Abstract
Reports place the frequency of axillary nerve injury at 6% for all brachial plexus injuries, emphasizing the importance of an accurate anatomic description of this nerve within the deltoid in order to reduce iatrogenic injury. The aim of the present study was to explore the anatomic variations of the axillary nerve within the deltoid muscle. Fifty human cadavers were dissected, resulting in 100 nerve specimens. The anterior and posterior branches of the axillary nerve were identified and their length measured from their point of origin (split from the axillary nerve) to their termination in the deltoid muscle. In 65% of cases, the axillary nerve split into two branches (anterior and posterior) within the quadrangular space, and in the remaining 35% split within the deltoid muscle. The posterior branch of the deltoid muscle irrespectively of origin gave off a branch to the teres minor and the superior lateral brachial cutaneous nerve in 100% of cases. The branch to the posterior part of the deltoid muscle was present in 90% of cases, and the branch to the middle part of the deltoid was present in 38% of cases. The anterior branch of the deltoid muscle provided a branch to the joint capsule, a branch to the anterior part of the deltoid muscle and the middle part of the deltoid in 100% of cases. In 18% of the cases, the anterior branch of the axillary nerve provided a branch to the posterior part of the deltoid muscle. The middle part of the deltoid muscle received dual innervation in 38% of cases and the posterior part of the deltoid muscle in 8% of the cases.
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References
Apaydin N, Uz A, Bozkurt M, Elhan A (2007) The anatomic relationship of the axillary nerve and the surgical landmarks for its localization from the anterior aspect of the shoulder. Clin Anat 20:273–277
Aszmann O, Dellon AL (1996) The internal topography of the axillary nerve: an anatomic and histologic study as it relates to microsurgery. J Reconstr Microsurg 12:359–363
Ball C, Steger T, Galatz L, Yamaguchi K (2003) The posterior branch of the axillary nerve: an anatomic study. J Bone Joint Surg Am 85:1497–1501
Cetik O, Uslu M, Acar HI, Comert A, Tekdemir I, Cift H (2006) Is there a safe area for the axillary nerve in the deltoid muscle? A cadaveric study. J Bone Joint Surg Am 88:2395–2399
Duparc F, Bocquet G, Simonet J, Freger P (1997) Anatomical basis of the variable aspects of injuries of the axillary nerve (Excluding the terminal branches of the deltoid muscle). Surg Radiol Anat 19:127–132
Esmail A, Getz C, Schwartz D, Wierzbowski L, Ramsey M, Williams G (2005) Axillary nerve monitoring during arthroscopic shoulder stabilization. Arthroscopy 21:665–671
Gardner M, Griffith M, Dines J, Lorich D (2004) A minimally invasive approach for plate fixation of the proximal humerus. Bull Hosp Jt Dis 62:18–23
Grant JC. (1978) Grant’s atlas of anatomy, 7th edn. Williams and Wilkins, Baltimore, pp 6–40
Gryler E, Greis P, Burks R, West J (2001) Axillary nerve temperatures during radio frequency capsulorrhapy of the shoulder. Arthroscopy 17:567–572
Hong T, Kumar VP, Nather A (2005) The posterior neuromuscular compartment of the deltoid. Plast Reconstr Surg 115:1660–1664
Jobe CM (1990) Gross anatomy of the shoulder. In: Rockwood CA Jr, Matsen FA 3rd (eds) The Shoulder. WB Saunders, Philadelphia, pp 70–72
Kulkarni R, Nandedkar A, Mysorekar VR (1992) Position of the axillary nerve in the deltoid muscle. Anat Rec 232:316–317
Loukas M, Louis RG Jr, Hullett J, Loiacano M, Skidd P, Wagner T (2005) An anatomical classification of the variations of the inferior phrenic vein. Surg Radiol Anat 27:566–574
Nassar JA, Wirth MA, Burckhart SS, Schenck RC Jr (1997) Morphology of the axillary nerve in an anterioinferior shoulder arthroscopy portal. Arthroscopy 13:600–605
Perimutter GS (1999) Axillary nerve injury. Clin Orthop Relat Res 368:28–36
Price M, Tillett E, Acland R, Nettleton S (2004) Determining the relationship of the axillary nerve to the shoulder joint capsule form an arthroscopic perspective. J Bone Joint Surg Am 86:2135–2141
Rosse C, Gaddum-Rosse P (1997) Pectoral region, axilla, and shoulder. In: Hollinshead’s textbook of anatomy, 5th edn. Lippincott-Raven, Philadelphia pp 193–237
Tubbs S, Tyler-Kabara E, Aikens A, Martin J, Weed L, Salter G, Oakes J (2005) Surgical anatomy of the axillary nerve within the quadrangular space. J Neurosurg 102:912–914
Vathana P, Chiarapattanakom P, Ratanalaka R, Vorasatit P (1998) The relationship of the axillary nerve and the acromion. J Med Assoc Thai 81:953–957
Zhao X, Hung L, Zhang G, Phil M, Lao J (2001) Applied anatomy of the axillary nerve for selective neurotization of the deltoid muscle. Clin Orthop Relat Res 390:244–251
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Loukas, M., Grabska, J., Tubbs, R.S. et al. Mapping the axillary nerve within the deltoid muscle. Surg Radiol Anat 31, 43–47 (2009). https://doi.org/10.1007/s00276-008-0409-3
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DOI: https://doi.org/10.1007/s00276-008-0409-3