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C6 and not C5 nerve fibers more commonly contribute most to deltoid muscle innervation: anatomical study with application to better diagnosing cervical nerve injuries

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Abstract

Most anatomical textbooks list both the C5 and C6 spinal nerves as contributing to the deltoid muscle’s innervation via the axillary nerve. To our knowledge, no previous study has detailed the exact spinal nerve components of the axillary nerve terminating in the deltoid via cadaveric dissection. Twenty formalin-fixed cadavers (40 sides) underwent dissection of the brachial plexus. The fascicles making up the axillary nerve branch that specifically terminated in the deltoid muscle were traced proximally. The axillary nerve branch to the deltoid muscle was most commonly (70%) made up of three spinal nerve segments and less commonly (30%) by two spinal nerve segments. For all axillary nerve branches to the deltoid muscle, C4 spinal nerves contributed 0–5%, C5 spinal nerves contributed 1–80%, C6 spinal nerve contributed 15–99%, C7 spinal nerves contributed 0–30%, and C8 and T1 spinal nerves were not found to contribute any fibers to any deltoid muscle branches. The nerve to the deltoid muscle was contributed to equally by C5 and C6 nerve fibers on 10% of sides. On 16% of sides, C5 contributed the most nerve fibers to this muscle. On 35% of sides, C6 contributed the majority fibers found in the axillary nerve branches to the deltoid. Based on our anatomical study, C6 is more often than not the main level of innervation. C5 was never the sole component of the axillary nerve branches to the deltoid muscle. Such anatomical data will now need to be reconciled with clinical studies.

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References

  1. Agur AMR, Dalley AF (2020) Grant’s Atlas of Anatomy, 15th edn. Wolters Kluwer Health, Riverwood

  2. Aszmann OC, Dellon AL (1996) The internal topography of the axillary nerve: an anatomic and histologic study as it relates to microsurgery. J Reconstr Microsurg 12(6):359–363. https://doi.org/10.1055/s-2007-1006498 (PMID: 8866374)

    Article  CAS  PubMed  Google Scholar 

  3. Avis D, Power D (2018) Axillary nerve injury associated with glenohumeral dislocation: a review and algorithm for management. EFORT open reviews 3(3):70–77

    Article  Google Scholar 

  4. Bydon M, Macki M, Kaloostian P, Sciubba DM, Wolinsky JP, Gokaslan ZL, Belzberg AJ, Bydon A, Witham TF (2014) Incidence and prognostic factors of c5 palsy: a clinical study of 1001 cases and review of the literature. Neurosurgery 74(6):595–604

    Article  Google Scholar 

  5. Bydon M, Michalopoulos GD, Spinner RJ (2021) Postoperative C5 palsy: apples, oranges, and rotten tomatoes. World Neurosurgery 151:145–146

    Article  Google Scholar 

  6. Drake RL, Vogl AW, Mitchell AWM (2019) Upper limb. In: Gray’s Anatomy for Students, 4th edn. Elsevier, Netherlands. pp 714

  7. Furukawa Y, Miyaji Y, Kadoya A, Kamiya H, Chiba T, Hatanaka Y et al (2021) Determining C5, C6 and C7 myotomes through comparative analyses of clinical, MRI and EMG findings in cervical radiculopathy. Clin Neurophysiol Pract 6:88–92

    Article  Google Scholar 

  8. Gu Y (1996) Functional motor innervation of brachial plexus roots. An intraoperative electrophysiological study. Chin Med J (Engl) 109:749–751

    CAS  Google Scholar 

  9. Harris W (1904) The true form of the brachial plexus and its motor distribution. J Anat Physiol 38:399–422

    CAS  PubMed  PubMed Central  Google Scholar 

  10. Houten JK, Buksbaum JR, Collins MJ (2020) Patterns of neurological deficits and recovery of postoperative C5 nerve palsy. J Neurosurg Spine 31:1–9

    Google Scholar 

  11. Hur MS, Woo JS, Park SY, Kang BS, Shin C, Kim HJ, et al. (2011) Destination of the C4 component of the prefixed brachial plexus. Clin Anat 24:717-720

  12. Imagama S, Matsuyama Y, Yukawa Y, Kawakami N, Kamiya M, Kanemura T, Ishiguro N (2010) Nagoya Spine Group. C5 palsy after cervical laminoplasty: a multicentre study. J Bone Joint Surg Br 92(3):393-400

  13. Iwanaga J, Singh V, Ohtsuka A, Hwang Y, Kim HJ, Moryś J, Ravi KS, Ribatti D, Trainor PA, Sañudo JR, Apaydin N, Şengül G, Albertine KH, Walocha JA, Loukas M, Duparc F, Paulsen F, Del Sol M, Adds P, Hegazy A, Tubbs RS (2021) Acknowledging the use of human cadaveric tissues in research papers: recommendations from anatomical journal editors. Clin Anat 34:2–4. https://doi.org/10.1002/ca.23671

    Article  PubMed  Google Scholar 

  14. Kang MS, Woo JS, Hur MS, Lee KS (2014) Spinal nerve composition and innervation of the axillary nerve. Muscle Nerve 50:856–858

    Article  Google Scholar 

  15. Koo JH, Lee KS (2007) Anatomic variations of the spinal origins of the main terminal branches of the brachial plexus. Korean J Physiol Anthropol 20:11–19

    Article  Google Scholar 

  16. Leechavengvongs S, Teerawutthichaikit T, Witoonchart K et al (2015) Surgical anatomy of the axillary nerve branches to the deltoid muscle. Clin Anat 28:118–122

    Article  Google Scholar 

  17. Nakashima H, Imagama S, Yukawa Y, Kanemura T, Kamiya M, Yanase M, Ito K, Machino M, Yoshida G, Ishikawa Y, Matsuyama Y, Hamajima N, Ishiguro N, Kato F (2012) Multivariate analysis of C-5 palsy incidence after cervical posterior fusion with instrumentation. J Neurosurg Spine 17(2):103–110

    Article  Google Scholar 

  18. Pellerin M, Kimball Z, Tubbs RS, Nguyen S, Matusz P, Cohen-Gadol AA (2010) The prefixed and postfixed brachial plexus: a review with surgical implications. Surg Radiol Anat 32:251–260

    Article  Google Scholar 

  19. Shoja MM, Radhakrishnan RS, Tubbs RS. The axillary nerve. In: Kerr’s Brachial Plexus, Medical Classics edn. Rhazes, LLC

  20. Sinha S, Prasad GL, Lalwani S (2016) A cadaveric microanatomical study of the fascicular topography of the brachial plexus. J Neurosurg 125(2):355–362

    Article  Google Scholar 

  21. Sunderland S, Marshall RD, Swaney WE (1959) The intraneural topography of the circumflex, musculocutaneous and obturator nerves. Brain 82:116–129

    Article  CAS  Google Scholar 

  22. Tessler J, Talati R. Axillary Nerve Injury (2021) StatPearls, Treasure Island, FL

  23. Tubbs RS, Tyler-Kabara EC, Aikens AC, Martin JP, Weed LL, Salter EG, Oakes WJ (2005) Surgical anatomy of the axillary nerve within the quadrangular space. J Neurosurg 102(5):912–914

    Article  Google Scholar 

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Acknowledgements

The authors sincerely thank those who donated their bodies to science so that anatomical research could be performed. Results from such research can potentially increase mankind’s overall knowledge that can then improve patient care. Therefore, these donors and their families deserve our highest gratitude.13

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Authors and Affiliations

  1. Department of Anatomical Sciences, St. George’s University, St. George’s, Grenada

    Connor Thimjon & Marios Loukas

  2. Department of Anatomical Dissection and Donation, Medical University of Łódź, Łódź, Poland

    Łukasz Olewnik

  3. Department of Neurosurgery, Tulane Center for Clinical Neurosciences, Tulane University School of Medicine, 131 S. Robertson St. Suite 1300, New Orleans, LA, 70112, USA

    Joe Iwanaga, Aaron S. Dumont & R. Shane Tubbs

  4. Department of Neurology, Tulane University School of Medicine, New Orleans, LA, USA

    Joe Iwanaga & R. Shane Tubbs

  5. Department of Neurological Surgery, University of Wisconsin, Madison, WI, USA

    Amgad Hanna

  6. Department of Neurosurgery and Ochsner Neuroscience Institute, Ochsner Health System, New Orleans, LA, USA

    R. Shane Tubbs

  7. Department of Structural and Cellular Biology, Tulane University School of Medicine, New Orleans, LA, USA

    R. Shane Tubbs

  8. Department of Surgery, Tulane University School of Medicine, New Orleans, LA, USA

    R. Shane Tubbs

Authors
  1. Connor Thimjon
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  2. Łukasz Olewnik
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  3. Joe Iwanaga
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  4. Marios Loukas
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  5. Aaron S. Dumont
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  6. Amgad Hanna
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  7. R. Shane Tubbs
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Contributions

Conceptualization: ASD and RST. Data acquisition: ŁO, JI, and RST. Data analysis or interpretation: CT, ML, and RST. Drafting of the manuscript: CT, ŁO, and JI. Critical revision of the manuscript: ASD, AH, and RST. Approval of the final version of the manuscript: all authors.

Corresponding author

Correspondence to Joe Iwanaga.

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The protocol of the study did not require approval by the ethical committees or informed consent. The study followed the Declaration of Helsinki (64th WMA General Assembly, Fortaleza, Brazil, October 2013).

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Thimjon, C., Olewnik, Ł., Iwanaga, J. et al. C6 and not C5 nerve fibers more commonly contribute most to deltoid muscle innervation: anatomical study with application to better diagnosing cervical nerve injuries. Neurosurg Rev 45, 2401–2406 (2022). https://doi.org/10.1007/s10143-022-01761-z

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  • DOI: https://doi.org/10.1007/s10143-022-01761-z

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