Analysis of Nerve Endings in the Superior Labrum-Biceps Complex by Fluorescence Immunohistochemistry and Confocal Laser Microscopy^[*]

Abstract

Objectives The capsuloligamentous structures of the shoulder work as static stabilizers, together with the biceps and rotator cuff muscles, increasing the contact surface of the glenoid cavity. Free nerve endings and mechanoreceptors have been identified in the shoulder; however, there are a few studies that describe the presence of these nerves in the biceps' insertion. The present study aimed to describe the morphology and distribution of nerve endings using immunofluorescence with protein gene product 9.5 (PGP 9.5) and confocal microscopy.

Methods Six labrum-biceps complexes from six fresh-frozen cadavers were studied. The specimens were coronally cut and prepared using the immunofluorescence technique. In both hematoxylin and eosin (H&E) and immunofluorescence, the organization of the connective tissue with parallel collagen fibers was described.

Results In the H&E study, vascular structures and some nerve structures were visualized, which were identified by the elongated presence of the nerve cell. All specimens analyzed with immunofluorescence and confocal microscopy demonstrated poor occurrence of morphotypes of sensory corpuscles and free nerve endings. We identified free nerve endings located in the labrum and in the bicipital insertion, and sparse nerve endings along the tendon. Corpuscular endings with fusiform, cuneiform, and oval aspect were identified in the tendon.

Conclusion These findings support the hypothesis that the generation of pain in the superior labral tear from Anterior to posterior (SLAP) lesions derives from the more proximal part of the long biceps cord and even more from the upper labrum. Future quantitative studies with a larger number of specimens may provide more information on these sensory systems.

Keywords

biceps - fluorescent antibody technique - labrum - mechanoreceptors - nerve endings - shoulder

Authors' contributions

Fernandes E. G. was responsible for the conception, design, intellectual and scientific content of the study, acquisition and interpretation of data, and manuscript writing. Cavalcante M. L. C. was responsible for the research, manuscript editing, interpretation of data, and critical review and submission of the manuscript . Jamacaru F. V., Fernandes E. G., Coelho J. V. V., and Leite J. A. D. were involved in the technical procedures.

^* Work developed at the Department of Orthopedics, Universidade Federal do Ceará, Hospital Universitário Walter Cantídio, Fortaleza, Ceará, Brazil.

Publication History

Received: 01 June 2020

Accepted: 16 September 2020

Article published online:
13 August 2021

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