Characterization of an anatomic safe zone surrounding the lower subscapular nerve during an open deltopectoral approach

Kempland C. Walley, Kaitlin L. Saloky, Gary F. Updegrove, Hector Lopez, April Armstrong

Research output: Contribution to journalArticle

Abstract

Background: Due to anatomic variance in subscapular nerve innervation patterns, it is theorized that the dysfunction of the subscapularis could be the result of iatrogenic denervation during mobilization of the subscapularis while exposing the anterior glenohumeral joint in anterior surgical approaches. The purpose of this study was to describe innervation patterns of the subscapularis and to characterize a safe zone when conducting an anterior surgical approach. Methods: The study used 6 human cadaveric shoulder specimens (12 shoulders total). A deltopectoral approach was used to expose the axillary nerve back to the posterior cord of the brachial plexus and reveal the origins of the upper and lower subscapularis nerves. An anatomic safe zone was characterized by measuring distances from both the upper and lower subscapularis nerve insertions with respect to that of the lateral border of the conjoint tendon, the bicipital groove, superior border of the subscapularis, and the axillary nerve (for the lower subscapular nerve only) with the arm in 30° abduction. Results: The anatomic safe zone of the subscapular nerves medial to the conjoint tendon is less than 32 mm. In relation to the axillary nerve, the safe zone is less than 10 mm inferiorly and 15 mm medially. Conclusions: This described safe zone with respect to the lateral border of the conjoint tendon and axillary nerve is aimed to provide guidance to reduce iatrogenic injury of the subscapular nerves during anterior shoulder exposure. Extra care should be undertaken while dissecting past this safe zone to prevent iatrogenic subscapular nerve injury.

Original languageEnglish (US)
Pages (from-to)671-677
Number of pages7
JournalJournal of Shoulder and Elbow Surgery
Volume28
Issue number4
DOIs
StatePublished - Apr 1 2019

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Rotator Cuff
Tendons
Shoulder Joint
Brachial Plexus
Wounds and Injuries
Denervation
Arm

All Science Journal Classification (ASJC) codes

  • Surgery
  • Orthopedics and Sports Medicine

Cite this

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title = "Characterization of an anatomic safe zone surrounding the lower subscapular nerve during an open deltopectoral approach",
abstract = "Background: Due to anatomic variance in subscapular nerve innervation patterns, it is theorized that the dysfunction of the subscapularis could be the result of iatrogenic denervation during mobilization of the subscapularis while exposing the anterior glenohumeral joint in anterior surgical approaches. The purpose of this study was to describe innervation patterns of the subscapularis and to characterize a safe zone when conducting an anterior surgical approach. Methods: The study used 6 human cadaveric shoulder specimens (12 shoulders total). A deltopectoral approach was used to expose the axillary nerve back to the posterior cord of the brachial plexus and reveal the origins of the upper and lower subscapularis nerves. An anatomic safe zone was characterized by measuring distances from both the upper and lower subscapularis nerve insertions with respect to that of the lateral border of the conjoint tendon, the bicipital groove, superior border of the subscapularis, and the axillary nerve (for the lower subscapular nerve only) with the arm in 30° abduction. Results: The anatomic safe zone of the subscapular nerves medial to the conjoint tendon is less than 32 mm. In relation to the axillary nerve, the safe zone is less than 10 mm inferiorly and 15 mm medially. Conclusions: This described safe zone with respect to the lateral border of the conjoint tendon and axillary nerve is aimed to provide guidance to reduce iatrogenic injury of the subscapular nerves during anterior shoulder exposure. Extra care should be undertaken while dissecting past this safe zone to prevent iatrogenic subscapular nerve injury.",
author = "Walley, {Kempland C.} and Saloky, {Kaitlin L.} and Updegrove, {Gary F.} and Hector Lopez and April Armstrong",
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Characterization of an anatomic safe zone surrounding the lower subscapular nerve during an open deltopectoral approach. / Walley, Kempland C.; Saloky, Kaitlin L.; Updegrove, Gary F.; Lopez, Hector; Armstrong, April.

In: Journal of Shoulder and Elbow Surgery, Vol. 28, No. 4, 01.04.2019, p. 671-677.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Characterization of an anatomic safe zone surrounding the lower subscapular nerve during an open deltopectoral approach

AU - Walley, Kempland C.

AU - Saloky, Kaitlin L.

AU - Updegrove, Gary F.

AU - Lopez, Hector

AU - Armstrong, April

PY - 2019/4/1

Y1 - 2019/4/1

N2 - Background: Due to anatomic variance in subscapular nerve innervation patterns, it is theorized that the dysfunction of the subscapularis could be the result of iatrogenic denervation during mobilization of the subscapularis while exposing the anterior glenohumeral joint in anterior surgical approaches. The purpose of this study was to describe innervation patterns of the subscapularis and to characterize a safe zone when conducting an anterior surgical approach. Methods: The study used 6 human cadaveric shoulder specimens (12 shoulders total). A deltopectoral approach was used to expose the axillary nerve back to the posterior cord of the brachial plexus and reveal the origins of the upper and lower subscapularis nerves. An anatomic safe zone was characterized by measuring distances from both the upper and lower subscapularis nerve insertions with respect to that of the lateral border of the conjoint tendon, the bicipital groove, superior border of the subscapularis, and the axillary nerve (for the lower subscapular nerve only) with the arm in 30° abduction. Results: The anatomic safe zone of the subscapular nerves medial to the conjoint tendon is less than 32 mm. In relation to the axillary nerve, the safe zone is less than 10 mm inferiorly and 15 mm medially. Conclusions: This described safe zone with respect to the lateral border of the conjoint tendon and axillary nerve is aimed to provide guidance to reduce iatrogenic injury of the subscapular nerves during anterior shoulder exposure. Extra care should be undertaken while dissecting past this safe zone to prevent iatrogenic subscapular nerve injury.

AB - Background: Due to anatomic variance in subscapular nerve innervation patterns, it is theorized that the dysfunction of the subscapularis could be the result of iatrogenic denervation during mobilization of the subscapularis while exposing the anterior glenohumeral joint in anterior surgical approaches. The purpose of this study was to describe innervation patterns of the subscapularis and to characterize a safe zone when conducting an anterior surgical approach. Methods: The study used 6 human cadaveric shoulder specimens (12 shoulders total). A deltopectoral approach was used to expose the axillary nerve back to the posterior cord of the brachial plexus and reveal the origins of the upper and lower subscapularis nerves. An anatomic safe zone was characterized by measuring distances from both the upper and lower subscapularis nerve insertions with respect to that of the lateral border of the conjoint tendon, the bicipital groove, superior border of the subscapularis, and the axillary nerve (for the lower subscapular nerve only) with the arm in 30° abduction. Results: The anatomic safe zone of the subscapular nerves medial to the conjoint tendon is less than 32 mm. In relation to the axillary nerve, the safe zone is less than 10 mm inferiorly and 15 mm medially. Conclusions: This described safe zone with respect to the lateral border of the conjoint tendon and axillary nerve is aimed to provide guidance to reduce iatrogenic injury of the subscapular nerves during anterior shoulder exposure. Extra care should be undertaken while dissecting past this safe zone to prevent iatrogenic subscapular nerve injury.

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U2 - 10.1016/j.jse.2018.09.008

DO - 10.1016/j.jse.2018.09.008

M3 - Article

VL - 28

SP - 671

EP - 677

JO - Journal of Shoulder and Elbow Surgery

JF - Journal of Shoulder and Elbow Surgery

SN - 1058-2746

IS - 4

ER -