Cadaveric anatomic study mapping the axillary nerve's position relative to the glenoid rim and inferior glenohumeral ligament from an arthroscopic perspective. Two novel techniques were used: intra-articular IGHL window dissection and Evans blue dye coronal sectioning. Specimens were placed in the standard lateral decubitus arthroscopic position to simulate operative conditions.
During arthroscopic inferior capsular work — capsulolabral reconstruction, thermal capsulorrhaphy, or capsular release. The axillary nerve is invisible but never far away.
The 6 o'clock position on the glenoid rim is the highest-risk location: the nerve averages just 12.4 mm away, and it sits only 2.5 mm from the inferior glenohumeral ligament throughout its course. These numbers do not change much as you move anterior or posterior, so the entire inferior capsular arc from 4 to 8 o'clock deserves respect.
When a patient reports sensory changes over the lateral arm after an inferior capsular procedure, that is an axillary nerve injury until proven otherwise. Motor loss to teres minor may accompany it but is easy to miss on routine exam.
The authors caution that joint distention during live arthroscopy and pathologic capsular anatomy (patulous capsule, detached labrum) could bring the nerve even closer than what these cadaveric measurements suggest.
Cadaveric anatomic study mapping the axillary nerve's position relative to the glenoid rim and inferior glenohumeral ligament from an arthroscopic perspective. Two novel techniques were used: intra-articular IGHL window dissection and Evans blue dye coronal sectioning. Specimens were placed in the standard lateral decubitus arthroscopic position to simulate operative conditions.
During arthroscopic inferior capsular work — capsulolabral reconstruction, thermal capsulorrhaphy, or capsular release. The axillary nerve is invisible but never far away.
The 6 o'clock position on the glenoid rim is the highest-risk location: the nerve averages just 12.4 mm away, and it sits only 2.5 mm from the inferior glenohumeral ligament throughout its course. These numbers do not change much as you move anterior or posterior, so the entire inferior capsular arc from 4 to 8 o'clock deserves respect.
When a patient reports sensory changes over the lateral arm after an inferior capsular procedure, that is an axillary nerve injury until proven otherwise. Motor loss to teres minor may accompany it but is easy to miss on routine exam.
The authors caution that joint distention during live arthroscopy and pathologic capsular anatomy (patulous capsule, detached labrum) could bring the nerve even closer than what these cadaveric measurements suggest.