title: Arthroscopic-assisted exploration of the axillary nerve through a posterior open approach: A novel technique.
abstract: BACKGROUND
  Previous studies have described a segment of the axillary nerve (AN) that cannot be surgically explored through standard open surgical approaches (blind zone). This study aimed to evaluate the feasibility of combining the standard posterior approach to the AN by using an arthroscope to visualize all segments of the AN.
  
  
  METHODS
  Four fresh-frozen shoulders in two adult human torsos were included in the study. A standard posterior approach was performed on each shoulder, and a dry arthroscopy was performed through the surgical opening in an attempt to visualize all the segments of the AN. A surgical clip was placed at the most proximal and anterior segment of the AN that could be visualized with the arthroscope. A standard open deltopectoral approach was then performed to determine the exact location of the surgical clip and its relation to the origin of the AN.
  
  
  RESULTS
  All segments of the AN (including the blind zone) were visualized from the quadrilateral space to their origin from the posterior cord in all four specimens. The surgical clip was found at an average of 1 cm (range from 0.5 to 1.5 cm) from the origin of the AN from the posterior cord.
  
  
  CONCLUSIONS
  This cadaveric study shows that it is feasible to visualize all segments of the AN (including the blind zone) using this novel approach that combines the use of the standard posterior approach to the AN with dry arthroscopic exploration. Clinical studies are necessary to evaluate the utility of this novel approach.
authors.affiliation: Department of Neurologic Surgery, Mayo Clinic, 200 1st Street South West, Rochester, MN 55905, USA; Department of Plastic, Hand and Reconstructive Surgery, BG Unfallklinik Frankfurt, Frankfurt, Germany.
authors.forename: Andrés A
authors.initials: AA
authors.lastname: Maldonado
authors.affiliation: Department of Neurologic Surgery, Mayo Clinic, 200 1st Street South West, Rochester, MN 55905, USA. Electronic address: spinner.robert@mayo.edu.
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Spinner
authors.affiliation: Division of Hand Surgery, Department of Orthopedic Surgery, Mayo Clinic, 200 1st Street South West, Rochester, MN 55905, USA.
authors.forename: Allen T
authors.initials: AT
authors.lastname: Bishop
authors.affiliation: Division of Hand Surgery, Department of Orthopedic Surgery, Mayo Clinic, 200 1st Street South West, Rochester, MN 55905, USA.
authors.forename: Alexander Y
authors.initials: AY
authors.lastname: Shin
authors.affiliation: Division of Hand Surgery, Department of Orthopedic Surgery, Mayo Clinic, 200 1st Street South West, Rochester, MN 55905, USA.
authors.forename: Bassem T
authors.initials: BT
authors.lastname: Elhassan
mesh_terms: D001182:Arthroscopy / Q000379:methods*; D001365:Axilla / Q000033:anatomy & histology / Q000294:innervation*; D002102:Cadaver; D006801:Humans; D059348:Peripheral Nerve Injuries / Q000517:prevention & control
keywords: Axillary nerve; Axillary nerve exploration; Blind zone; Open-arthroscopic approach