"" Langer’s Axillary Arch – Case Presentation and Literature Overview

Case Report

Austin J Anat. 2014;1(4): 1020.

Langer’s Axillary Arch – Case Presentation and Literature Overview

Hirtler L*

Department of Systematic Anatomy, Medical University Vienna, Austria

*Corresponding author: Hirtler L, Department of Systematic Anatomy, Center for Anatomy and Cell Biology, Medical University of Vienna, Währinger straße 13, 1090 Vienna, Austria

Received: August 27, 2014; Accepted: September 24, 2014; Published: September 29, 2014

Abstract

Langer’s axillary arch is an important anatomical variant of the shoulder region, connecting the latissimus dorsi and the pectoralis major muscles. Due to its frequency, clinicians should be aware of this variant as misidentifications could lead to severe complications in patient treatment.

The presented axillary arch was identified in a 67 years old specimen. Its innervation by the lateral pectoral nerve and blood supply by the subscapular artery could be preserved.

In conclusion, this case report and literature overview point out a clinical important anatomical variant, Langer’s axillary arch. Its misidentification can lead to wrong diagnoses and massive surgical complications, which could easily be avoided by intimate anatomical knowledge of the axillar region and its most frequent variants.

Keywords: Langer’s axillary arch; Anatomical variant; Shoulder region; Lateral pectoral nerve; Subscapular artery; Latissimus dorsi muscle; Pectoralis major muscle

Introduction

Langer’s axillary arch is an important anatomical variant of the shoulder region, connecting the latissimus dorsi muscle and the pectoralis major muscle. With a frequency of 7-8 % [1-9] it is a variant seen often in this region. However, this frequency range is depending on the population. Numbers can be found in literature between 1.7% in the Turkish population [10] and 43.8% in the Chinese population [11]. Cases of this anatomical variant reported during surgery are even less frequent [12] ranging from 0.25% to 4.3% [8, 13-15].

The history of the axillary arch is already a long one. First described in 1783 by Bugnone [16] and in 1793 by Ramsay [5,17], this variant became of greater interest after the account of Langer in 1846 [18,19]. Nevertheless one should mention, that Bugnone [16] and Ramsay [5,17] both described a muscular variation, and that Langer [18,19] mentions a fibrous arch without any muscular fibres. However, nowadays “Langer’s axillary arch”, as mentioned first by Testut [20] and now known by this name throughout literature, is the term for any variant coursing between the latissimus dorsi muscle and the pectoralis major muscle.

Jelev [21] summarized the three main characteristics of a typical axillary arch in his literature review:

The aim of this report was, to show the high variability of this anatomical variant, to emphasise the importance of its correct identification and to summarize existing literature on muscular variants in this shoulder by an example of a muscular axillary arch found during dissection.

Case Presentation

During the dissection course for our medical students at the anatomical institute of the medical university, this variant was observed in a 67 years old male specimen. The specimen was previously prepared for dissection by perfusion with a formol-phenol-solution.

The muscular slip of the axillary arch was identified in a right shoulder, running from the latissimus dorsi muscle towards the insertion of the pectoralis major muscle at the crest of the greater tubercle of the humerus. There it inserted distally to the insertion of the pectoralis major muscle directly into the humerus (Figure 1).

Citation: Hirtler L. Langer’s Axillary Arch – Case Presentation and Literature Overview. Austin J Anat. 2014;1(4): 1020. ISSN:2381-8921