Purpose
This study was performed to determine the relation of the subscapular nerves to the
medial base of the coracoid when using an arthroscopic approach.
Methods
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.
Results
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.
Conclusions
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.
Clinical Relevance
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.
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References
- 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
Article info
Publication history
Published online: April 22, 2013
Accepted:
February 7,
2013
Received:
July 18,
2012
Footnotes
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.
Identification
Copyright
© 2013 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.
