An association between the inferior humeral head osteophyte and teres minor fatty infiltration: evidence for axillary nerve entrapment in glenohumeral osteoarthritis

Authors:

Peter J. Millett, MD, MSca, Jean-Yves Schoenahl, MDa, Matthew J. Allen, VetMB, PhD, Tatiana Motta, DVM, MScb, Trevor R. Gaskill, MD

Abstract:

Glenohumeral osteoarthritis (GHOA) is characterized by pain, weakness, and cartilage degeneration. In some circumstances, a large inferior humeral osteophyte (goat’s beard deformity) may develop, extending into the inferior glenohumeral joint capsule. Considering the intimate relationship of the axillary nerve to the inferior glenohumeral joint capsule, it is plausible that large humeral osteophytes may place the axillary nerve at risk for injury.

The axillary nerve provides motor innervation to the deltoid and teres minor muscles and is critical for normal shoulder function. It also carries sensory fibers from the lateral shoulder and innervates portions of the glenohumeral capsule. As exemplified by quadrilateral space syndrome, compression of the axillary neurovascular bundle can contribute to posterolateral shoulder pain and motor dysfunction. Many patients with GHOA also complain of lateral and posterior shoulder pain. Therefore, axillary nerve injury as a result of osteophytic spurring in patients with GHOA may manifest as posterior shoulder pain clinically or as fatty infiltration of distally innervated musculature on imaging modalities.

It is unclear, however, whether the neurovascular bundle is displaced as the inferior osteophyte grows or whether the osteophyte encroaches on the fixed neurovascular bundle to produce irritation. Therefore, the purpose of this study was to compare the proximity of the axillary neurovascular bundle to the inferior humerus in arthritic cohorts in the presence or absence of humeral osteophytes. Furthermore, teres minor fatty infiltration, serving as a surrogate marker of axillary nerve dysfunction, will be quantified. These factors will then be correlated with the presence and size of the inferior humeral osteophytes. Our hypothesis was that glenohumeral osteophytes are capable of encroaching on the axillary nerve and, if of sufficient magnitude, may result in axillary nerve dysfunction. This dysfunction will in turn be manifested as an increase in the degree of fatty infiltration within the teres minor muscle.

For the complete study: An association between the inferior humeral head osteophyte and teres minor fatty infiltration: evidence for axillary nerve entrapment in glenohumeral osteoarthritis

Peter Millett, MD

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Alexandra Thompson

Mar 23, 2024

by Alexandra Thompson on Peter Millett, MD

110%

Dr. Millett and his team did a SLAP tear repair and bicep tenodesis on my left shoulder. I use my arms as an artist, and love to swim in the ocean, surf, paddle, and telemark ski. So regaining full use of my shoulder and keeping my bicep attached was very important to me. Now, over two years later, my shoulder has the equivalent range of motion as my other arm and as before the injury, and no pain. After the first three months it felt so good and was so strong that - to my horror - I completely forgot my six-month follow-up.

Not only did Dr. Millett and his team make my arm as good as new, but having had the experience of such kindness and expertise throughout the process of surgery and recovery is like an added shoulder superpower.

Thank you Rita, Brooke, Jason, Sarah, Camille, Olivia, Dr. Millett and everyone! And see you soon when my husband comes in for his knee...

Jeff Chandler

Jan 31, 2022

by Jeff Chandler on Peter Millett, MD

Flawless procedure, Easy recovery

Dr. Millet's repaired my knee and tibia, following a botched operation by a different surgeon. That procedure was virtually pain free and I was weight bearing within a few days. That was 18 years ago and the knee is still strong. A few years after the knee incident, Dr Millet repaired my shoulder. My insurance company approved me for 3 months of disability following that surgery. I was off pain medication in 2 days and had 90% range of motion within a week. I withdrew my disability claim and returned to work within two weeks of surgery. I’m not a famous athlete—just a regular guy. Nonetheless, I was treated like an NFL at the Steadman clinic. Most notable was the time for recovery. Other surgeons perform their hour-long task in the OR and don’t involve themselves in the other functions. Peter and his team manages the entire process from diagnosis, anesthesia, nursing care, and therapy. He takes a holistic approach to patient care and doesn’t skip any steps.

Jenn West

Jul 2, 2021

by Jenn West on Peter Millett, MD

Saved My Life

I went to Dr. Millett after 7 knee surgeries (6 on my right and 1 on my left) and had seen 11 different surgeons who all refused to remove femur metal from my right leg. I am highly allergic to metal and the chronic pain was leaving me bedridden for 3.5wks out of a month. He personally wrote me back on my inquiry, listened to my concerns, scheduled my surgery within a week (due to insurance issues) and personally followed up with my recovery. The level of patient care from Dr. Millett and his ENTIRE team is above any care I have ever received in my 20 years of dealing with orthopedic surgeons. There are not enough words to describe the level of care, dedication and professionalism you receive from Dr. Millett and his staff.
My only disappointment is that I did not find him sooner!!!

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An association between the inferior humeral head osteophyte and teres minor fatty infiltration: evidence for axillary nerve entrapment in glenohumeral osteoarthritis

Authors:

Abstract:

About the Author: Peter Millett, MD