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Practical guidelines to safe surgery about the subscapularis

S W Yung1, M D Lazarus, D T Harryman

  • 1Department of Orthopaedic Surgery, Singapore General Hospital, Republic of Singapore.

Journal of Shoulder and Elbow Surgery
|November 1, 1996
PubMed
Summary
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This study maps subscapularis nerve insertions to guide surgeons in safely mobilizing the subscapularis tendon during anterior shoulder reconstruction. Protecting the axillary nerve is key to preserving subscapularis function and glenohumeral stability.

Area of Science:

  • Orthopedic Surgery
  • Neuroanatomy

Background:

  • Restoring glenohumeral joint function after failed anterior reconstructive surgery often requires mobilizing the subscapularis tendon.
  • The subscapularis muscle is crucial for anterior glenohumeral stability and strength.

Purpose of the Study:

  • To identify subscapularis nerve insertion points relative to surgical landmarks.
  • To provide surgical guidelines for avoiding denervation of the subscapularis muscle.

Main Methods:

  • Examination of subscapularis innervation in 11 fresh-frozen cadaveric shoulders.
  • Recording subscapular nerve insertion points relative to the axillary nerve, conjoined tendon, and anterior glenoid rim.

Main Results:

  • The anterior glenoid rim and medial conjoined tendon border serve as reliable guides to nerve insertion points.

Related Experiment Videos

  • Nerves were consistently found at least 1.5 cm medial to these landmarks.
  • The lower subscapular nerve is located near the axillary nerve.
  • Conclusions:

    • The axillary nerve is a critical landmark for protecting subscapularis innervation during deltopectoral approaches.
    • Identifying and protecting the axillary nerve minimizes the risk of iatrogenic injury to the subscapularis nerve.