Axillary nerve position in the anterosuperior approach of the shoulder: a cadaveric study

Ikemoto, Roberto Yukio; Nascimento, Luis Gustavo Prata; Bueno, Rogério Serpone; Almeida, Luiz Henrique Oliveira; Strose, Eric; Murachovsky, Joel

doi:10.1590/1413-78522015230100960

Cited by 11 publications

(6 citation statements)

References 13 publications

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“…Theoretically, the axillary nerve is more at risk in the anterolateral approach (incisions larger than 5 cm) compared to the deltopectoral approach. However, some authors 18 19 have shown that the anterolateral approach is safe for the axillary nerve, resulting in good functional outcomes. Similarly, a systematic review 20 of 24 articles involving 831 patients submitted to the anterolateral approach found a low incidence of iatrogenic axillary nerve injury and a good functional outcome (Constant-Murley score of 75.2) after osteosynthesis of a proximal humerus fracture.…”

Section: Discussionmentioning

confidence: 99%

“…Não observamos complicações relacionados ao nervo axilar. Apesar de, teoricamente, o nervo axilar estar mais em risco na via de acesso anterolateral (incisões maiores do que 5 cm) em comparação com a deltopeitoral, alguns autores 18 19 demonstram que essa abordagem é segura para essa estrutura, e os pacientes evoluem com bom resultado funcional. Neste mesmo contexto, uma revisão sistemática, 20 de 24 artigos com 831 pacientes operados pela via anterolateral, observou baixa incidência de lesão iatrogênica do nervo axilar e bom resultado funcional (pontuação na escala de Constant-Murley de 75,2) após osteossíntese de fratura do úmero proximal.…”

Section: Discussionunclassified

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Avaliação funcional do ombro após osteossíntese da fratura da tuberosidade maior: Há influência da luxação glenoumeral?

Mouraria

Cunha

Coelho

et al. 2022

Rev Bras Ortop (Sao Paulo)

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Resumo Objetivo Avaliar os resultados funcional e radiográfico pós-operatórios do ombro, em pacientes submetidos a sutura transóssea de fratura da tuberosidade maior (FTM) por acesso anterolateral, e a influência da luxação glenoumeral nesses resultados. Métodos Realizou-se estudo retrospectivo e avaliação funcional (pela escala de Constant-Murley). Calculou-se a distância entre a tuberosidade maior e a superfície articular do úmero proximal (por meio de radiografia em incidência anteroposterior verdadeira) após a consolidação. Usou-se o teste Exato de Fisher para as variáveis independentes categóricas, e os testes tde Student ou de Mann-Whitney para as não categóricas. Resultados Ao todo, 26 pacientes preencheram os critérios de inclusão. A associação de luxação glenoumeral com FTM foi observada em 38% da amostra. A média da pontuação na escala de Constant-Murley foi de 82,5 + 8,02. A presença de luxação associada não alterou o resultado funcional. A distância média da consolidação da tuberosidade maior do úmero em relação à superfície articular da cabeça umeral foi de 9 + 4,3 mm abaixo da linha articular da cabeça umeral. Pacientes com luxação associada evoluíram com redução menor, mas isso não influenciou na pontuação na escala de Constant-Murley. Conclusão As FTMs submetidas ao tratamento cirúrgico com sutura transóssea evoluíram com bom resultado funcional. A presença de luxação dificultou a redução anatômica da tuberosidade maior. Entretanto, isso não influenciou na pontuação na escala de Constant-Murley.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionunclassified

Avaliação funcional do ombro após osteossíntese da fratura da tuberosidade maior: Há influência da luxação glenoumeral?

Mouraria

Cunha

Coelho

et al. 2022

Rev Bras Ortop (Sao Paulo)

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“…Uz et al [ 15 ] studied 30 shoulder specimens and recorded that the mean distance from the postero-lateral aspect of the acromion process to the axillary nerve and its branches was 7.80 cm. Ikemoto et al [ 16 ] studied 24 shoulders and found that the average distance between the acromion and the axillary nerve on the antero-superior approach was 5.32±0.60 cm in both shoulders. Gurushantappa and Kuppasad [ 17 ] dissected forty shoulders and found that the mean distance of axillary nerve from postero-lateral aspect of acromion process was 7.46±0.99 cm.…”

Section: Discussionmentioning

confidence: 99%

Re-definition of position and calculation of safe area for axillary nerve in deltoid muscle with its clinical relevance: a cadaveric study

et al. 2018

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Several authors have made efforts to define the position of the axillary nerve within deltoid muscle and to calculate the so called safe area for this nerve but it still remains a matter of debate. The primary aim of the study was to investigate the acromio-axillary (AA) distance and its correlation with upper arm length. The secondary aim was to re-define the safe area for axillary nerve within deltoid muscle. Sixty shoulders of thirty adult human cadavers were dissected using standard methods. The distance from the anterior and posterior edge of acromion to the upper border of the course of the axillary nerve was measured and recorded as anterior and posterior AA distance respectively. Correlation analysis was done between the upper arm length and AA distance for each limb. The ratios between anterior and posterior AA distance and upper arm length were calculated and mentioned as anterior index and posterior index, respectively. The mean of anterior and posterior AA distance was 5.22 cm and 4.17 cm, respectively. The mean of upper arm length was 29.30 cm. The means of anterior index and posterior indices were 0.18 and 0.14, respectively. There was a significant correlation between upper arm length and both the anterior and posterior AA distance. The axillary nerve was found to lie at variable distance from the acromion. The minimum AA distance was found to be 3.50 cm. So this should be considered as the maximum permissible length of the deltoid split. Upper arm length has strong correlation with both anterior and posterior AA distances. The ideal safe area for the axillary nerve was found to be a quadrangular area above it and the size of which depends on the length of the upper arm.

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“…Even so, neurologic lesions are relatively frequent and well-documented complications of reverse total shoulder arthroplasty [6]. Though many anatomic and cadaveric studies exist describing the location and course of the axillary nerve in this region, none have described an axillary nerve bypassing the quadrangular space and remaining anterior to the humerus within the deltopectoral interval to innervate the deltoid muscle [5, 7–9]. We describe a case of this anatomic variant that we encountered during the deltopectoral approach for reverse total shoulder arthroplasty.…”

Section: Introductionmentioning

confidence: 99%

Unusual anatomic variant of the axillary nerve challenging the deltopectoral approach to the shoulder: a case report

2019

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Background The deltopectoral approach is a well-described surgical approach to the proximal humerus and glenohumeral joint. One of the structures at risk during this approach is the axillary nerve. Typically, the axillary nerve arises off the posterior cord of the brachial plexus and courses lateral to the proximal humerus and inferior to the glenohumeral joint, exiting the axilla through the quadrangular space. We describe a case of an aberrant axillary nerve, coursing anteriorly across the glenohumeral joint within the deltopectoral groove encountered during a reverse total shoulder arthroplasty. Case presentation A 73-year-old female presented complaining of atraumatic progressive right shoulder pain of several months duration. Clinical and radiographic findings were consistent with advanced rotator cuff arthropathy. After failing appropriate non-operative treatment, the patient elected to undergo reverse total shoulder arthroplasty. During the deltopectoral approach to the glenohumeral joint, the axillary nerve was found to be coursing deep to the cephalic vein within the deltopectoral interval. The nerve was isolated and protected, and the glenohumeral joint was accessed via a small window in the anterior deltoid muscle. The remainder of the procedure was performed without complication. The patient was found to be healing well and with normal axillary nerve function at 4-month follow-up. Conclusions Neurologic lesions are well-documented complications of reverse total shoulder arthroplasty. The integrity of the axillary nerve is of particular importance to reverse total shoulder arthroplasty as it innervates the deltoid and post-operative function of the extremity is dependent upon a functioning deltoid muscle. Extreme care must be taken to avoid insult to the axillary nerve and any aberrant paths it may course around the glenohumeral joint.

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Axillary nerve position in the anterosuperior approach of the shoulder: a cadaveric study

Cited by 11 publications

References 13 publications

Avaliação funcional do ombro após osteossíntese da fratura da tuberosidade maior: Há influência da luxação glenoumeral?

Avaliação funcional do ombro após osteossíntese da fratura da tuberosidade maior: Há influência da luxação glenoumeral?

Re-definition of position and calculation of safe area for axillary nerve in deltoid muscle with its clinical relevance: a cadaveric study

Unusual anatomic variant of the axillary nerve challenging the deltopectoral approach to the shoulder: a case report

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