Ultrasound-guided anterior approach to the axillary and intercostobrachial nerves in the axillary fossa: an anatomical investigation

Feigl, Georg; Aichner, Elisabeth; Mattersberger, Christian; Zahn, Peter; González, C. Avila; Litz, R. J.

doi:10.1016/j.bja.2018.06.006

Cited by 20 publications

(10 citation statements)

References 35 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Most studies investigating the AN deal with the course of the nerve in relation to the DM (Loukas et al, ) or with the distribution of its distal branches in the shoulder joint and the surrounding muscles and skin (Apaydin et al, 2009). In a recent cadaveric study, Feigl et al reported an anterior approach to the blockade of the AN and intercostobrachial nerve in the axillary fossa (Feigl et al, ). They identified the AN in the quadrangular space in 99% of cases and demonstrated the feasibility of an anterior approach.…”

Section: Discussionmentioning

confidence: 99%

Ultrasonography‐guided anterior approach for axillary nerve blockade: An anatomical study

et al. 2019

View full text Add to dashboard Cite

Combined ultrasound (US)-guided blockade of the suprascapular and axillary nerves (ANs) has been proposed as an alternative to interscalene blockade for pain control in shoulder joint pathology or postsurgical care. This technique could help avoid respiratory complications and/or almost total upper limb palsy. Nowadays, the AN blockade is mostly performed using an in-plane caudal-to-cephalic approach from the posterior surface of the shoulder, reaching the nerve immediately after it exits the neurovascular quadrangular space (part of the spatium axillare). Despite precluding most respiratory complications, this approach has not made postsurgical pain relief any better than an interscalene blockade, probably because articular branches of the AN are not blocked.Cephalic-to-caudal methylene blue injections were placed in the first segment of the AN of six Thiel-embalmed cadavers using an US-guided anterior approach in order to compare the distribution with that produced by a posterior approach to the contralateral AN in the same cadaver. Another 21 formalin-fixed cadavers were bilaterally dissected to identify the articular branches of the AN.We found a good spread of the dye on the AN and a constant relationship of this nerve with the subscapularis muscle. The dye reached the musculocutaneous nerve, which also contributes to shoulder joint innervation. We describe the anatomical landmarks for an ultrasonography-guided anterior AN blockade and hypothesize that this anterior approach will provide better pain control than the posterior approach owing to complete blocking of the joint nerve. Clin. Anat. 33:488-499, 2020.

show abstract

Section: Discussionmentioning

confidence: 99%

Ultrasonography‐guided anterior approach for axillary nerve blockade: An anatomical study

et al. 2019

View full text Add to dashboard Cite

show abstract

“…In their cadaveric study, in 91 out of 92 limbs, AXN was identified at the inferolateral border of the subscapular muscle to enter the quadrangular space. In this approach, the insertion of the subscapular muscle at the lesser tubercle defines the roof of the space [ 19 ]. We also noted similar observations in this study.…”

Section: Discussionmentioning

confidence: 99%

Revisiting the Surgical Approaches to Decompression in Quadrilateral Space Syndrome: A Cadaveric Study

Charmode¹,

Mehra²,

Kushwaha³

2022

Cureus

View full text Add to dashboard Cite

BackgroundQuadrangular space syndrome involves compression of the axillary nerve and posterior circumflex humeral artery. In a few cases, its management requires surgical decompression. The current study reviews the surgical approaches used in the decompression of neurovascular structures and presents our reflections and recommendations. MethodologyIn this study, four human cadavers were used for dissection of the axillae and the scapular region by the senior residents of the Department of Anatomy and Department of Orthopedics. The residents dissected the quadrangular space in the eight upper limbs using anterior and posterior surgical approaches. ResultsTo identify the quadrangular space and secure its contents, the posterior approach was recognized as the easier and quicker method by both Anatomy and Orthopedic residents; however, it may result in increased postoperative morbidity. Although the anterior (deltopectoral) approach involves more skill, it reduces postoperative morbidity. ConclusionsThe anterior (deltopectoral) approach with suggested modifications can be an effective method in the surgical decompression of quadrangular space syndrome. The authors suggest more cadaveric studies to provide anatomists and surgeons with the opportunity to practice and evaluate older and newer surgical approaches.

show abstract

“…The axillary nerve block through the posterior approach, introduced by Rothe [ 13 ], is neither easy to perform nor effective, because the anatomical structures are not always recognizable and because of the articular branches that innervate the glenohumeral joint branch out proximally on the quadrilateral space of Velpeau [ 16 ]. More recently, Chang and Feigl described two different ultrasound-guided approaches to track the axillary nerve in the inferior axillary fossa [ 14 , 15 ]. In our opinion, this is an interesting approach but should be reserved for skilled professionals because of the complexity of sonoanatomy in recognizing nerve branches and the proximity to the vascular structures that could increase procedural risks.…”

Section: Discussionmentioning

confidence: 99%

“…Among these techniques, the most commonly used is the suprascapular nerve block (SSnb) [ 8 , 12 ], which accounts for about 70% of the sensory innervation of the shoulder. Because of the difficulty in effectively reducing pain due to the complexity of shoulder innervation, studies have explored selective axillary nerve blocks with a posterior approach [ 13 ] or from the axillae [ 14 , 15 ]. These techniques are not always technically easy to perform, and in many cases they cannot cover all axillary nerve branches, especially the glenohumeral articular branch, emerging proximally to the quadrangular space in a high percentage of cases, as described by Gonzalez-Arnay et al [ 16 ], so they are not always effective.…”

Section: Introductionmentioning

confidence: 99%

Evaluation of Interfascial Plane and Pericapsular Nerve Blocks to the Shoulder Joint: A Preliminary Analysis of Shoulder Anterior Capsular Block

et al. 2021

View full text Add to dashboard Cite

Introduction:The aim of this study is to verify if the shoulder anterior capsular block (SHAC), combined with other nerve blocks, is effective in relieving shoulder pain, avoiding motor block and allowing an early rehabilitation program. Methods: Seventy-five consecutive patients with painful shoulder were treated with the SHAC, alone (30 patients) or in combination with a suprascapular nerve block (SSnb: 25 patients) or with pectoralis and serratus plane block (PECS-2: 20 patients). All blocks were performed with 0.2% ropivacaine plus 8 mg dexamethasone. All patients were treated with threeweekly physiotherapy sessions for the following 2 weeks and then with home exercises. Results: The post-procedural analgesic effect was strong in all groups, with a mean change in numeric rating scale (NRS) values of -6.05 in group 1, -6.25 in group 2, and -6.19 in group 3 (p \ .0001), allowing all patients to complete an immediate physiotherapy session. Only a few

show abstract

Ultrasound-guided anterior approach to the axillary and intercostobrachial nerves in the axillary fossa: an anatomical investigation

Abstract: We describe a reliable ultrasonographic approach to visualise the AXN and ICBN anteriorly from the conventional ABPB approach as confirmed in this cadaver study.

Cited by 20 publications

References 35 publications

Ultrasonography‐guided anterior approach for axillary nerve blockade: An anatomical study

Ultrasonography‐guided anterior approach for axillary nerve blockade: An anatomical study

Revisiting the Surgical Approaches to Decompression in Quadrilateral Space Syndrome: A Cadaveric Study

Evaluation of Interfascial Plane and Pericapsular Nerve Blocks to the Shoulder Joint: A Preliminary Analysis of Shoulder Anterior Capsular Block

Contact Info

Product

Resources

About