Axillary nerve

Axillary nerve
Brachial plexus. (Axillary nerve is visible in gray near center.)
The suprascapular, axillary, and radial nerves. (Axillary labeled at upper right.)
Details
From	posterior cord (C5, C6)
Innervates	deltoid, teres minor, axilla
Identifiers
Latin	nervus axillaris
TA	A14.2.03.059
FMA	37072
*Anatomical terms of neuroanatomy* [edit on Wikidata]

The axillary nerve or the circumflex nerve is a nerve of the human body, that originates from the brachial plexus (upper trunk, posterior division, posterior cord) at the level of the axilla (armpit) and carries nerve fibers from C5 and C6. The axillary nerve travels through the quadrangular space with the posterior circumflex humeral artery and vein.

Structure

The nerve lies at first behind the axillary artery, and in front of the subscapularis, and passes downward to the lower border of that muscle.

It then winds backward, in company with the posterior humeral circumflex artery, through a quadrangular space bounded above by the teres minor, below by the teres major, medially by the long head of the triceps brachii, and laterally by the surgical neck of the humerus, and divides into an anterior, a posterior, and a collateral branch to the long head of the triceps brachii branch.

The anterior branch (upper branch) winds around the surgical neck of the humerus, beneath the deltoid muscle, with the posterior humeral circumflex vessels. It continues as far as the anterior border of the deltoid to provide motor innervation. The anterior branch also gives off a few small cutaneous branches, which pierce the muscle and supply in the overlaying skin.
The posterior branch (lower branch) supplies the teres minor and the posterior part of the deltoid. The posterior branch pierces the deep fascia and continues as the superior (or upper) lateral cutaneous nerve of arm, which sweeps around the posterior border of the deltoid and supplies the skin over the lower two-thirds of the posterior part of this muscle, as well as that covering the long head of the triceps brachii.
The motor branch of the long head of the triceps brachii arises, on average, a distance of 6 mm (range 2–12 mm) from the terminal division of the posterior cord termination.^[1]
The trunk of the axillary nerve gives off an articular filament which enters the shoulder joint below the subscapularis.

Function

The axillary nerve supplies three muscles in the arm: deltoid (a muscle of the shoulder), teres minor (one of the rotator cuff muscles) and the long head of the triceps brachii. Traditionally, the axillary nerve was thought to only supply the deltoid and teres minor. However, a study conducted in 2004 determined that, in 20 cadaveric specimens and 15 surgical dissections on participants, the long head was innervated by a branch of the axillary nerve in all cases.^[1]

The axillary nerve also carries sensory information from the shoulder joint, as well as the skin covering the inferior region of the deltoid muscle - the "regimental badge" area (which is innervated by the superior lateral cutaneous nerve branch of the axillary nerve).

The posterior cord of the brachial plexus splits inferiorly to the glenohumeral joint giving rise to the axillary nerve which wraps around the surgical neck of the humerus, and the radial nerve which wraps around the humerus anteriorly and descends along its lateral border.

Clinical significance

The axillary nerve may be injured in anterior-inferior dislocations of the shoulder joint, compression of the axilla with a crutch or fracture of the surgical neck of the humerus. An example of injury to the axillary nerve includes axillary nerve palsy. Injury to the nerve results in:

Paralysis of the teres minor muscle and deltoid muscle, resulting in loss of abduction of arm (from 15-90 degrees), weak flexion, extension, and rotation of shoulder. Paralysis of deltoid and teres minor muscles results in flat shoulder deformity.
Loss of sensation in the skin over a small part of the lateral upper arm (an area known as the regimental badge/patch).

Additional images

Brachial plexus with courses of spinal nerves shown
Suprascapular and axillary nerves of right side, seen from behind.
Cutaneous nerves of right upper extremity.
Diagram of segmental distribution of the cutaneous nerves of the right upper extremity.
Axillary nerve
Axillary nerve
Axillary nerve
Axillary nerve

References

This article incorporates text in the public domain from the 20th edition of Gray's Anatomy (1918)

1 2 de Sèze MP, Rezzouk J, de Sèze M, Uzel M, Lavignolle B, Midy D, Durandeau A (2004). "Does the motor branch of the long head of the triceps brachii arise from the radial nerve?". Surg Radiol Anat. 26 (6): 459–461. doi:10.1007/s00276-004-0253-z. PMID 15365769.

External links

Axillary_nerve at the Duke University Health System's Orthopedics program

Nerves of the brachial plexus

Supraclavicular

root (dorsal scapular, long thoracic)
upper trunk (suprascapular, to the subclavius)

Infraclavicular

lateral cord	lateral pectoral ansa pectoralis musculocutaneous (lateral cutaneous of forearm) median/lateral root: anterior interosseous palmar recurrent common palmar digital (proper palmar digital)

medial cord	medial pectoral ansa pectoralis cutaneous: medial cutaneous of forearm medial cutaneous of arm ulnar: muscular palmar dorsal (dorsal digital nerves) superficial (common palmar digital, proper palmar digital) deep median/medial root: see above

posterior cord	subscapular (upper, lower) thoracodorsal axillary (superior lateral cutaneous of arm) radial: muscular cutaneous (posterior of arm, inferior lateral of arm, posterior of forearm) superficial (dorsal digital nerves) deep (posterior interosseous)

Other

cutaneous innervation of the upper limbs

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