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Axillary nerve
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{{Short description|Nerve of the human body near the armpit}} {{Infobox nerve | Name = Axillary nerve | Latin = nervus axillaris | Image = Brachial plexus 2.svg | Caption = Brachial plexus. (Axillary nerve is visible in gray near center.) | Image2 = Gray818.png | Caption2 = The [[suprascapular nerve|suprascapular]], axillary, and [[radial nerve]]s. (Axillary labeled at upper right.) | Innervates = [[deltoid muscle|Deltoid]], [[teres minor]] | BranchFrom = [[Posterior cord]] (C5, C6) | BranchTo = }} The '''axillary nerve''' or the '''circumflex nerve''' is a [[nerve]] of the human body, that originates from the [[brachial plexus]] ([[upper trunk]], [[Dorsal ramus of spinal nerve|posterior division]], [[posterior cord]]) at the level of the [[axilla]] (armpit) and carries [[Nerve|nerve fibers]] from [[Cervical spinal nerve 5|C5]] and [[Cervical spinal nerve 6|C6]].<ref name=":0">{{Citation|last=Rea|first=Paul|title=Chapter 3 - Neck|date=2016-01-01|url=http://www.sciencedirect.com/science/article/pii/B978012803633400003X|work=Essential Clinically Applied Anatomy of the Peripheral Nervous System in the Head and Neck|pages=131–183|editor-last=Rea|editor-first=Paul|publisher=Academic Press|language=en|doi=10.1016/b978-0-12-803633-4.00003-x|isbn=978-0-12-803633-4|access-date=2020-10-25|url-access=subscription}}</ref><ref name=":1">{{Citation|last=Pezeshk|first=Parham|title=Chapter 13 - Imaging of Entrapped Peripheral Nerves|date=2015-01-01|url=http://www.sciencedirect.com/science/article/pii/B9780124103900000147|work=Nerves and Nerve Injuries|pages=167–171|editor-last=Tubbs|editor-first=R. Shane|place=San Diego|publisher=Academic Press|language=en|doi=10.1016/b978-0-12-410390-0.00014-7|isbn=978-0-12-410390-0|access-date=2020-10-25|editor2-last=Rizk|editor2-first=Elias|editor3-last=Shoja|editor3-first=Mohammadali M.|editor4-last=Loukas|editor4-first=Marios|url-access=subscription}}</ref><ref>{{Citation|last1=Ryan|first1=Monique M.|title=Chapter 14 - Mononeuropathies|date=2015-01-01|url=http://www.sciencedirect.com/science/article/pii/B9780124170445000147|work=Neuromuscular Disorders of Infancy, Childhood, and Adolescence (Second Edition)|pages=243–273|editor-last=Darras|editor-first=Basil T.|place=San Diego|publisher=Academic Press|language=en|doi=10.1016/b978-0-12-417044-5.00014-7|isbn=978-0-12-417044-5|access-date=2020-10-25|last2=Jones|first2=H. Royden|author-link=Monique Ryan|editor2-last=Jones|editor2-first=H. Royden|editor3-last=Ryan|editor3-first=Monique M.|editor4-last=De Vivo|editor4-first=Darryl C.|url-access=subscription}}</ref> The axillary nerve travels through the [[quadrangular space]] with the [[posterior circumflex humeral artery]] and vein to innervate the [[Deltoid muscle|deltoid]] and [[Teres minor muscle|teres minor]]. ==Structure== The nerve lies at first behind the [[axillary artery]],<ref>{{Citation|last1=Kretschmer|first1=Thomas|title=Chapter 36 - Iatrogenic Injuries of the Nerves|date=2015-01-01|url=http://www.sciencedirect.com/science/article/pii/B9780128026533000853|work=Nerves and Nerve Injuries|pages=557–585|editor-last=Tubbs|editor-first=R. Shane|place=San Diego|publisher=Academic Press|language=en|doi=10.1016/b978-0-12-802653-3.00085-3|isbn=978-0-12-802653-3|access-date=2020-10-25|last2=Heinen|first2=Christian|editor2-last=Rizk|editor2-first=Elias|editor3-last=Shoja|editor3-first=Mohammadali M.|editor4-last=Loukas|editor4-first=Marios|url-access=subscription}}</ref> and in front of the [[subscapularis]],<ref name=":0" /> and passes downward to the lower border of that muscle. It then winds from anterior to posterior around the neck of the [[humerus]], in company with the [[posterior humeral circumflex artery]],<ref name=":1" /> through the [[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),<ref name=":0" /> 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]],<ref>{{Citation|last=Voight|first=M. L.|title=Chapter 39 - Shoulder Instability|date=2017-01-01|url=http://www.sciencedirect.com/science/article/pii/B9780323286831000394|work=Orthopaedic Physical Therapy Secrets (Third Edition)|pages=335–341|editor-last=Placzek|editor-first=Jeffrey D.|publisher=Elsevier|language=en|doi=10.1016/b978-0-323-28683-1.00039-4|isbn=978-0-323-28683-1|access-date=2020-10-25|editor2-last=Boyce|editor2-first=David A.|url-access=subscription}}</ref> 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 muscle|deltoid]].<ref name=":1" /> The posterior branch pierces the deep fascia and continues as the [[Superior lateral cutaneous nerve of arm|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.<ref name="seze"/> * The trunk of the axillary nerve gives off an articular filament which enters the [[shoulder joint]] below the [[subscapularis]]. ===Variation=== Traditionally, the axillary nerve is thought to only supply the [[Deltoid muscle|deltoid]] and [[Teres minor muscle|teres minor]]. However, several studies on [[cadaver]]s pointed out that the long head of [[triceps brachii]] is innervated by a branch of the axillary nerve.<ref>{{cite journal|last1=Rezzouk|first1=J|last2=Durandeau|first2=A|last3=Vital|first3=JM|last4=Fabre|first4=T|title=Long head of the triceps brachii in axillary nerve injury: anatomy and clinical aspects|journal=Revue de Chirurgie Orthopédique et Réparatrice de l'Appareil Moteur|date=October 2002|volume=88|issue=6|pages=561–564|pmid=12447125}}</ref><ref name="seze">{{cite journal|vauthors=de Sèze MP, Rezzouk J, de Sèze M, Uzel M, Lavignolle B, Midy D, Durandeau A | title = Does the motor branch of the long head of the triceps brachii arise from the radial nerve?| journal = Surg Radiol Anat | volume = 26 | issue = 6 | pages = 459–461 | year = 2004 | pmid = 15365769| doi = 10.1007/s00276-004-0253-z| s2cid = 10052988}}</ref><ref><!--This is before Pulsus journals were acquired by OMICS, this is not a predatory source-->{{cite journal|last1=Komala|first1=Nanjundaiah|last2=Shashanka|first2=MallasandraJayadevaiah|last3=Sheshgiri|first3=Chowdapurkar|title=Long head of triceps supplied by axillary nerve|journal=International Journal of Anatomical Variations|date=16 April 2012|volume=5|pages=35–37|url=https://www.pulsus.com/scholarly-articles/long-head-of-triceps-supplied-by-axillary-nerve.html|access-date=26 January 2018}}</ref> ==Function== The axillary nerve supplies two [[muscle]]s in the arm: [[deltoid muscle|deltoid]] (a muscle of the shoulder) and [[teres minor]] (one of the [[rotator cuff]] muscles). The axillary nerve also carries sensory information from the [[shoulder joint]]. It also innervates the skin, covering the inferior region of the deltoid muscle, known as the regimental badge area.<ref name=":2">{{Citation|last=Jacob|first=S.|title=Chapter 2 - Upper Limb|date=2008-01-01|url=http://www.sciencedirect.com/science/article/pii/B9780443103735500051|work=Human Anatomy|pages=5–49|editor-last=Jacob|editor-first=S.|publisher=Churchill Livingstone|language=en|doi=10.1016/b978-0-443-10373-5.50005-1|isbn=978-0-443-10373-5|access-date=2021-01-11|url-access=subscription}}</ref> This is innervated by the [[Superior lateral cutaneous nerve of arm|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 [[Injury of axillary nerve|injured]] in anterior-inferior [[Dislocated shoulder|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 the regimental badge area.<ref name=":2" /> Direct trauma to the nerve can also lead to paralysis and loss of sensation.<ref>{{Citation|last=Neal|first=Sara|title=Chapter 33 - Peripheral Nerve Injury of the Upper Extremity|date=2015-01-01|url=http://www.sciencedirect.com/science/article/pii/B9780128026533000828|work=Nerves and Nerve Injuries|pages=505–524|editor-last=Tubbs|editor-first=R. Shane|place=San Diego|publisher=Academic Press|language=en|doi=10.1016/b978-0-12-802653-3.00082-8|isbn=978-0-12-802653-3|access-date=2020-10-25|editor2-last=Rizk|editor2-first=Elias|editor3-last=Shoja|editor3-first=Mohammadali M.|editor4-last=Loukas|editor4-first=Marios|url-access=subscription}}</ref> ==Additional images== <gallery> File:Brachial_plexus_color.svg|Brachial plexus with courses of spinal nerves shown File:Gray810.png|Suprascapular and axillary nerves of right side, seen from behind. File:Gray811and813.PNG|Cutaneous nerves of right upper extremity. File:Gray812and814.svg|Diagram of segmental distribution of the cutaneous nerves of the right upper extremity. File:Slide6a.JPG|Axillary nerve File:Slide2dj.JPG|Axillary nerve File:Slide12dj.JPG|Axillary nerve File:Slide18OOO.JPG|Axillary nerve </gallery> ==See also== *[[Axillary nerve dysfunction]] ==References== {{Gray's}} {{Reflist}} ==External links== * {{DukeOrtho|axillary_nerve}} {{Brachial plexus}} {{Portal bar|Anatomy}} {{Authority control}} {{DEFAULTSORT:Axillary Nerve}} [[Category:Nerves of the upper limb]] [[Category:Axillas]]
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