Glenohumeral arthroscopy portals established using an outside-in technique: neurovascular anatomy at risk

The purpose of this study was to examine the neurovascular structures at risk during placement of glenohumeral arthroscopy portals using an outside-in technique.

Anatomic cadaveric study.

Five fresh-frozen cadaveric specimens were used in this study. Each shoulder was mounted on a custom-designed apparatus allowing shoulder arthroscopy in a lateral decubitus position. The following portals were established using an outside-in technique and marked using an 18-gauge spinal needle: posterior, posterolateral, anterior, 5-o'clock, anterosuperolateral, and Port of Wilmington. Each specimen was carefully dissected after the procedure, and the distance from each portal site to the adjacent relevant neurovascular structures (axillary nerve, musculocutaneous nerve, lateral cord of the brachial plexus, cephalic vein, and axillary artery) was measured using a precision caliper.

Except for the cephalic vein, all of the neurovascular structures were more than 20 mm away from all the portals evaluated. When creating either an anterior portal or a 5-o'clock position portal, the mean distance from the portal to the cephalic vein was 18.8 mm and 9.8 mm, respectively. In one anterior portal, a direct injury to the cephalic vein occurred.

Our study suggests that shoulder arthroscopy portals placed in an outside-in fashion are unlikely to produce neurologic injury. However, the cephalic vein is at risk during placement of an anterior or 5-o'clock position portal, although probably with minimal subsequent patient morbidity. Placing portals in an outside-in fashion guarantees the correct angle of approach, with minimal risk to adjacent neurologic structures.

This study shows the safety of standard and accessory glenohumeral arthroscopy portals.