Purpose
The purpose of this study was to examine the neurovascular structures at risk during
placement of glenohumeral arthroscopy portals using an outside–in technique.
Type of study
Anatomic cadaveric study.
Methods
Five fresh-frozen cadaveric specimens were used in this study. Each shoulder was mounted
on a custom-designed apparatus allowing shoulder arthroscopy in a lateral decubitus
position. The following portals were established using an outside–in technique and
marked using an 18-gauge spinal needle: posterior, posterolateral, anterior, 5-o’clock,
anterosuperolateral, and Port of Wilmington. Each specimen was carefully dissected
after the procedure, and the distance from each portal site to the adjacent relevant
neurovascular structures (axillary nerve, musculocutaneous nerve, lateral cord of
the brachial plexus, cephalic vein, and axillary artery) was measured using a precision
caliper.
Results
Except for the cephalic vein, all of the neurovascular structures were more than 20
mm away from all the portals evaluated. When creating either an anterior portal or
a 5-o’clock position portal, the mean distance from the portal to the cephalic vein
was 18.8 mm and 9.8 mm, respectively. In one anterior portal, a direct injury to the
cephalic vein occurred.
Conclusions
Our study suggests that shoulder arthroscopy portals placed in an outside–in fashion
are unlikely to produce neurologic injury. However, the cephalic vein is at risk during
placement of an anterior or 5-o’clock position portal, although probably with minimal
subsequent patient morbidity. Placing portals in an outside–in fashion guarantees
the correct angle of approach, with minimal risk to adjacent neurologic structures.
Clinical relevance
This study shows the safety of standard and accessory glenohumeral arthroscopy portals.
Key words
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to ArthroscopyAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Complications associated with arthroscopic shoulder surgery.Arthroscopy. 2002; 18: 88-95
- Venous pseudoaneurysm as a complication of shoulder arthroscopy.J Shoulder Elbow Surg. 1996; 5: 404-406
- Complications of shoulder arthroscopy.Arthroscopy. 1992; 8: 395
- Complications of shoulder arthroscopy.Orthop Rev. 1991; 20: 743-751
- Complications of shoulder arthroscopy.J South Orthop Assoc. 1997; 6: 190-196
- Arthroscopic shoulder instability surgery. Complications.Clin Sports Med. 1999; 18: 737-767
- Neurologic complications due to arthroscopy.J Bone Joint Surg Am. 1993; 75: 917-926
- The use of somatosensory evoked potentials for detection of neuropraxia during shoulder arthroscopy.Arthroscopy. 1988; 4: 250-255
- Cutaneous nerve lesions of the shoulder and arm after arthroscopic surgery.J Shoulder Elbow Surg. 1995; 4: 254-258
- Anterior portal selection for shoulder arthroscopy.Arthroscopy. 1985; 1: 33-39
- Shoulder arthroscopy and nerve injury.Arthroscopy. 1995; 11: 458-466
- Arthroscopic portals.Orthop Clin North Am. 1993; 24: 19-26
- Morphology of the axillary nerve in an anteroinferior shoulder arthroscopy portal.Arthroscopy. 1997; 13: 600-605
- Clinical and anatomic considerations in the use of a new anterior inferior subaxillary nerve arthroscopy portal.Arthroscopy. 1996; 12: 634-637
- The antero-inferior (transmuscular) approach for arthroscopic repair of the Bankart lesion.Arthroscopy. 1996; 12: 309-322
- Anterior portals in shoulder arthroscopy.Arthroscopy. 1989; 5: 201-208
- The low anterior five-o’clock portal during arthroscopic shoulder surgery performed in the beach-chair position.Am J Sports Med. 1999; 27: 571-574
- Anterior-inferior (5 o’clock) portal for shoulder arthroscopy.Arthroscopy. 1995; 11: 519-525
- SLAP lesions in the overhead athlete.Orthop Clinics North Am. 2001; 32: 431-441
- Shoulder injuries in overhead athletes. The “dead arm” revisited.Clinics Sports Med. 2000; 19: 125-158
- Dead arm syndrome.Tech Shoulder Elbow Surg. 2001; 2: 74-84
- Type II SLAP lesions.Arthroscopy. 1998; 14: 553-565
- Arthroscopic treatment of anterior shoulder instability.Operat Tech Orthop. 2001; 11: 17-23
- The trans-rotator cuff approach to SLAP lesions. Technical aspects for repair and a clinical follow-up of 31 patients at a minimum 2 year follow-up.Arthroscopy. 2002; 18: 372-377
Article info
Identification
Copyright
© 2004 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.
