The Anterior Approach for Transfer of Radial Nerve Triceps Fascicles to the Axillary Nerve

2019 ◽  
Vol 44 (4) ◽  
pp. 345.e1-345.e6 ◽  
Author(s):  
Andrea S. Bauer ◽  
Remy V. Rabinovich ◽  
Peter M. Waters
Keyword(s):  
Radial Nerve ◽  
Anterior Approach ◽  
Axillary Nerve

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

2019 ◽  
Vol 12 (1) ◽  
pp. 24-30
Author(s):  
Stephen Gates ◽  
Brian Sager ◽  
Garen Collett ◽  
Avneesh Chhabra ◽  
Michael Khazzam
Keyword(s):  
Internal Rotation ◽  
Nerve Injury ◽  
Radial Nerve ◽  
Latissimus Dorsi ◽  
External Rotation ◽  
Axillary Nerve ◽  
Dynamic Nature ◽  
Iatrogenic Nerve Injury ◽  
Relationship Of ◽  
The Relationship

Background The purpose of this study was to define the relationship of the axillary and radial nerves, particularly how these are affected with changing arm position. Methods Twenty cadaveric shoulders were dissected, identifying the axillary and radial nerves. Distances between the latissimus dorsi tendon and these nerves were recorded in different shoulder positions. Positions included adduction/neutral rotation, abduction/neutral rotation for the axillary nerve, adduction/internal rotation, adduction/neutral rotation, adduction/external rotation, and abduction/external rotation for the radial nerve. Results Width of the latissimus tendon at its humeral insertion was 29.3 ± 5.7 mm. Mean distance from the latissimus insertion to the axillary nerve in adduction/neutral rotation was 24.2 ± 7.1 mm, the distance increased to 41.1 ± 9.8 mm in abduction/neutral rotation. Mean distance from the latissimus insertion to the radial nerve was 15.3 ± 5.5 mm with adduction/internal rotation, 25.8 ± 6.9 mm in adduction/neutral rotation, and 39.5 ± 6.8 mm in adduction/external rotation. Mean distance increased with abduction/external rotated 51.1 ± 7.4 mm. Conclusions Knowing the axillary and radial nerve locations relative to the latissimus dorsi tendon decreases the risk of iatrogenic nerve injury. Understanding the dynamic nature of these nerves related to different shoulder positions is critical to avoid complications.

scholarly journals Minimally Invasive Plate Osteosynthesis in Humeral Shaft Fractures via Anterior Approach

2021 ◽  
Vol 8 (13) ◽  
pp. 745-750
Author(s):  
Nikhilkumar Sureshkumar Oza ◽  
Ganesh A ◽  
Anand Kumar Singh ◽  
Pulin Bihari Das ◽  
Anurag Singh ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Scoring System ◽  
Radial Nerve ◽  
Anterior Approach ◽  
Plate Osteosynthesis ◽  
Case Series ◽  
Minimally Invasive Plate Osteosynthesis ◽  
Fracture Union ◽  
Excellent Outcome ◽  
Radial Nerve Injury

BACKGROUND This case series was conducted to evaluate the intraoperative and post-operative outcomes of fracture shaft of humerus managed by indirect reduction and minimally invasive plate osteosynthesis (MIPO) via anterior approach. METHODS In this case series 26 diaphyseal fractures of the humerus treated with MIPO, between June 2017 and February 2020 at a tertiary care hospital were included. All the patients were followed up for a minimum period of 2 years postoperatively. The objective was to evaluate these cases clinically for shoulder and elbow range of motion and document any complications. Other parameters such as duration of surgery and radiological time for fracture union were also documented. RESULTS The mean duration for surgery was 86.5 minutes. The University of California Los Angeles (UCLA) shoulder scoring system rated 18 patients (69.2 %) as excellent outcome, 07 patients (26.9 %) as good outcome, and 1 patient (3.8 %) as fair outcome. The MAYO Elbow Performance Scoring system rated 20 patients (76.9 %) as excellent outcome and 06 patients (23.1 %) as good outcome. About 96 % of patients achieved fracture union by the end of 16 weeks post-operatively (mean 13.4 weeks). No complications related to infection, iatrogenic radial nerve injury or implant failure were noted in the study. 4 cases had varus angulation deformity but did not affect shoulder or elbow function. CONCLUSIONS MIPO is a safe and effective technique for the management of diaphyseal humerus fractures, with early fracture healing, less risk of complications such as infection and iatrogenic radial nerve injury, along with a cosmetically acceptable scar. KEYWORDS Fracture Fixation, Fracture Healing, Humeral Fractures, Radial Nerve, Shoulder

Humeral shaft fractures

2011 ◽  
Author(s):  
Chris Little
Keyword(s):  
Nerve Conduction ◽  
Anterior Approach ◽  
Axillary Nerve ◽  
Nerve Conduction Studies ◽  
Humeral Shaft ◽  
Multiple Injuries ◽  
Pathological Fractures ◽  
Nerve Lesions ◽  
Humeral Shaft Fractures ◽  
Floating Elbow

♦ Deformity is well tolerated♦ Anterior approach for proximal shaft, but avoid damaging the axillary nerve♦ Nerve lesions which do not recover within three weeks should be investigated with nerve conduction studies♦ Most isolated fractures treated non-operatively♦ Floating elbow, multiple injuries, open or pathological fractures consider fixation♦ Open plating and nailing both give good results.

The anatomy of the anconeus nerve redefined

2021 ◽  
pp. 175319342110614
Author(s):  
Mauro Maniglio ◽  
Ezequiel E. Zaidenberg ◽  
Ezequiel F. Martinez ◽  
Carlos R. Zaidenberg
Keyword(s):  
Radial Nerve ◽  
Axillary Nerve ◽  
The Other ◽  
Anatomical Landmarks ◽  
Medial Head ◽  
Articular Capsule

The anconeus nerve is the longest branch of the radial nerve and suitable as a donor for the neurotization of the axillary nerve. The aim of this study was to map its topographical course with reference to palpable, anatomical landmarks. The anconeus nerve was followed in 15 cadaveric specimens from its origin to its entry to the anconeus. It runs between the lateral and the medial head of the triceps before entering the medial head and running intramuscularly further distal. Exiting the muscle, it lies on the periosteum and the articular capsule of the elbow, before entering the anconeus muscle. Two types of anconeus nerve in relation to branches innervating triceps were found: nine nerves also innervated the lateral triceps head, while the other six only contributed two branches to its innervation. The course of the anconeus nerve is important for harvesting as a donor nerve and to protect the nerve in surgical elbow approaches.

scholarly journals Anterior humeral approach with nerve stimulator

2018 ◽  
Vol 26 (3) ◽  
pp. 230949901880300
Author(s):  
Murat Gulcek ◽  
Mehmet Gamli
Keyword(s):  
Minimally Invasive ◽  
Nerve Injury ◽  
Radial Nerve ◽  
Anterior Approach ◽  
Screw Fixation ◽  
Plate Osteosynthesis ◽  
Minimally Invasive Plate Osteosynthesis ◽  
Nerve Stimulator ◽  
Invasive Approach ◽  
Radial Nerve Injury

Introduction: The prevalence of radial nerve injury during surgery is as high as the prevalence of radial nerve injury due to trauma. The aim of this study is to minimize the risk of iatrogenic injury of radial nerve. Materials and Methods: Fifty patients with middle or distal diaphysis fractures of humerus and 18 patients with pseudoarthrosis at the same localizations were treated with surgery. Plate-screw fixation was performed with anterior approach in 43 patients. Eleven patients had minimally invasive plate osteosynthesis, and 14 patients had intramedullary nailing. The localization of the radial nerve was determined with nerve stimulator at the area of dissection. Results: Iatrogenic radial nerve injury did not occur in patients treated with open reduction or minimally invasive approach. Discussion: Nerve stimulator may be a method that decreases radial nerve injury, an iatrogenic complication. This method may be used in anterior approach and minimally invasive procedures.

Restoration of Shoulder Abduction after Radial to Axillary Nerve Transfer following Trauma or Shoulder Arthroplasty

2013 ◽  
Vol 3 (1) ◽  
pp. 99-103
Author(s):  
James A Nunley ◽  
Fraser J Leversedge ◽  
Walter H Wray ◽  
J Mack Aldridge
Keyword(s):  
Nerve Injury ◽  
Shoulder Arthroplasty ◽  
Radial Nerve ◽  
Conflicts Of Interest ◽  
Case Series ◽  
Nerve Transfer ◽  
Axillary Nerve ◽  
Shoulder Abduction ◽  
Anterior Branch ◽  
Significant Difference

ABSTRACT Purpose A loss of active shoulder abduction due to axillary nerve dysfunction may be caused by brachial plexus or isolated axillary nerve injury and is often associated with a severe functional deficit. The purpose of this study was to evaluate retrospectively the restoration of deltoid strength and shoulder abduction after transfer of a branch of the radial nerve to the axillary nerve for patients who had sustained an axillary nerve injury. Materials and methods We retrospectively reviewed all patients who underwent transfer of a branch of the radial nerve to the anterior branch of the axillary nerve at our institution, either alone or in combination with other nerve transfers, between 2004 and 2011. We identified, by chart review, 12 patients with an average follow-up of 16.7 months (6-36 months) who met inclusion criteria. Results Active shoulder abduction significantly improved from an average of 9.6° (0-60°) to 84.5° (0-160°) (p < 0.005). Average initial deltoid strength significantly improved from 0.3 (0-2) on the M scale to an average postoperative deltoid strength of 2.8 (0-5) (p < 0.005). Five of 12 (41.7%) achieved at least M4 strength and eight of 12 (66.7%) achieved at least M3 strength. No statistically significant difference was seen when subgroup analysis was performed for isolated nerve transfer vs multiple nerve transfer, mechanism of injury with MVC vs shoulder arthroplasty, age, branch of radial nerve transferred, or time from injury to surgery. No significant change in triceps strength was observed with an average of 4.9 (4-5) strength preoperatively and 4.8 (4-5) postoperatively (p = 0.34). There were three patients who achieved no significant gain in shoulder abduction or deltoid strength for unknown reasons. Conclusion Transfer of a branch of the radial nerve to the anterior branch of the axillary nerve is successful in improving deltoid strength and shoulder abduction in most patients. Our series, the largest North American series to our knowledge, has not shown outcomes as favorable as other series. Larger multicenter trials are needed. Type of study/Level of evidence This is a retrospective case series representing a level IV study. Funding No outside funding was received and the authors have no conflicts of interest to disclose. Wray WH III, Aldridge JM III, Nunley JA II, Ruch DS, Leversedge FJ. Restoration of Shoulder Abduction after Radial to Axillary Nerve Transfer following Trauma or Shoulder Arthroplasty. The Duke Orthop J 2013;3(1):99-103.

scholarly journals MACROANATOMICAL ASPECTS OF BRACHIAL PLEXUS AND ITS BRANCHES IN THE INDIGENOUS DUCK

2017 ◽  
Vol 15 (1) ◽  
pp. 1-6
Author(s):  
J. Alam ◽  
M. S. Arifin ◽  
M. T. Hussan
Keyword(s):  
Brachial Plexus ◽  
Ulnar Nerve ◽  
Radial Nerve ◽  
Cervical Vertebrae ◽  
Axillary Nerve ◽  
Dorsal Side ◽  
The Body ◽  
Median Surface ◽  
Flexor Muscle ◽  
Thoracic Spinal

The injury to the peripheral nervous system is common clinical problem especially injury to the wing is the most common in birds. The present study aimed to document the detailed features of the morphological structure and the innervations areas of the brachial plexus in indigenous duck (Anas platyrhynchos domesticus). A total of six mature indigenous ducks (three of them were male and three were female) were used in this study. After administering an anesthetic to the birds, the body cavities were opened. The birds were fixed with formaldehyde after draining of the blood. The nerves of the brachial plexus were dissected separately and photographed. The brachial plexus was formed by the union of the ventral branches of 14thand 15th cervical spinal nerve and 1st, 2nd and 3rd thoracic spinal nerves, which were confirmed by palpation and counting the cervical vertebrae. Present study revealed that few small and large branches originated from brachial plexus and innervated into the specific muscles and their adjacent structure. Five nerve roots formed three nerve trunks in the duck, which constitute the dorsal and ventral cords. The pectoral trunk and median-ulnar nerve originated from ventral cord, while dorsal cord gives axillary nerve continued as a radial nerve into the wing of duck. The axillary nerve innervated into to skin of the dorsal side of the wing and shoulder deltoideous muscles, coracobrachialis muscles and propatagiasis cervical muscles. The radial nerve innervated to the humuro-brachial and triceps muscles, extensor carpi radial and supinator muscles. The ulnar nerve innervated extensor aspect of joint, flexor carpi ulnar muscles and superficial flexor muscle. The median nerve innervated into the median surface of the brachial and metacarpal region, flexor carpi radial muscle, pronator teres muscles, superficial and profound digital flexor muscles. The general macroanatomical shape of the brachial plexus and the distribution of the nerves originating from this plexus displayed some differences from other birds.

scholarly journals Surgical Implications of Innervation Pattern of the Triceps Muscle: A Cadaveric Study

2018 ◽  
Vol 10 (03) ◽  
pp. 139-142 ◽  
Author(s):  
Prashant Chaware ◽  
John Santoshi ◽  
Manmohan Patel ◽  
Mohtashim Ahmad ◽  
Bertha Rathinam
Keyword(s):  
Radial Nerve ◽  
Axillary Nerve ◽  
Nerve Supply ◽  
Upper Limbs ◽  
Innervation Pattern ◽  
Medial Head ◽  
Triceps Muscle ◽  
Muscle Transfers ◽  
Long Head ◽  
Lateral Head

AbstractThe innervation pattern of triceps is complex and not fully comprehended. Anomalous innervations of triceps have been described by various authors. We have attempted to delineate the nerve supply of the triceps and documented the anomalous innervations of its different heads. The brachial plexus and its major branches (in the region of the axilla and arm) and triceps were dissected in 36 embalmed cadaver upper limbs. Long head received one branch from radial nerve in 31 (86%) specimens. Four (11%) specimens received two branches including one that had dual innervation from the radial and axillary nerves, and one (3%) specimen had exclusive innervation from a branch of the axillary nerve. Medial head received two branches arising from the radial nerve in 34 (94%) specimens. One (3%) specimen received three branches from the radial nerve whereas one (3%) had dual supply from the radial and ulnar nerves. Lateral head received multiple branches exclusively from the radial nerve, ranging from 2 to 5, in all (100%) specimens. Knowledge of the variations in innervation of the triceps would not only help the surgeon to avoid inadvertent injury to any of the nerve branches but also offers new options for nerve and free functional muscle transfers.

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