Subdeltoid Bursa as a Safe Marker for Avoiding Injury to the Axillary Nerve

Abstract

Background

Surgical approaches have been developed to enhance exposure and facilitate operative procedures. Some approaches are not commonly used or preferred due to prolonged learning curves and higher risk of iatrogenic injuries, which can be distressing to both the patient and the surgeon. The antero-superior approach provides good exposure to the rotator cuff, the anterior and posterior aspects of the shoulder and the glenoid. This approach is gaining popularity as a preferred exposure for shoulder arthroplasty as well as trauma surgery. Knowledge of the axillary nerve anatomy, however, is vital in this approach; in order to avoid injury.

Method

We have dissected the axillary nerve in six cadavers and measured its distance from inferior reflection of the subdeltoid bursa.

Results

The axillary nerve was at least 1.5 cm distal to the bursa in all cases.

Conclusion

The deltoid muscle can safely be split to the level indicated by a finger placed into the inferior recess of the subdeltoid bursa. This method uses the patient's own anatomy, and does not rely on nonstandard data, or unreliable points of reference such as the acromion and offers a reliable guide for the use of this approach safely.