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Abstract

The axillary nerve passes below the subscapularis muscle, inferior capsule of the shoulder, and through the quadrilateral space to supply the teres minor and the deltoid . The nerve is tethered to the deep surface of the deltoid by fascia, but free of the humerus which can rotate independently. The location of the axillary nerve makes it vulnerable to injury during shoulder dislocation, proximal humeral fractures and open or arthroscopic surgery. Procedures to regain function include nerve grafting, nerve transfer and functional muscle transfer. Reports of the anatomy of the axillary nerve have been variable. A review of the current literature is presented to help avoid iatrogenic trauma, understand the clinical presentation of nerve injury, including quadrilateral space syndrome and has implications for surgeries involving selective innervation.

Keywords

Axillary nerve Anatomy Quadrilateral space Deltoid Shoulder Dislocation Arthroscopy Shoulder Arthroplasty 

Supplementary material

Video 32.1

(MPG 1679 kb)

Video 32.2

Anterior view of a cadaveric specimen showing axillary nerve coursing around the neck of the humerus in the quadrilateral space . The anterior branch of the axillary nerve can be seen supplying the deltoid muscle. A window of subdeltoid fascia has been removed to expose the nerve (Copyright Dr Gregory Bain) (MPG 3,470 kb)

324233_1_En_32_MOESM3_ESM.mpg (3 mb)
Video 32.3 Superior view of a cadaveric specimen showing the anterior branch of the axillary nerve supplying the deltoid muscle. The free course of the axillary nerve is relatively short. It is teathered to the teres minor by one branch and to the deltoid by multiple branches (Copyright Dr Gregory Bain) (MPG 3,068 kb)
324233_1_En_32_MOESM4_ESM.mpg (1.9 mb)
Video 32.4 Anterior view of a cadaveric specimen showing axillary nerve coursing around the neck of the humerus in the quadrilateral space . The relationship of the nerve to the capsule is seen (Copyright Dr Gregory Bain) (MPG 1,950 kb)
324233_1_En_32_MOESM5_ESM.mpg (5 mb)
Video 32.5 Anterior view of a cadaveric specimen showing effect of rotation on the axillary nerve . The relationship of the nerve to the capsule is seen. External rotation of the shoulder stretched the subscapularis and pulled the axillary nerve taut anteriorly. Internal rotation resulted in the subscapularis and axillary nerve becoming lax (Copyright Dr Gregory Bain) (MPG 5,133 kb)
324233_1_En_32_MOESM6_ESM.mpg (9.7 mb)
Video 32.6 Arthroscopic view of cadaveric specimen viewed through a posterior portal. The course of the axillary nerve has been marked with needles (Copyright Dr Gregory Bain) (MPG 9,924 kb)

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Copyright information

© ISAKOS 2015

Authors and Affiliations

  1. 1.Department of OrthopaedicTauranga Hospital TaurangaTaurangaNew Zealand
  2. 2.Grace Orthopaedic Centre TaurangaTaurangaNew Zealand

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