Anatomy and quantitation of the subscapular nerves

INTRODUCTIONThe brachial plexus is a complex network of nerves which extends from the neck to the axilla and supplies motor, sensory and sympathetic fibres to the upper extremity.The brachial plexus is formed by platuing of ventral rami of the lower four cervical and the first thoracic nerves.The plexus extends from the inferior lateral portion of the neck downward and laterally over the first rib, posterior to the clavicle and enters the axilla. The brachial plexus is divided into supraclavicular part and infraclavicular part. The infraclavicular part consists of three cords-lateral, medial and posterior. The posterior cord runs posterior to the second part of the axillary artery behind the pectoralis minor muscle and gives off the following branchesupper subscapular nerve, thoracodorsal nerve, lower ABSTRACTBackground: Purpose of current study was to describe the variations in the origin of the thoracodorsal nerve of the posterior cord of brachial plexus and its distance of origin from mid-clavicular point in the South Indian population. These variations are important during surgical approaches to the axilla and upper arm, administration of anesthetic blocks, interpreting effects of nervous compressions and in repair of plexus injuries. The patterns of branching show population differences. Data from the South Indian population is scarce. Methods: Forty brachial plexuses from twenty formalin fixed cadavers were explored by gross dissection. Origin and order of branching of axillary nerve and its distance of origin from mid-clavicular point was recorded. Representative photographs were then taken using a digital camera (Sony Cybershot R, W200, 7.2 Megapixels). Results: In forty specimens studied, 72.5% of thoracodorsal nerves originated from posterior cord, which was predominant (75%) on the left side, 15% arose from axillary nerve which was observed in 20% of the right sided specimens and 12.5% had origin from the common trunk which was significant (15%) on the left side. In 32.5% of specimens, thoracodorsal nerve had origin at a distance of 4.1-4.5 cm, in 32.5% at a distance of 4.6-5.0 cm, in 17.5% at a distance of 5.1-5.5 cm, in 12.5% at a distance of 3.6-4.0 cm and in 5% at a distance of t more than 5.5 cm from mid-clavicular point. Conclusion: Majority of thoracodorsal nerves in studied population display a wide range of variations. Significant number of thoracodorsal nerve also takes origin from axillary nerve and from common trunk at various distances from a fixed point. Anesthesiologists administering local anesthetic blocks, clinicians interpreting effects of nerve injuries of the upper limb and surgeons operating in the axilla should be aware of these patterns to avoid inadvertent injury and this study provide the necessary insight into the branching pattern of the thoracodorsal nerve and its distance of origin. Further study of the origin of thoracodorsal nerve of posterior cord of brachial plexus and its distance of origin from mid-clavicular point is recommended

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“…The thoracodorsal nerve always originated as a single nerve from the brachial plexus. 9 The latter observation correlates with the present study.…”

Section: Resultssupporting

confidence: 93%

Study of variations in the branching pattern of thoracodorsal nerve

Bhosale

Mallashetty

2014

Int J Res Med Sci

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“…This is within the range of 78.6% and 98.5% described in literature [4,7]. The rest originated from the axillary nerve (10.7%) which was similar to 8.9% found by Ballesteros & Ramirez [12] but slightly lower than 13% reported by Fazan et al [3].…”

Section: Discussionsupporting

confidence: 84%

“…Knowledge of possible variations may help in the management of such injuries. Further, understanding of the variations is valuable in the administration of anaesthetic blocks [4,6], surgical approaches to the neck, axilla and upper arm, interpretation of nervous compressions by tumours or aneurysms [4] and use of the subscapular branches in neurotization procedures for repair of plexus injuries due to birth trauma [7].…”

Section: Introductionmentioning

confidence: 99%

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2014

J Brachial Plex Peripher Nerve Inj

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“…In a study of 62 specimens by R. Shane Tubs et al the upper subscapular nerve arose as a single nerve in 90.3% (56) of the cases, as two independent nerve trunks in 8% (5) of the cases and as three independent nerve trunks in 1.6% (1) of the cases [25].…”

Section: Discussionmentioning

confidence: 95%

Study of Variations in the Branching Pattern and Distance of Origin of Branches of Posterior Cord of Brachial Plexus

Bhosale¹,

A.Y²

2017

IJAR

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Background: Keeping in mind the frequency at which the surgical procedures are performed in the axilla, the organization and branching of brachial plexus and its topography becomes clinically significant and it is extremely complicated. Brachial plexus is the seat of explorations for oncosurgeons operating for breast carcinoma, schwannoma, neurofibroma, Anesthesiologists performing brachial plexus block, Plastic surgeons harboring myo-cutaneous flaps, Orthopedicians dealing with shoulder arthroplasty, humeral and clavicular fractures and for clinicians to explain the inexplicable signs of nerve compressions. The clinical importance of the variations in posterior cord is discussed in the light of various medical scenarios.

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Anatomy and quantitation of the subscapular nerves

Cited by 50 publications

References 12 publications

Study of variations in the branching pattern of thoracodorsal nerve

Study of variations in the branching pattern of thoracodorsal nerve

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Study of Variations in the Branching Pattern and Distance of Origin of Branches of Posterior Cord of Brachial Plexus

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