Surgically relevant anatomy of the axillary and radial nerves in relation to the latissimus dorsi tendon in variable shoulder positions: A cadaveric study

Gates, Stephen; Sager, Brian; Collett, Garen; Chhabra, Avneesh; Khazzam, Michael

doi:10.1177/1758573218825476

Cited by 6 publications

(9 citation statements)

References 26 publications

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“…We found that the axillary nerve was generally located behind the PCHA, so the medial approach did not increase the risk of axillary nerve injury. It is reported that shoulder abduction could protect the axillary nerve and radial nerve when working near the latissimus dorsi tendon insertion [37]. The musculocutaneous nerve is the only nerve that normally appears in the surgical area.…”

Section: Discussionmentioning

confidence: 99%

Anatomical Study for the Treatment of Proximal Humeral Fracture Through the Medial Approach

Xiang

Wang

Yang

et al. 2021

Preprint

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Background: The treatment of complex 3- and 4- part proximal humeral fractures has been controversial due to numerous postoperative complications. With the further study of medial support and blood supply of humeral head, new techniques and conception are developing. The study aims to illustrate the medial approach of the proximal humeral fracture through cadaver autopsy.Method: Upper limbs from 19 cadavers have been dissected to expose the shoulder joint. We selected the coracoid process as the bony reference. Vernier caliper will be used to measure the following data, including distance from coracoid process to circumflex brachial artery, distance between anterior humeral circumflex artery (ACHA) and posterior circumflex brachial artery (PCHA) and their diameters. Assessment included the characteristics of the vascular supply around the humeral head, identification of the structures at risk, quality of exposure of the bony structures, and feasibility of fixation.Results: Medial plate can be easily placed in 86.84% anatomical patterns. An interval of 2 to 3cm (24.29 ± 3.42 mm) was available for internal fixation. ACHA (49.35 ± 8.13 mm, 35.14 - 68.53 mm) and PCHA (49.62 ± 7.82 mm, 37.67 - 66.76 mm) were about 5cm away from the coracoid process. Risk factors including ACHA and PCHA originate in common, PCHA originated from the deep brachial artery (DBA), the presence of perforator vessels; musculocutaneous nerve intersects with ACHA, the diameter of PCHA: ACHA < 1.5. In 13.15% anatomical patterns, this risk factor should be taken seriously. Conclusion: The medial approach opens a new perspective in the optimal management of complex fractures of proximal humerus. Anatomical research proves that the medial approach is feasible. The interval between ACHA and PCHA is suitable for placement. Anatomical pattern and indication have been discussed, and we hypothesized that ACHA has been destroyed in complex PHFs. With further studies on the anatomy and mechanism of injury, the development of more clinical cases will be an important work of our institution in the future.

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Section: Discussionmentioning

confidence: 99%

Anatomical Study for the Treatment of Proximal Humeral Fracture Through the Medial Approach

Xiang

Wang

Yang

et al. 2021

Preprint

View full text Add to dashboard Cite

show abstract

“…Compared to other nerves, the musculocutaneous nerve is the only nerve that requires special attention in medial approach. It is reported that shoulder abduction could protect the axillary nerve and radial nerve when working near the latissimus dorsi tendon insertion [ 35 ]. We found that the axillary nerve was generally located behind the PCHA, so the medial approach did not increase the risk of axillary nerve injury.…”

Section: Discussionmentioning

confidence: 99%

Anatomical study for the treatment of proximal humeral fracture through the medial approach

et al. 2022

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Background The treatment of complex 3- and 4-part proximal humeral fractures has been controversial due to numerous postoperative complications. With the further study of medial support and blood supply of humeral head, new techniques and conception are developing. The study aims to illustrate the medial approach of the proximal humeral fracture through cadaver autopsy. Method Upper limbs from 19 cadavers have been dissected to expose the shoulder joint. We selected the coracoid process as the bony reference. Vernier caliper will be used to measure the following data, including distance from coracoid process to circumflex brachial artery, distance between anterior humeral circumflex artery (ACHA) and posterior circumflex brachial artery (PCHA) and their diameters. Assessment included the characteristics of the vascular supply around the humeral head, identification of the structures at risk, quality of exposure of the bony structures, and feasibility of fixation. Results The medial approach is appropriate in 86.84% anatomical patterns. Between the lower part of the shoulder capsule and the insertion of conjoined tendon, the bony surface exposed was limited by the interval between ACHA and PCHA. An interval of 2 to 3 cm (24.29 ± 3.42 mm) was available for medial plate. ACHA (49.35 ± 8.13 mm, 35.14–68.53 mm) and PCHA (49.62 ± 7.82 mm, 37.67–66.76 mm) were about 5 cm away from the coracoid process. Risk structures including ACHA and PCHA originate in common, PCHA originated from the deep brachial artery (DBA), the presence of perforator vessels, musculocutaneous nerve intersects with ACHA, the diameter of PCHA: ACHA < 1.5. In 13.15% anatomical patterns, this risk structure should be taken seriously. Conclusion The medial approach opens a new perspective in the optimal management of complex fractures of proximal humerus. Anatomical research proves that the medial approach is feasible. The interval between ACHA and PCHA is suitable for placement. Anatomical pattern and indication have been discussed, and we hypothesized that ACHA has been destroyed in complex PHFs. With further studies on the anatomy and mechanism of injury, the development of more clinical cases will be an important work of our institution in the future.

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“…Similarly, the radial nerve passes through the triangular interval just 22.1 ± 3.6 mm distal and inferior to the humeral insertion [13]. This distance is somewhat dynamic such that both nerves are closer to the LDTT insertion in a position of adduction [17]. When the LDTT is performed, the tendon can be safely released directly off the humeral insertion under direct visualization.…”

Section: Functional and Surgical Anatomy Of The Latissimus Dorsi Tendon Transfermentioning

confidence: 99%

Reverse Total Shoulder Arthroplasty with Concurrent Latissimus Dorsi Tendon Transfer

Scholten,

Trasolini,

Waterman

2021

Curr Rev Musculoskelet Med

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Purpose of Review Reverse total shoulder arthroplasty (rTSA) has emerged as an effective treatment option for patients with rotator cuff arthropathy resulting from irreparable rotator cuff tears. However, patients with combined loss of abduction and external rotation may still experience functional deficits after rTSA. One option to address this has been the latissimus dorsi tendon transfer (LDTT), or modified L'Episcopo procedure. The purpose of this review is to describe the role of LDTT with rTSA and to critically evaluate the evidence on whether a supplemental LDTT ultimately improves patient function.Recent Findings Patients with an intact rotator cuff demonstrated a significant increase in active external rotation following rTSA compared to those with a deficient rotator cuff following rTSA. Compared to their pre-operative baseline assessments, patients who undergo rTSA with LDTT report significant improvements in active external rotation. However, a randomized trial comparing rTSA patients with and without LDTT failed to demonstrate a significant difference in active external rotation or patientreported outcomes between groups. Summary Observational studies have shown that patients experience significant improvements in active range of motion and various patient-reported outcome measures following rTSA with latissimus dorsi tendon transfer. When directly comparing rTSA with LDTT to rTSA alone, the current literature fails to demonstrate a statistically significant difference in active external rotation or patient-reported outcomes at short-term follow-up. Further randomized controlled trials are required to fully understand the potential benefits of added tendon transfer in the rTSA patient population.

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Surgically relevant anatomy of the axillary and radial nerves in relation to the latissimus dorsi tendon in variable shoulder positions: A cadaveric study

Cited by 6 publications

References 26 publications

Anatomical Study for the Treatment of Proximal Humeral Fracture Through the Medial Approach

Anatomical Study for the Treatment of Proximal Humeral Fracture Through the Medial Approach

Anatomical study for the treatment of proximal humeral fracture through the medial approach

Reverse Total Shoulder Arthroplasty with Concurrent Latissimus Dorsi Tendon Transfer

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