IJAR.2020.101
Type of Article: Original Research
Volume 8; Issue 1.3 (March 2020)
Page No.: 7350-7355
DOI: https://dx.doi.org/10.16965/ijar.2020.101
CONTRIBUTION OF AXILLARY NERVE IN THE INNERVATION OF LONG HEAD OF TRICEPS BRACHII: A CADAVERIC STUDY
Gyata Mehta 1, Geetha Rani BG *2, Varsha Mokhasi 3.
1 Associate professor, Department of Anatomy, Vydehi institute of Medical Sciences & Research Centre, #82 EPIP area, Whitefield Bangalore, Karnataka, India.
*2 Assistant Professor, Department of Anatomy, Vydehi institute of Medical Sciences & Research Centre, #82 EPIP area, Whitefield Bangalore, Karnataka, India.
3 Professor & HOD, Department of Anatomy, Vydehi institute of Medical Sciences & Research Centre, #82 EPIP area, Whitefield Bangalore, Karnataka, India.
Corresponding Author: Dr Geetha Rani BG, Assistant Professor, Department of Anatomy, Vydehi institute of Medical Sciences & Research Centre, #82 EPIP area, Whitefield Bangalore 560066, Karnataka, India. Mobile no- 9964068258 E-Mail: lalithgeetha246@gmail.com
ABSTRACT
Background: Traditionally the axillary nerve innervates the Deltoid and the Teres minor(TM) muscle. Axillary nerve injuries are common in shoulder dislocation, fracture surgical neck of humerus, brachial plexus injuries and neuropathies. Traumatic injuries of axillary nerve have also shown weakness of Long head of triceps and in surgical practice, the nerve to long head of triceps is utilized for nerve transfer to neurotise the deltoid muscle in patients with axillary nerve injuries. Hence the aim of the study was to find out the prevalence of contribution of axillary nerve to the innervation of Long head of triceps brachii (LHT).
Materials and Methods: Nine embalmed adult human cadavers (bilaterally) and twelve disarticulated upper extremities were dissected. Total of thirty upper extremities were dissected. The axillary nerve was observed emerging from the quadrangular space. Anterior and posterior branches of axillary nerve were noted. The muscular branches to deltoid, TM and LHT were traced to their point of innervation. The focus was on the branch of axillary nerve supplying the LHT. The branching configuration was classified into three types. Type I- posterior branch of axillary nerve supplying the LHT, Type II- Branch to TM supplying the LHT and Type III- A branch from the bifurcation of anterior & posterior branch of axillary nerve supplying LHT.
Results: The present study showed that axillary nerve innervated the LHT in 8 out of 30 limbs (26.66%). Amongst these, in 4 limbs(50%) posterior branch of axillary nerve supplied the LHT(type I ), in 3 limbs(37.5%) branch to TM supplied the LHT(type II) and in 1 limb(12.5%) a branch from the bifurcation of axillary nerve into anterior and posterior branch supplied the LHT( type III). It was also observed that in 2 (6.66%) specimens, axillary nerve was the only supply to LHT and in 6 (20%) specimens both axillary nerve & radial nerve supplied the LHT and in the remaining 22 (73.3%) specimens, only the radial nerve supplied the LHT.
Conclusion: Awareness of the variation of axillary nerve supplying the LHT is important for surgeons, orthopaedicians and anaesthetists for surgical treatment of traumatic nerve injuries.
Key words: Axillary Nerve, Motor Innervation, Long Head Of Triceps, Variations.
REFERENCES
- Gray H.Pectoral girdle,shoulder and axilla.In: Gray’s Anatomy. The Anatomical Basis of Clinical Practice.Susan Standring 40thLondon: Elsevier Churchill Livingstone;2010.p791-830.
- Rezzouk J,Durandeau A, Vital JM, FabreT. Long heads of triceps brachii in axillary nerve imjury:anatomy and clinical aspects.Rev Chir Orthop Reparatrice Appar Mot. 2002;88(6):561-4.
- Witoonchart K et al. Nerve transfer to deltoid muscle using the nerve to the long head of triceps, part I: an anatomic feasible study. Plastic surgery.2001;6:123-133.
- Drake RL,Vogl AW, Mitchell AW. Upper limb-Pectoral region and axilla.In: Gray’s Anatomy for students. 3rd Philadelphia: Elsevier Churchill Livingstone;2015.p721-749.
- Marios Loukas, Joanna Grabska, Shane Tubbs, Nihal Apaydin, Robert Jordan. Mapping the axillary nerve within the deltoid muscle. Surgical and Radiologic Anatomy.2009;(3);43-47.
- Aysun UZ, NihalApaydin, Murat Rozkut, Alailtin Fihan. The anatomic branch pattern of the axillary nerve. Journal of Shoulder & Elbow Surgery.2007;16(2): 240-44.
- Elizabeth et al.Surgical anatomy of the axillary nerve in the quadrangular space. Journal of Neurosurgery .2005;102(5):912-14.
- F Dupare, G Bocquet, J Simonet, P Freger. Anatomical basis of the variable aspects of injuries of the axillary nerve. Surg Radiol Anat.1997;19:127-32.
- Craig M. Ball, Thomas Steger, Leesa M. Galatz, Ken Yamaguchi. The posterior branch of the Axillary nerve: An Anatomic Study. The Journal of Bone and Joint Surgery.2003;85A(8):1497-1501.
- RosseC, Gaddum- RosseP.Pectoral region, axilla and shoulder.In: Hollinshed’s text book of Anatomy . 5thPhiladelphia: Lippincott- Raven;1997.p193-237.
- Michael D. Wade, Arthur R. Mcdowell, Janine M. Ziermann. Innervation of the Long Head of the Triceps Brachii in Humans—A fresh Look TheAnatomical Record. 2018; 301:473-483.
- Obaid Al-Meshal, Alain Gilbert.Triceps Innervation Pattern: Implications for Triceps nerve to Deltoid nerve transfer. BioMed Research International.2013; 1-3.
- de Seze MP, Rezzouk J, de Seze M, Uzel M, LavignolleB, Midy D, Durandeau A. Does the motor branch of the long head of the triceps brachii arise from the radial nerve?An anatomic and electromyographic study. Surg Radiol Anat 2004;26(6):459-61
- Sharadkumar Pralhad Sawant, Shaguphta T. Shaikh, Rakhi M. More. The Axillary nerve giving motor branch to the Long Head of the Triceps muscle-A case report. International Journal of Analytical, Pharmaceutical and Biomedical Sciences.2012;1(4):15-19
- Komala Nanjundaiah, SM Jayadevaiah, Sheshgiri Chowdapurkar.Long Head of triceps supplied by axillary nerve. International Journal of Anatomical Variations.2012;5:35-37
- Alexandra J. Erhardt, Bennett Futterman. Variations in the Innervation of the Long Head of the Triceps Brachii: A Cadaveric Investigation. Clin Orthop Relat Res. 2017; 475:247–250
- Takkallapalli Anitha, Anwar Unisa Sabry, Moota Aditya, Mohammed Awais, P. Jayasudha. Clinically relevant variations in branching pattern of axillary nerve. Med Allied Sci. 2019; 9(2):63-66
- Seema, S.R. Gangadhar. Variations in the formation and branching pattern of brachial plexus. Revista Argentina de Anatomía.2015;VI(1):30-33
- Sadler TW. Limbs- Limb musculature. In: Langman’s Medical Embryology.13th Philadelphia: Lippincott Williams Wilkins; 2016.p163-167.
- Mythraeyee Prasad, Bina Isaac. Variations in the branching pattern of the Radial nerve branches to Triceps brachii muscle. Journal of Clinical and Diagnostic Research.2019;13(2):1-6.