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First, selective blockade of the suprascapular and axillary nerves will leave several nerves unblocked: upper subscapular (teres major), lower subscapular, thoracodorsal (latissimus dorsi) and lateral and medial pectoral.
Consider arthroscopic stabilisation: surgery involves the glenoid, predominantly innervated by the suprascapular nerve; irrigating fluid causes marked distension of the joint capsule, predominantly innervated by both suprascapular and axillary nerves.
In contrast, I report just two inadvertent radial nerve blocks due to spread of the local anaesthetic medial to the posterior cord with axillary nerve block.
The majority of patients receiving the block are having arthroscopic surgery to a region of the shoulder that is predominantly supplied by the suprascapular and axillary nerves.
Key Words: axillary nerve, interscalene nerve block, shoulder surgery, suprascapular nerve
The inferior, lateral and anterior structures of the shoulder joint are supplied primarily by the axillary nerve, a branch of the posterior cord, which also supplies the deltoid and has fibres to teres minor.
In older patients, the inability to lift the arm overhead most likely represents a disruption of the rotator cuff although axillary nerve palsy must be ruled out.
Up to 45% of patients with anterior shoulder dislocation have been reported to experience neurologic injury, most commonly to the axillary nerve.
Bryan WJ, Shauder K, Tullos HS: The axillary nerve and its relationship to common sports medicine shoulder procedures.
Recently, an anatomic study was performed to characterize the axillary nerve as it crosses the raphe between the middle and anterior heads of the deltoid.
The axillary nerve was readily palpable as a cord-like structure between the deltoid and humerus as it exits the quadrangular space with the posterior humeral circumflex vessels.
We report a rare form of transient upper brachial plexus injury involving both the radial and axillary nerves following intra-operative right lateral positioning for Kuntscher intramedullary nail insertion.