Quantitation of the lower subscapular nerve for potential use in neurotization procedures.
OBJECTIVE
New information regarding nerve branches of the brachial plexus can be useful to the surgeon performing neurotization procedures following patient injury. Nerves in the vicinity of the axillae have been commonly used for neural grafting procedures, with the exception of the lower subscapular nerve (LSN).


METHODS
The authors dissected and measured the LSN in 47 upper extremities (left and right sides) obtained in 27 adult cadavers, and determined distances between the LSN and surrounding nerves to help quantify it for possible use in neurotization procedures. The mean diameter of the LSN was 2.3 mm. The mean length of the LSN from its origin at the posterior cord until it branched to the subscapularis muscle was 3.5 cm, and the mean distance from this branch until its termination in the teres major muscle was 6 cm. Therefore, the mean length of the entire LSN from the posterior cord to the teres major was 9.5 cm. When the LSN was mobilized to explore its possible use in neurotization, it reached the entrance site of the musculocutaneous nerve into the coracobrachialis muscle in all but three sides and was within 1.5 cm from this point in these three. In the other specimens, the mean length of the LSN distal to this site of the musculocutaneous nerve was 2 cm. The mobilized LSN reached the axillary nerve trunk as it entered the quadrangular space in all specimens. The mean length of the LSN distal to this point on the axillary nerve was 2.5 cm. Furthermore, on all but one side the LSN was found within the confines of an anatomical triangle previously described by the authors.


CONCLUSIONS
The authors hope that these data will prove useful to the surgeon for both identifying the LSN and planning for potential neurotization procedures of the brachial plexus.
Tubbs
R Shane
RS
Department of Cell Biology and School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama 35233, USA. rstubbs@uab.edu
Khoury
Charles A
CA
Salter
E George
EG
Acakpo-Satchivi
Leslie
L
Wellons
John C
JC
Blount
Jeffrey P
JP
Oakes
W Jerry
WJ
D001365:Axilla / Q000294:innervation; D001917:Brachial Plexus / Q000293:injuries* / Q000601:surgery; D004550:Elbow / Q000294:innervation; D006801:Humans; D018482:Muscle, Skeletal / Q000294:innervation; D009138:Musculocutaneous Nerve / Q000033:anatomy & histology / Q000601:surgery; D009416:Nerve Regeneration / Q000502:physiology; D016067:Nerve Transfer / Q000379:methods*; D010525:Peripheral Nerves / Q000033:anatomy & histology / Q000637:transplantation*; D011843:Radiculopathy / Q000601:surgery*; D012540:Scapula / Q000294:innervation; D012782:Shoulder / Q000294:innervation; D020858:Tissue and Organ Harvesting / Q000379:methods*