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Scapulothoracic anatomy for the arthroscopist
L J Ruland1, C M Ruland, L S Matthews
1Department of Orthopaedic Surgery, Union Memorial Hospital, Baltimore, Maryland, USA.
Summary
This study maps scapulothoracic spaces for safe arthroscopic surgery portals. Identifying safe zones helps avoid neurovascular structures during endoscopic management of subscapular snapping.
Area of Science:
- Orthopedic Surgery
- Anatomy
- Arthroscopy
Background:
- Endoscopic management is a new treatment for painful subscapular snapping.
- Understanding scapulothoracic anatomy is crucial for safe arthroscopic portal placement.
Purpose of the Study:
- To identify the boundaries of scapulothoracic spaces.
- To determine the relationship of neurovascular structures to safe arthroscopic portal sites.
Main Methods:
- Anatomic dissection of eight fresh, unembalmed cadaveric shoulders.
- Arthroscopic dissection of eight fresh, unembalmed cadaveric shoulders.
Main Results:
- Two triangular spaces identified: serratus anterior and subscapularis spaces, divided by the serratus anterior muscle.
- Serratus anterior space contains a bursa; its boundaries are the chest wall, serratus anterior, and rhomboids.
- Subscapularis space boundaries are the serratus anterior muscle, subscapularis muscle, and axilla.
Conclusions:
- Recommended arthroscopic portal sites are inferior to the scapular spine and 3-4 finger-breadths from the vertebral border.
- These portal recommendations aim to avoid neurovascular structures and ensure safe arthroscope orientation.