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Position of the axillary nerve in the deltoid muscle.

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THE ANATOMICAL RECORD 232:316-317 (1992)
Position of the Axillary Nerve in the Deltoid Muscle
ROOPA R. KULKARNI, ASHALATA N. NANDEDKAR, AND V.R. MYSOREKAR
Department of Anatomy, M.S. Ramaiah Medical College, Bangalore (R.R.K., V.R.M.), and
Department of Anatomy, Armed Forces Medical College, Pune (A.N.N.), India
ABSTRACT
The relationship of the anterior branch of the axillary nerve to
the deltoid muscle was studied on both sides in 66 adult cadavers. The nerve runs
a course on the deep surface of the deltoid muscle about 2.2 cm above the midpoint
on the vertical plane of the muscle.
Intramuscular injection into the deltoid muscle is
still a common practice. In such a procedure, a knowledge of the precise position of the axillary (circumflex)
nerve gains importance because a n accidental injection
into this nerve could cause undesirable side effects.
Textbook descriptions of the axillary nerve are
vague. According to Johnston and Whillis (1946), the
axillary nerve crosses the humerus about 2 cm above
the midpoint of a line joining the tip of the acromion to
the insertion of the deltoid muscle. Gardner et al.
(1975) indicate the level of the axillary nerve by a horizontal plane through the middle of the deltoid. Basmajian (1978) states that the axillary nerve's position
can be indicated on the skin surface by a horizontal line
drawn 5 cm below the angle of the acromion. Hollinshead (1982) notes that the nerve lies only about 1.5-2
below the acromion. According to Ellis (1983), the axillary nerve is related closely to the surgical neck of the
humerus, a hand's breadth below the acromion process.
MATERIALS AND METHODS
Nineteen male and seven female adult cadavers from
the M.S. Ramaiah Medical College, Bangalore, and 24
male and 16 female adult cadavers from the Armed
Forces Medical College, Pune, were studied. The procedure followed was identical in all the cadavers. The
skin and fascia over both deltoid muscles in each cadaver were reflected. The origin and insertion of the
deltoid muscle were defined. The total length of the
deltoid muscle across its convexity was measured by a
thread from the angle of the acromion to the lowest
part of the insertion, and it was read on a scale graduated in millimeters. The midpoint on the vertical
plane of the deltoid muscle was marked and a transverse incision across the muscle was made at this level.
The two flaps of the muscle were reflected, and i t was
found that in all cases the anterior branch of the axillary nerve was in the upper flap. The precise position of
this branch from the margin of the upper flap was measured and read on the scale. The pooled data from the
two colleges were statistically analyzed.
Table 1. Mean position of the anterior branch of the
axillary nerve'
Limb
R
L
'Z
=
Mean distance
above the centre
of the deltoid
muscle in cm
2.37
2.41
SE
0.07
0.07
n
66
66
0.396: P > 0.05.
follows a normal distribution, the 99% confidence interval for the mean distance of the nerve from the midpoint on the vertical plane of the deltoid muscle lies
between 2.2-2.6 cm. When the data for the two sexes
were separately analyzed statistically, there was no
difference found on both of the sides, in the position of
the nerve from the midpoint, on the vertical plane of
the deltoid muscle. A regression equation was drawn to
give the precise position of the anterior branch of the
axillary nerve when the length of the deltoid muscle
was known. The equation was Y = 0.19 X - 0.81
where X is the total length of the deltoid muscle and Y
is the position of the nerve from the midpoint of the
muscle.
DISCUSSION
Since the origin and insertion of the deltoid muscle
can be precisely defined in a living individual, our findings in the cadaver can be extrapolated to those in the
living. Various textbooks have given the position of the
axillary nerve as coursing from the midpoint of the
deltoid muscle to a point 1.5" below the angle of the
acromion. From our findings, it is clear that this nerve
is 2.2-2.6 cm above the midpoint on the vertical plane
of the muscle. Our findings substantiate only the description of the axillary nerve given by Johnston and
Whillis (1946).
ACKNOWLEDGMENTS
RESULTS
We are grateful to Shri. N.S. Narasimha Murthy,
assistant professor of statistics, Department of Com-
Table 1gives the data for the position of the anterior
branch of the axillary nerve in the two limbs, irrespective of sex.
The mean position of the anterior branch of the axillary nerve is the same for the right and left limbs.
Assuming t h a t the mean position of the axillary nerve
Received April 10, 1991; accepted July 31, 1991.
Address reprint requests to Dr. V.R. Mysorekar, Dept. of Anatomy,
M.S. Ramaiah Medical College, Gokula Extension Post, Bangalore
560 054, India.
0 1992 WILEY-LISS, INC
AXILLARY NERVE
munity Medicine, M.S. Ramaiah Medical College, Bangalore, for statistical analysis of the data.
LITERATURE CITED
Basmajian, J.V. 1978 Grant’s Method of Anatomy, 9th ed. S. Chand &
Co., New Delhi, pp. 95-96.
317
Ellis, H. 1983 Clinical Anatomy, 7th ed. Blackwell, Oxford, p. 200.
Gardner, E., D.J. Gray, and R. ORahilly 1975 Anatomy, 4th ed. W.B.
Saunders, Philadelphia, p. 114.
Hollinshead, W.H. 1982 Anatomy for Surgeons, 3rd ed., Vol. 3. Harper
& Row, Philadelphia, p. 336.
Johnston, T.B., and J. Whillis 1946 Gray’s Anatomy, 29th ed. Longmans Green, London, p. 1497.
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