Friday, April 5, 2013

Protecting the anterior branch of the axillary nerve

Prediction of the location of the anterior branch of the axillary nerve, using correlations with physical factors: a cadaveric study

This article reports the location of the main anterior branch of the axillary nerve in 25 male and 20 female cadavers. The mean vertical between the upper margin of the middle acromion an the axillary nerve was  6.5 ± 0.8 cm. Although there is a strong correlation between the axillary nerve distance and the humeral length, there was substantial variation as shown in the graph below from the article.
Furthermore, as shown in the figure below, the axillary nerve branches extensively, so that branches to the critical anterior fibers of the deltoid may be incised with incisions much shorter than those required to injure the main anterior branch.
We see, not infrequently, patients with a 'telltale V' of anterior deltoid atrophy after incisions that split the deltoid, suggesting that branches of the nerve have been injured. 

Our surgical approach to the rotator cuff is through a split in the tendinous raphe between the anterior and middle deltoid and limiting this split to less than two inches.

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