisions.
Keywords: spasticity; shoulder spasticity; selective neurectomy; functional surgery; lateral pectoral nerve; ultrasonography; methylene blue spasticity; shoulder spasticity; selective neurectomy; functional surgery; lateral pectoral nerve; ultrasonography; methylene blue

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MDPI and ACS Style

Zerbinati, P.; Bemporad, J.; Massimiani, A.; Bianchini, E.; Mazzoli, D.; Glorioso, D.; della Vecchia, G.; De Luca, A.; De Blasiis, P. Lateral Pectoral Nerve Identification through Ultrasound-Guided Methylene Blue Injection during Selective Peripheral Neurectomy for Shoulder Spasticity: Proposal for a New Procedure. J. Pers. Med. 2024, 14, 116. https://doi.org/10.3390/jpm14010116

AMA Style

Zerbinati P, Bemporad J, Massimiani A, Bianchini E, Mazzoli D, Glorioso D, della Vecchia G, De Luca A, De Blasiis P. Lateral Pectoral Nerve Identification through Ultrasound-Guided Methylene Blue Injection during Selective Peripheral Neurectomy for Shoulder Spasticity: Proposal for a New Procedure. Journal of Personalized Medicine. 2024; 14(1):116. https://doi.org/10.3390/jpm14010116

Chicago/Turabian Style

Zerbinati, Paolo, Jonathan Bemporad, Andrea Massimiani, Edoardo Bianchini, Davide Mazzoli, Davide Glorioso, Giuseppe della Vecchia, Antonio De Luca, and Paolo De Blasiis. 2024. "Lateral Pectoral Nerve Identification through Ultrasound-Guided Methylene Blue Injection during Selective Peripheral Neurectomy for Shoulder Spasticity: Proposal for a New Procedure" Journal of Personalized Medicine 14, no. 1: 116. https://doi.org/10.3390/jpm14010116

APA Style

Zerbinati, P., Bemporad, J., Massimiani, A., Bianchini, E., Mazzoli, D., Glorioso, D., della Vecchia, G., De Luca, A., & De Blasiis, P. (2024). Lateral Pectoral Nerve Identification through Ultrasound-Guided Methylene Blue Injection during Selective Peripheral Neurectomy for Shoulder Spasticity: Proposal for a New Procedure. Journal of Personalized Medicine, 14(1), 116. https://doi.org/10.3390/jpm14010116

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