Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.
ADVANCED SEARCH
Log in
Top
Knee Surgery, Sports Traumatology, Arthroscopy
Published in: Knee Surgery, Sports Traumatology, Arthroscopy 9/2015

01-09-2015 | Shoulder

Distribution of the axillary nerve to the subacromial bursa and the area around the long head of the biceps tendon

Authors: H. Nasu, A. Nimura, K. Yamaguchi, K. Akita

Published in: Knee Surgery, Sports Traumatology, Arthroscopy | Issue 9/2015

Login to get access

Abstract

Purpose

Patients with a shoulder disorder often complain of pain on the anterior or lateral aspect of the shoulder. Such pain has been thought to originate from the suprascapular nerve. However, taking into consideration the distinctive course of the axillary nerve, the axillary nerve is likely to supply branches to the structure around the shoulder joint. This study was conducted to clarify the division, course, and distribution of the branches which originate from the axillary nerve and innervate structures around the shoulder joint.

Methods

The division, course, and distribution of the branches which originate from the axillary nerve and innervate structures around the shoulder joint were examined macroscopically by dissecting 20 shoulders of 10 adult Japanese cadavers.

Results

The thin branches from the anterior branch of the axillary nerve were distributed to the subacromial bursa and the area around the long head of the biceps tendon. The branches from the main trunk of the axillary nerve or the branch to the teres minor muscle were distributed to the infero-posterior part of the shoulder joint.

Conclusion

The pain on the anterior or lateral aspect of the shoulder, which has been thought to originate from the suprascapular nerve, might be related to the thin branches which originate from the axillary nerve and innervate the subacromial bursa and the area around the long head of the biceps tendon.

Clinical relevance

These results would be useful to consider the cause of the shoulder pain or to prevent the residual pain after the biceps tenodesis.
Literature
1.
Aiyama S, Kihara S (1973) On the cutaneous branches of the axillary nerve with special reference to their topographic relation to the deltoid muscle. Hirosaki igaku 24:413–423 (in Japanese with English abstract)
2.
Alpantaki K, McLaughlin D, Karagogeos D, Hadjipavlou A, Kontakis G (2005) Sympathetic and sensory neural elements in the tendon of the long head of the biceps. J Bone Joint Surg Am 87:1580–1583CrossRefPubMed
3.
Aszmann OC, Dellon AL, Birely BT, McFarland EG (1996) Innervation of the human shoulder joint and its implications for surgery. Clin Orthop Relat Res 330:202–207CrossRefPubMed
4.
Ball CM, Steger T, Galatz LM, Yamaguchi K (2003) The posterior branch of the axillary nerve: an anatomic study. J Bone Joint Surg Am 85:1497–1501PubMed
5.
Boileau P, Krishnan SG, Coste JS, Walch G (2002) Arthroscopic biceps tenodesis: a new technique using bioabsorbable interference screw fixation. Arthroscopy 8:1002–1012CrossRef
6.
Ebraheim Ebraheim NA, Whitehead JL, Alla SR, Moral MZ, Castillo S, McCollough AL, Yeasting RA, Liu JNA (2011) The suprascapular nerve and its articular branch to the acromioclavicular joint: an anatomic study. J Shoulder Elbow Surg 20:13–17CrossRef
7.
Elser F, Braun S, Dewing CB, Giphart JE, Millett PJ (2011) Anatomy, function, injuries, and treatment of the long head of the biceps brachii tendon. Arthroscopy 27:581–591CrossRefPubMed
8.
Frohse F, Fränkel M (1908) M. deltoideus. Schultermuskeln. In: Von Bardeleben K (ed) Die muskeln des menschlichen armes. Gustav Fischer, Jena, pp 27–39
9.
Gelber PE, Reina F, Monllau JC, Yema P, Rodriguez A, Caceres E (2006) Innervation patterns of the inferior glenohumeral ligament: anatomical and biomechanical relevance. Clin Anat 19:304–311CrossRefPubMed
10.
11.
Hsu AR, Ghodadra NS, Provencher MT, Lewis PB, Bach BR (2011) Biceps tenotomy versus tenodesis: a review of clinical outcomes and biomechanical results. J Shoulder Elbow Surg 20:326–332CrossRefPubMed
12.
Ide K, Shirai Y, Ito H, Ito H (1996) Sensory nerve supply in the human subacromial bursa. J Shoulder Elbow Surg 5:371–382CrossRefPubMed
13.
Khan KM, Cook JL, Maffulli N, Kannus P (2000) Where is the pain coming from in tendinopathy? It may be biochemical, not only structural, in origin. Br J Sports Med 34:81–83PubMedCentralCrossRefPubMed
14.
Loukas M, Grabska J, Tubbs RS, Apaydin N, Jordan R (2009) Mapping the axillary nerve within the deltoid muscle. Surg Radiol Anat 31:43–47CrossRefPubMed
15.
Lutton DM, Gruson KI, Harrison AK, Gladstone JN, Flatow EL (2011) Where to tenodese the biceps: proximal or distal? Clin Orthop Relat Res 469:1050–1055PubMedCentralCrossRefPubMed
16.
Mazzocca AD, Rios CG, Romeo AA, Arciero RA (2005) Subpectoral biceps tenodesis with interference screw fixation. Arthroscopy 21:896.e1–896.e7
17.
Morisawa Y, Uemura H, Michinaka Y, Hasegawa S, Yamamoto H (1997) A morphological study of the mechanoreceptors in the rotator cuff, the subacromial bursa and the coracoacromial ligament. Kansestu geka 16:917–922 (in Japanese)
18.
Murakami M, Yoshikawa G, Tarumoto R, Dohi J (1997) Sensory nerve endings of the capsule and pain onset mechanism in the shoulder joint. Kansestu geka 16:923–930 (in Japanese)
19.
Ochiai N, Sato S, Sugioka K, Kenmoku T, Saisu T, Fujita K, Mastuki K (2010) Lateral side of the shoulder pain due to the shoulder pathology. Katakansestu 34:569–573 (in Japanese with English abstract)
20.
Rauber A (1870) II. Die Nerven des Oberarmknochens. In: Rauber A (ed) Ueber die Knochen-Nerven des Oberarms und Oberschenkels. Caesar Fritsch, München, pp 13–15  
21.
Ritchie ED, Tong D, Chung F, Norris AM, Miniaci A, Vairavanathan SD (1997) Suprascapular nerve block for postoperative pain relief in arthroscopic shoulder surgery: a new modality? Anesth Analg 84:1306–1312PubMed
22.
Sander B, Lavery K, Pennington S, Warner JJP (2008) Biceps tendon tenodesis: success with proximal versus distal fixation. Arthroscopy 24:e9CrossRef
23.
Soifer TB, Levy HJ, Soifer FM, Kleinbart F, Vigorita V, Bryk E (1996) Neurohistology of the subacromial space. Arthroscopy 12:182–186CrossRefPubMed
24.
Szabó I, Boileau P, Walch G (2008) The proximal biceps as a pain generator and results of tenotomy. Sports Med Arthrosc 16:180–186CrossRefPubMed
25.
Tosounidis T, Hadjileontis C, Triantafyllou C, Sidiropoulou V, Kafanas A, Kontakis G (2013) Evidence of sympathetic innervation and α1-adrenergic receptors of the long head of the biceps brachii tendon. J Orthop Sci 18:238–244CrossRefPubMed
26.
Uz A, Apaydin N, Bozkurt M, Elhan A (2007) The anatomic branch pattern of the axillary nerve. J Shoulder Elbow Surg 16:240–244CrossRefPubMed
27.
Vorster W, Lange CP, Briët RJ, Labuschagne BC, du Toit DF, Muller CJ, de Beer JF (2008) The sensory branch distribution of the suprascapular nerve: an anatomic study. J Shoulder Elbow Surg 17:500–502CrossRefPubMed
28.
Wittstein JR, Queen R, Abbey A, Toth A, Moorman CT III (2011) Isokinetic strength, endurance, and subjective outcomes after biceps tenotomy versus tenodesis: a postoperative study. Am J Sports Med 39:857–865CrossRefPubMed
29.
30.
Zhang Q, Zhou J, Ge H, Cheng B (2013) Tenotomy or tenodesis for long head biceps lesions in shoulders with reparable rotator cuff tears: a prospective randomised trial. Knee Surg Sports Traumatol Arthrosc. doi:10.​1007/​s0016701325878 PubMedCentral
Metadata
Title
Distribution of the axillary nerve to the subacromial bursa and the area around the long head of the biceps tendon
Authors
H. Nasu
A. Nimura
K. Yamaguchi
K. Akita
Publication date
01-09-2015
Publisher
Springer Berlin Heidelberg
Published in
Knee Surgery, Sports Traumatology, Arthroscopy / Issue 9/2015
Print ISSN: 0942-2056
Electronic ISSN: 1433-7347
DOI
https://doi.org/10.1007/s00167-014-3112-4

Other articles of this Issue 9/2015

Knee Surgery, Sports Traumatology, Arthroscopy 9/2015 Go to the issue

Experimental Study

Effect of open wedge high tibial osteotomy on the lateral tibiofemoral compartment in sheep. Part III: analysis of the microstructure of the subchondral bone and correlations with the articular cartilage and meniscus

Shoulder

Anteroposterior translation of the glenohumeral joint in various pathologies: differences between shoulder MRI in the adducted neutral rotation and abducted externally rotated positions

Knee

Efficacy of intraarticular application of ketamine or ketamine–levobupivacaine combination on post-operative pain after arthroscopic meniscectomy

Experimental Study

Opioids as an alternative to amide-type local anaesthetics for intra-articular application

Shoulder

Accuracy of magnetic resonance imaging to diagnose superior labrum anterior–posterior tears

Hip

Reliability of hip internal rotation range of motion measurement using a digital inclinometer