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Abstract
Because endoscopic management has recently been introduced as treatment for painful
subscapular snapping, we designed a cadaveric study to identify the boundaries of
the scapulothoracic spaces and the relationship of important neurovascular structures
to safe portal sites for arthroscopic surgery. We studied eight fresh, unembalmed
cadaveric shoulders by anatomic dissection alone and eight fresh, unembalmed cadaveric
shoulders by dissection after arthroscopy. We noted the following findings: (1) the
scapulothoracic articulation has two triangular spaces, the serratus anterior space
and the subscapularis space, that are divided obliquely by the serratus anterior muscle;
(2) the boundaries of the larger serratus anterior space include the chest wall anteriorly,
the serratus anterior muscle posteriorly, and the rhomboids medially; (3) the boundaries
of the subscapularis space are the serratus anterior muscle anteriorly, the subscapularis
muscle posteriorly, and the axilla laterally; and (4) a well-defined bursa occupies
the serratus anterior space. Based on these findings, we recommend that portals for
arthroscopic surgery should be inferior to the spine of the scapula and three to four
fingerbreadths from the vertebral border of the scapula (1) to avoid the neurovascular
structures at the superomedial angle of the scapula, (2) to avoid the dorsosacpular
nerve and artery, and (3) to prevent perpendicular orientation of the arthroscope
to the lateral chest wall.
Keywords
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© 1995 Published by Elsevier Inc.