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The Potential Use of Intraoperative Ultrasound to Locate the Axillary Nerve Along Its Course Around the Humerus

Lenko, Eric S, Lenko
http://rave.ohiolink.edu/etdc/view?acc_num=osu1523994898360527

Abstract Details

2018, Doctor of Philosophy, Ohio State University, Anatomy.
Proximal humerus fractures account for nearly nine percent of all upper extremity fractures. Many of these fractures can be managed conservatively. However, surgical reduction of greater than one centimeter-displaced fractures requires surgical exposure that risks damage to the axillary nerve. There is significant variability in the location of the axillary nerve as it travels around the surgical neck of the humerus, based on how the measurements are taken. Given the variability in the vertical position of the axillary nerve in the literature, the surgeon is not able to assume the axillary nerve lies within the safe zone, since a percentage of all measured are located closer than five centimeters from the chosen bony landmarks on the scapula. Therefore, the axillary nerve must be specifically identified in each patient in order to avoid iatrogenic injury. Ultrasound imaging may be beneficial in identifying the axillary nerve location intraoperatively to guide the surgeon, since its utility has been previously supported when tracking needle location for axillary nerve blocks. The goal of the study was to compare the location of the axillary nerve along its course around the humerus via dissection and ultrasound imaging. Additionally, this study aimed to determine a prevalence of lateral pectoral nerve branching to the anterior deltoid. The initial study compared the location of the axillary nerve along its course around the surgical neck of the humerus at three divisions, anterior, lateral, and posterior via cadaver dissection. There was no significant difference between the six positions measured. There were three measurements locating the axillary nerve less than five centimeters from the origin of the deltoid. The axillary nerve terminates less than two centimeters from the medial border of the anterior deltoid making it vulnerable to injury during anterior approaches to the shoulder. Ultrasound and dissection was performed on seven shoulders of fresh cadavers to correlate the location of the axillary nerve with respect to the bony landmarks. There was a strong correlation (.831) between the measurements suggesting ultrasound may provide accuracy of the real-time location of the axillary nerve for potential use in the operative environment. The third portion of the study repeated the same six test positions utilizing ultrasound imaging on human volunteers. There was a significant different between the posterior and both the anterior and lateral positions with respect to the deltoid origin on the clavicle and scapula. Again, seven measurements located the axillary nerve proximal to the established safe zone. Finally, the lateral pectoral nerve was found branching to the undersurface of the deltoid after traveling across the deltopectoral groove in four percent of the cadaver samples. Future studies are necessary to derive a comparable percentage from a larger sample size. The four portions of the study contribute to the understanding of locating the axillary nerve within the deltoid. The next step would be to incorporate ultrasound imaging while performing these surgeries on cadavers to determine vulnerability of the axillary nerve and the potential effects on surgical time.
John Bolte, IV, PhD (Advisor)
Laura Boucher, PhD (Committee Member)
Yun Seok Kang, PhD (Committee Member)
James Latshaw, MD (Committee Member)
160 p.
Anatomy and Physiology
axillary nerve; deltoid; ultrasound; location; dissection

Recommended Citations

Citations

  • Lenko, Lenko, E. S. (2018). The Potential Use of Intraoperative Ultrasound to Locate the Axillary Nerve Along Its Course Around the Humerus [Doctoral dissertation, Ohio State University]. OhioLINK Electronic Theses and Dissertations Center. http://rave.ohiolink.edu/etdc/view?acc_num=osu1523994898360527

    APA Style (7th edition)

  • Lenko, Lenko, Eric. The Potential Use of Intraoperative Ultrasound to Locate the Axillary Nerve Along Its Course Around the Humerus. 2018. Ohio State University, Doctoral dissertation. OhioLINK Electronic Theses and Dissertations Center, http://rave.ohiolink.edu/etdc/view?acc_num=osu1523994898360527.

    MLA Style (8th edition)

  • Lenko, Lenko, Eric. "The Potential Use of Intraoperative Ultrasound to Locate the Axillary Nerve Along Its Course Around the Humerus." Doctoral dissertation, Ohio State University, 2018. http://rave.ohiolink.edu/etdc/view?acc_num=osu1523994898360527

    Chicago Manual of Style (17th edition)

osu1523994898360527
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This open access ETD is published by The Ohio State University and OhioLINK.