Determining the Relationship of the Axillary Nerve to the Shoulder Joint Capsule from an Arthroscopic Perspective

Price, Matthew R.; Tillett, Edward D.; Acland, Robert D.; Nettleton, G. S.

doi:10.2106/00004623-200410000-00003

Cited by 98 publications

(40 citation statements)

References 4 publications

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“…The results of our study showed that axillary nerve travels at an average distance of 1.1 cm from the glenoid labrum. Previously, Price et al (2004), using coronal section approach, found this distance to be as small as 2.5 mm. Another study has shown that posterior cord of the brachial plexus lies 12.4 6 3.2 mm from the anterior glenoid rim (McFarland et al, 2001).…”

Section: Discussionmentioning

confidence: 90%

“…The axillary nerve has long been known to be one of the nerves vulnerable to damage during shoulder arthroscopic and open surgical procedures that require manipulation or stabilization of the shoulder capsule (Perlmutter, 1999;Price et al, 2004). The localization of the axillary nerve is more hidden and it has a more complicated anatomic course than the other neural structures of the shoulder region.…”

Section: Introductionmentioning

confidence: 99%

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The anatomic relationships of the axillary nerve and surgical landmarks for its localization from the anterior aspect of the shoulder

Apaydın

Bozkurt

et al. 2006

Clinical Anatomy

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The axillary nerve has long been known to be one of the nerves vulnerable to damage during shoulder arthroscopic and open surgical procedures. The relationship of the axillary nerve to the shoulder capsule and the subscapularis muscle has not been well defined in orthopedic literature. This descriptive anatomical study aimed to present the course and the relations of the axillary nerve with neighboring neurovascular structures and the shoulder capsule and to define anatomical landmarks and regions that can be used practically in anterior surgical approaches to the shoulder region. To investigate the course of the axillary nerve and its relationship with neighboring structures, 30 shoulders of 15 fixed adult cadavers were dissected under the microscope through an anterior approach. A triangle-shaped anatomic area containing the axillary neurovascular bundle was defined. The closest distance between the axillary nerve and the anteromedial aspect of the coracoid tip and the glenoid labrum was measured as 3.7 cm and 1.1 cm on average, respectively. The distance between the anteromedial aspect of the coracoid tip and the point where the nerve passes through the medial edge of the subscapularis was measured as 2.5 cm on average. The results of this study demonstrate the anatomic pattern and the course of the axillary nerve and its relations with the shoulder capsule. Knowing the exact localization of the axillary nerve under the guidance of the defined anatomic triangle may provide a safer surgery.

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Section: Discussionmentioning

confidence: 90%

Section: Introductionmentioning

confidence: 99%

The anatomic relationships of the axillary nerve and surgical landmarks for its localization from the anterior aspect of the shoulder

Apaydın

Bozkurt

et al. 2006

Clinical Anatomy

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“…21 Price et al reported that AN lies closest to the glenoid at the 6 o'clock position, and the AN travels at a fixed distance from the inferior glenohumeral ligament throughout its course, and its average distance from the inferior glenohumeral ligament is 2.5 mm. 22 The study of Bryan et al showed that AN average distance from the inferior glenohumeral ligament is 3.2 mm. 23 According to these anatomic descriptions, anterior shoulder capsule between the 4:30 and 7 o'clock (right shoulder) positions is optimal place for blocking AN because of the initial point of separation of sensorial braches of joint.…”

Section: Discussionmentioning

confidence: 98%

Efficacy of analgesics in patients undergoing arthroscopic repair of rotator cuff at Gujarat Adani institute of medical science, Bhuj, Kutch, Gujarat

Kotak¹,

Rudani²

2017

Int J Res Orthop

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Background: To evaluate analgesic efficacy when catheters are positioned with assistance of arthroscope to block suprascapular and axillary nerves in patients undergoing arthroscopic repair of rotator cuff under general anesthesia.Methods: Present study was performed at department of orthopedics, Gujarat Adani Institute of Medical Science, Bhuj, Kutch, Gujarat. 24 patients who experienced arthroscopic repair of rotator cuff between July 2015 and October 2015 were catheterized to block suprascapular and axillary nerves through shoulder arthroscopy were incorporated in the study. Clinical outcomes were assessed using visual analog scale (VAS) scores preoperatively and at 0 h, 6 h, 12 h, 18 h, 24 h, and postoperative day 2.Results: Preoperative and postoperative 0 h, 6 h, 12 h, 18 h, 24 h, and day 2 mean VAS scores were 6.37±0.91, 0.45±0.39, 0.59±0.40, 0.62±0.39, 0.61±0.42, 0.51±0.35, and 1.54±0.50, respectively. No statistical difference was found among 0 h, 6 h, 12 h, 18 h, and 24 h time points; however, assessment of postoperative day 2 and postoperative 0 h, 6 h, 12 h, 18h and 24 h VAS scores showed statistically significant difference (P <0.05). All patients were discharged at the end of 24 h with no complication. The mean time (in minutes) required for blocking suprascapular nerve and axillar nerve were 14.38±3.21 and 3.75±0.85, respectively. Conclusions: These results confirmed that blocking two nerves with arthroscopic approach was an excellent pain management method in postoperative period. Accordingly, patients could recover rapidly and patients’ satisfaction could be improved.

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“…Careful shoulder manipulation is often required to gain full forward flexion and abduction. These maneuvers help to release 18 The cutting device should be kept close to the labrum. Gentle mobilization in abduction expands the capsulotomy and makes this step safer.…”

Section: Portals and Techniquementioning

confidence: 99%

“…At the 6 o'clock glenoid position, the nerve is found laterally, adjacent to the humerus, roughly 12.5 mm from the glenoid edge and 2.5-4 mm from the capsule. 18 Inferior capsule release is recommended near the labrum to prevent nerve damage.…”

Section: Portals and Techniquementioning

confidence: 99%

Primary Frozen Shoulder Syndrome: Arthroscopic Capsular Release

Arce

2015

Arthroscopy Techniques

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Idiopathic adhesive capsulitis, or primary frozen shoulder syndrome, is a fairly common orthopaedic problem characterized by shoulder pain and loss of motion. In most cases, conservative treatment (6-month physical therapy program and intra-articular steroid injections) improves symptoms and restores shoulder motion. In refractory cases, arthroscopic capsular release is indicated. This surgical procedure carries several advantages over other treatment modalities. First, it provides precise and controlled release of the capsule and ligaments, reducing the risk of traumatic complications observed after forceful shoulder manipulation. Second, release of the capsule and the involved structures with a radiofrequency device delays healing, which prevents adhesion formation. Third, the technique is straightforward, and an oral postoperative steroid program decreases pain and allows for a pleasant early rehabilitation program. Fourth, the procedure is performed with the patient fully awake under an interscalene block, which boosts the patient's confidence and adherence to the physical therapy protocol. In patients with refractory primary frozen shoulder syndrome, arthroscopic capsular release emerges as a suitable option that leads to a faster and long-lasting recovery.

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Determining the Relationship of the Axillary Nerve to the Shoulder Joint Capsule from an Arthroscopic Perspective

Cited by 98 publications

References 4 publications

The anatomic relationships of the axillary nerve and surgical landmarks for its localization from the anterior aspect of the shoulder

The anatomic relationships of the axillary nerve and surgical landmarks for its localization from the anterior aspect of the shoulder

Efficacy of analgesics in patients undergoing arthroscopic repair of rotator cuff at Gujarat Adani institute of medical science, Bhuj, Kutch, Gujarat

Primary Frozen Shoulder Syndrome: Arthroscopic Capsular Release

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