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Is There a Safe Area for the Axillary Nerve in the Deltoid Muscle?

A Cadaveric Study

¹ Kirikkale Universitesi Tip Fakultesi Ortopedi ve Travmatoloji Anabilim Dali, 71100 Kirikkale, Turkey. E-mail address for O. Cetik: ozgurcetik{at}hotmail.com
² Halil Ibrahim Acar, MD Ayhan Comert, MD Ibrahim Tekdemir, MD Ankara Universitesi Tip Fakultesi Anatomi Anabilim Dali, 06650 Sihiye, Ankara, Turkey. E-mail address for A. Comert: drayhancomert{at}yahoo.com

Investigation performed at Department of Orthopaedics and Traumatology, Kirikkale University School of Medicine, Kirikkale, Turkey, and Department of Anatomy, Ankara University School of Medicine, Ankara, Turkey

The authors did not receive grants or outside funding in support of their research for or preparation of this manuscript. They did not receive payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, educational institution, or other charitable or nonprofit organization with which the authors are affiliated or associated.

Methods: Twenty-four shoulders of embalmed adult cadavers were included in the study. The distance from the anterior edge of the acromion to the course of the axillary nerve was measured and was recorded as the anterior distance. The same measurement from the posterior edge of the acromion to the course of the axillary nerve was made and was recorded as the posterior distance for each limb. Correlation analysis was performed between the arm length and the anterior distance and the posterior distance for each limb. The ratios between arm length and the anterior and posterior distances were calculated for each case and were recorded as an anterior index and a posterior index.

Results: The average arm length was 30.40 cm. The average anterior distance was 6.08 cm, and the average posterior distance was 4.87 cm. There was a significant correlation between arm length and both anterior distance (r = 0.79, p < 0.001) and posterior distance (r = 0.61, p = 0.001). The axillary nerve was not found to lie at a constant distance from the acromion at every point along its course. The average anterior index was 0.20, and the average posterior index was 0.16.

Conclusions: The present study describes a safe area above the axillary nerve that is quadrangular in shape, with the length of the lateral edges being dependent on the individual's arm length. Using this safe area should provide a safe exposure for the axillary nerve during shoulder operations.

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