This study was performed to determine the relation of the subscapular nerves to the medial base of the coracoid when using an arthroscopic approach.
Twenty human cadaveric shoulder specimens were dissected, and measurements were taken from the medial base of the coracoid to the innervation points of the upper and lower subscapular nerves. Measurements were obtained with the humerus in both neutral and maximal external rotation.
The average distance of the upper subscapular nerve from the coracoid base was 31.6 ± 6.6 mm (range, 22 to 45 mm) in neutral rotation and 24.2 ± 7.4 mm (range, 11 to 35 mm) in external rotation. The lower subscapular nerve's insertion point averaged 42.6 ± 7.6 mm (range, 25 to 55 mm) from the coracoid base in neutral rotation and 33.9 ± 6.9 mm (range, 24 to 45 mm) in external rotation. For both nerves, their distance from the coracoid significantly decreased when the humerus was placed in external rotation.
The closest that the innervation point of either the upper or lower subscapular nerve came to the medial aspect of the coracoid was 11 mm.
Understanding the relationship of the subscapular nerves to the base of the coracoid allows a safe arthroscopic release of a retracted subscapularis muscle that has formed adhesions to the inferior aspect of the coracoid. Use of an arthroscopic elevator to release adhesions between the subscapularis and the inferior aspect of the coracoid does not appear to risk denervation of the subscapularis muscle.
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 access
One-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 Arthroscopy
Already a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
- Rupture of the subscapularis tendon (isolated or in combination with supraspinatus tear): When is a repair indicated?.J Shoulder Elbow Surg. 2006; 15: 659-664
- Diagnosis and treatment of anterosuperior rotator cuff tears.J Shoulder Elbow Surg. 2001; 10: 37-46
- Subscapularis, medial, and lateral coracohumeral ligament insertion anatomy. Arthroscopic appearance and incidence of ‘‘hidden’’ rotator interval lesions.Arthroscopy. 2001; 17: 173-180
- Incomplete tears of the subscapularis tendon associated with tears of the supraspinatus tendon: Cadaveric and clinical studies.J Shoulder Elbow Surg. 1998; 7: 510-515
- Partial tears of the subscapularis tendon found during arthroscopic procedures on the shoulder: A statistical analysis of sixty cases.Am J Sports Med. 2003; 31: 744-750
- Arthroscopic subscapularis repair: Surgical tips and pearls A to Z.Arthroscopy. 2006; 22: 1014-1027
- Arthroscopic subscapularis tendon repair: Technique and preliminary results.Arthroscopy. 2002; 18: 454-463
- Structural integrity and clinical outcomes after arthroscopic repair of isolated subscapularis tears.J Bone Joint Surg Am. 2007; 89: 1184-1193
- Subscapularis function and structural integrity after arthroscopic repair of isolated subscapularis tears.Am J Sports Med. 2011; 39: 1255-1262
- Surgery about the coracoid: Neurovascular structures at risk.Arthroscopy. 2004; 20: 591-595
- Human cadaveric study of subscapularis muscle innervation and guidelines to prevent denervation.J Shoulder Elbow Surg. 2008; 17: 659-662
- Subscapularis muscle enervation: The effect of arm position.J Shoulder Elbow Surg. 1996; 5: 214-218
- Practical guidelines to safe surgery about the subscapularis.J Shoulder Elbow Surg. 1996; 5: 467-470
Published online: April 22, 2013
Accepted: February 7, 2013
Received: July 18, 2012
The authors report the following potential conflict of interest or source of funding in relation to this article: B. H. is an employee of Arthrex, Inc., S. S. B. has received money from Arthrex, Inc., for consultancy, lectures, patents, royalties, travel, accommodations, and unrelated meeting expenses.
© 2013 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.