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Nerve plexuses are networks of interlacing nerves that serve as communication hubs to distribute and organize nerve action across various body regions. The nerve plexuses are organized into the cervical plexus located in the neck region, brachial plexus in the shoulder area, lumbar plexus found in the lower back, sacral plexus situated in the pelvis, and coccygeal plexus located in the coccygeal region.
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Identifying the axillary nerve during shoulder surgery: an anatomic study using advanced imaging.

Michael E Hachadorian1, Brendon C Mitchell1, Matthew Y Siow1

  • 1Department of Orthopaedic Surgery, University of California San Diego, San Diego, CA, USA.

JSES International
|December 21, 2020
PubMed
Summary

The axillary nerve (AXN) is close to key shoulder surgical landmarks, with distances varying by patient height and rotator cuff tear status. This MRI study provides crucial data for surgeons to prevent AXN injury during shoulder procedures.

Keywords:
LatarjetShoulderarthroplastyarthroscopyaxillaryinjurynerve

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Area of Science:

  • Orthopedic Surgery
  • Radiology
  • Neuroanatomy

Background:

  • The axillary nerve (AXN) is frequently injured during shoulder surgery.
  • Previous studies on AXN anatomy used small cadaveric samples.
  • This study utilizes a large MRI cohort for a more representative analysis.

Purpose of the Study:

  • To provide detailed measurements of the axillary nerve's (AXN) position relative to surgical landmarks.
  • To enhance intraoperative safety for surgeons performing shoulder procedures.
  • To investigate the influence of patient height and rotator cuff pathology on AXN location.

Main Methods:

  • Reviewed 257 high-resolution 3T MRI studies.
  • Four blinded reviewers measured AXN distances to the surgical neck of the humerus (SNH), lateral tip of the acromion (LTA), and inferior glenoid rim (IGR).
  • Assessed nerve location in relation to rotator cuff tear status and patient height.

Main Results:

  • Excellent inter-reviewer reliability (ICC 0.80-0.94).
  • Mean AXN distances: 1.7 cm to SNH, 1.6 cm to IGR, 7.1 cm to LTA.
  • Significant correlation between patient height and AXN-LTA distance (r=0.603, P<.001).
  • Rotator cuff tears increased AXN-SNH distance (P=.027).

Conclusions:

  • The axillary nerve (AXN) is vulnerable, with potential proximity as close as 5.6 mm to the inferior glenoid rim.
  • Patient height and rotator cuff integrity influence AXN positioning relative to surgical landmarks.
  • This study offers the first large-scale, MRI-based anatomical data of the AXN in living subjects to guide surgical practice.