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Arthroscopic visualization of the subscapularis tendon
J M Wright1, B Heavrin, R J Hawkins
1Steadman Hawkins Sports Medicine Foundation, Vail, Colorado, U.S.A.
Summary
Standard arthroscopy visualizes only 26% of the subscapularis tendon, leaving much of it concealed. This incomplete visualization of the subscapularis tendon is important for surgical planning.
Area of Science:
- Orthopedic Surgery
- Arthroscopy
- Anatomy
Background:
- The subscapularis tendon is crucial for shoulder function.
- Standard arthroscopic techniques are commonly used for shoulder joint assessment.
Purpose of the Study:
- To quantify the visible portion of the subscapularis tendon during glenohumeral arthroscopy.
- To measure the distance between the visible subscapularis tendon and the axillary nerve.
Main Methods:
- Cadaveric shoulder analysis using simulated lateral decubitus position and traction.
- Standard posterior portal glenohumeral arthroscopy performed on six specimens.
- Arthroscopic tagging of visible subscapularis portions, followed by dissection and measurement of surface area and distances.
Main Results:
- Arthroscopy visualized only 26% +/- 11% of the total subscapularis tendon surface area.
- The middle and inferior glenohumeral ligaments obscure the majority of the subscapularis tendon.
- A mean distance of 32.8 +/- 6.0 mm was found between the visible tendon's inferior aspect and the axillary nerve.
Conclusions:
- Standard arthroscopic visualization of the subscapularis tendon is incomplete.
- Lesions in the concealed portions of the subscapularis may be missed during arthroscopy.
- The significant safety margin to the axillary nerve is relevant for portal placement and anterior capsular procedures.