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Anatomic Study of Innervation of the Anterior Hip Capsule: Implication for Image-Guided Intervention

Short, Anthony, J., MBBS*; Barnett, Jessi Jo, G.; Gofeld, Michael, MD; Baig, Ehtesham, MD; Lam, Karen, MD; Agur, Anne, M.R., PhD; Peng, Philip, W.H., MBBS, FRCPC, Founder (Pain Medicine)‡§

Regional Anesthesia and Pain Medicine: February 2018 - Volume 43 - Issue 2 - p 186–192
doi: 10.1097/AAP.0000000000000701
Chronic and Interventional Pain: Original Articles

Background and Objectives The purpose of this cadaveric study was to determine the pattern of anterior hip capsule innervation and the associated bony landmarks for image-guided radiofrequency denervation.

Methods Thirteen hemipelvises were dissected to identify innervation of the anterior hip capsule. The femoral (FN), obturator (ON), and accessory obturator (AON) nerves were traced distally, and branches supplying the anterior capsule documented. The relationships of the branches to bony landmarks potentially visible with ultrasound were identified.

Results The anterior hip capsule received innervation from the FNs and ONs in all specimens and the AON in 7 of 13 specimens. High branches of the FN (originating above the inguinal ligament) were found exclusively in 12 specimens and passed between the anterior inferior iliac spine and the iliopubic eminence. The ONs were innervated exclusively by high branches (proximal to the division), by low branches (from the posterior branch), and by both in 4, 5, and 4 specimens, respectively. The most consistent landmark was the inferomedial acetabulum (radiographic “teardrop”). When present, the AON coursed over the iliopubic eminence before innervating the anterior hip capsule.

Conclusions Branches of the FNs and ONs consistently provided innervation to the anterior hip capsule. The AON also contributed innervation in many specimens. The relationship of the articular branches from these 3 nerves to the inferomedial acetabulum and the space between the anterior inferior iliac spine and iliopubic eminence may suggest potential sites for radiofrequency ablation.

From the *Department of Anaesthetics, Wrightington, Wigan and Leigh NHS Foundation Trust, Wigan, United Kingdom; and †Division of Anatomy, Department of Surgery, and ‡Department of Anesthesia, University of Toronto, and §Toronto Western Hospital, Toronto, Ontario, Canada.

Accepted for publication August 20, 2017.

Address correspondence to: Philip W.H. Peng, MBBS, FRCPC, Founder (Pain Medicine), Toronto Western Hospital, 399 Bathurst St, McL 2-405, Toronto, Ontario, Canada M5T 2S8 (e-mail: philip.peng@uhn.ca).

P.W.H.P. received equipment support from FUJIFILM SonoSite Inc, Canada. M.G. has consulting agreement with Medtronic Inc and Bioness Inc. The other authors declare no conflict of interest.

This study was funded in part by Physicians' Service Incorporated Foundation (K.L., P.W.H.P.) and a Merit Award from the University of Toronto (P.W.H.P.).

This project and the preliminary result were presented at the 15th Annual Pain Medicine Meeting of the American Society of Regional Anesthesia and Pain Medicine; November 17 to 19, 2016; San Diego, California.

Author Contributions: A.J.S. helped with dissection and manuscript preparation. J.J.G.B. helped with dissection, data collection, analysis, and manuscript preparation. E.B. helped with study design. K.L. helped with study design and dissection. M.G. helped with study design, dissection, and manuscript preparation. A.M.R.A. helped with study design, supervision of dissection, data analysis, and manuscript preparation. P.W.H.P. helped with study design, dissection, data analysis, and manuscript preparation.

Copyright © 2018 by American Society of Regional Anesthesia and Pain Medicine.