Anat Cell Biol.  2018 Jun;51(2):93-97. 10.5115/acb.2018.51.2.93.

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

• Patra A
• Singh M
• Kaur H
• Singla RK
• Malhotra V

• KMID: 2421172
• DOI: http://doi.org/10.5115/acb.2018.51.2.93

Abstract

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.

Keyword

Acromion; Axillary nerve; Acromio-axillary distance; Deltoid split; Safe area

MeSH Terms

Acromion
Adult
Arm
Cadaver*
Deltoid Muscle*
Extremities
Humans
Shoulder

Figure

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  Fig. 1 The inner surface of deltoid muscle showing the main trunk of axillary nerve with its anterior branch after removal of sub deltoid fascia over it.

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  Fig. 2 The deltoid muscle was replaced in its original anatomical position. The course of axillary nerve is shown with the help of needles, and the anterior acromio-axillary distance (AD) and posterior acromioaxillary distance (PD) were measured. AEA, anterior edge of acromion; PEA, posterior edge of acromion.

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  Fig. 3 Graph illustrating the correlation between upper arm length and anterior acromio-axillary distance.

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  Fig. 4 Graph illustrating the correlation between upper arm length and posterior acromio-axillary distance.

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