Purpose: The purpose of this study was to describe the musculotendinous relations and neurologic
structures at risk during establishment of posterior portals for access to the inferior
glenohumeral recess (IGHR). Methods: Three 18-gauge spinal needles were used to establish 2 posteroinferior portals and
1 axillary pouch portal in 14 embalmed cadaveric shoulders, without joint distention
and arthroscopic visualization. At dissection, musculotendinous structures traversed
by the needles were recorded, and distances from the (1) axillary nerve (at the deltoid
undersurface, quadrangular space, and capsule), (2) nerve to teres minor (at the inferior
border of the teres minor muscle and at the capsule), and (3) suprascapular nerve
were measured. Additional parameters studied included the vertical distances between
the acromion and IGHR and between the acromion and axillary nerve. Statistical analysis
(multiple comparisons procedure) was performed to compare relative portal safety.
Results: The mean distance of the axillary pouch portal to the 3 nerves, at each level, was
greater than that of the posteroinferior portals. In 1 specimen (7.1%), the posteroinferior
portal tracts were in close proximity (within 2 mm) to the axillary nerve and its
branch to the teres minor. The distance of the axillary pouch portal to the nerves
was significantly greater (P < .05) at every level, except at the deltoid undersurface. Conclusions: Our study suggests that posterior portal techniques described for access to the IGHR
are safe; the risk of axillary nerve injury with posteroinferior portals is low, though
possible. The axillary pouch portal is relatively farther away from the neurologic
structures and provides safer access to the same region. Clinical Relevance: Arthroscopic procedures that require access to the IGHR can be safely performed with
posteroinferior and axillary pouch portals. The axillary pouch portal may be used
preferentially for this access because it is placed farthest from the neurologic structures.
Key Words
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Article info
Publication history
Published online: February 13, 2008
Footnotes
The authors report no conflict of interest.
Identification
Copyright
© 2008 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.
