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  • By Author: Martin, Justin P. x
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R. Shane Tubbs, Elizabeth C. Tyler-Kabara, Alan C. Aikens, Justin P. Martin, Leslie L. Weed, E. George Salter and W. Jerry Oakes

Object. There is a paucity of literature regarding the surgical anatomy of the quadrangular space (QS), which is a potential site of entrapment for the axillary nerve. Muscle hypertrophy of this geometrical area and fascial bands within it have been implicated in compression of the axillary nerve.

Methods. Fifteen human cadavers (30 sides) were dissected for this study. Measurements of the QS and its contents were made. The mean height of this space was 2.5 cm and the mean width 2.5 cm; its mean depth was 1.5 cm. The axillary nerve was always the most superior structure in the space, and in all cases the nerve and artery hugged the surgical neck of the humerus just superior to the origin of the lateral head of the triceps brachii muscle. This arrangement placed the axillary nerve in the upper lateral portion of the QS in all cadaveric specimens. The nerve branched into its muscular components within this space in 10 sides (33%) and posterior to it in 20 sides (66%). The cutaneous component of the axillary nerve branched from the main trunk of the nerve posterior to the QS in all specimens. Fascial bands were found in this space in 27 (90%) of 30 sides.

Conclusions. Knowledge of the anatomy of the QS may aid the surgeon who wishes to explore and decompress the axillary nerve within this geometrical confine.

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R. Shane Tubbs, Elizabeth C. Tyler-Kabara, Alan C. Aikens, Justin P. Martin, Leslie L. Weed, E. George Salter and W. Jerry Oakes

Object. There is a paucity of literature regarding the surgical anatomy of the dorsal scapular nerve (DSN). The aim of this study was to elucidate the relationship of this nerve to surrounding anatomical structures.

Methods. Ten formalin-fixed human cadavers (20 sides) were dissected, and measurements made between the DSN and related structures. The nerve pierced the middle scalene muscle at a mean distance of 3 cm from its origin from the cervical spine and was more or less centrally located at this exit site. It lay a mean distance of 1.5 cm medial to the vertebral border of the scapula between the serratus posterior superior, posterior scalene, and levator scapulae muscles. It was found to have a mean distance of 2.5 cm medial to the spinal accessory nerve as it traveled on the anterior border of the trapezius muscle. The nerve intertwined the dorsal scapular artery in all specimens and was found along the anterior border of the rhomboid muscles. On 19 sides the DSN originated solely from the C-5 spinal nerve, and on one side it arose from the C-5 and C-6 spinal nerves.

Conclusions. Knowledge of the anatomy of the DSN will aid the surgeon who wishes to explore and decompress this structure.