title: Surgical anatomy of the axillary nerve and its implication in the transdeltoid approaches to the shoulder.
abstract: BACKGROUND
  Traumatic and iatrogenic injuries of the axillary nerve (AN) are frequent in clinical practice; nevertheless, its anatomy and its relationships with the transdeltoid approaches to the shoulder are not well documented.
  
  
  METHODS
  Anatomic study was performed on 16 shoulders of unembalmed cadavers. A proximal humeral internal locking system (PHILOS) plate was placed to simulate the osteosynthesis of a fracture of humeral surgical neck. The relationships between the plate and the nerve were evaluated. Selective dissection of all the nerve branches inside the deltoid muscle was performed.
  
  
  RESULTS
  The mean distance between the point where the AN entered into the deltoid muscle and the humeral head was 5.0 cm, and it was 6.8 cm from the acromion. The mean distance between the origins of the anterior and posterior branches of the axillary nerve was 5.4 cm. The mean diameter of the AN was 0.57 cm, the anterior branch diameter was 0.40 cm, of posterior branch diameter was 0.33 cm, and the teres minor branch diameter was 0.24 cm. The application of the PHILOS plate demonstrated that in 100% of cases, the 2 distal holes of the plate of those dedicated to the humeral head coincided with the passage of AN.
  
  
  CONCLUSIONS
  The different patterns of nerve branches inside the deltoid muscle show that the "safe zone" during transdeltoid approaches is the anterior region of the deltoid muscle for a maximum of 6.7 cm from the acromion. In addition, the insertion of the 2 distal screws of those dedicated to humeral head of the plate should be avoided.
authors.affiliation: Department of Human Anatomy and Physiology, University of Padova, Padova, Italy. carla.stecco@unipd.it
authors.forename: Carla
authors.initials: C
authors.lastname: Stecco
authors.forename: Giorgio
authors.initials: G
authors.lastname: Gagliano
authors.forename: Luca
authors.initials: L
authors.lastname: Lancerotto
authors.forename: Cesare
authors.initials: C
authors.lastname: Tiengo
authors.forename: Veronica
authors.initials: V
authors.lastname: Macchi
authors.forename: Andrea
authors.initials: A
authors.lastname: Porzionato
authors.forename: Raffaele
authors.initials: R
authors.lastname: De Caro
authors.forename: Roberto
authors.initials: R
authors.lastname: Aldegheri
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001365:Axilla / Q000294:innervation*; D002102:Cadaver; D057645:Deltoid Muscle / Q000294:innervation; D006801:Humans; D008875:Middle Aged; D010525:Peripheral Nerves / Q000033:anatomy & histology / Q000601:surgery; D012782:Shoulder / Q000601:surgery*