Universität zu Köln

Leschinger, Tim ORCID: 0000-0003-1319-6949, Hackl, Michael, Zeifang, Felix, Scaal, Martin, Mueller, Lars Peter and Wegmann, Kilian (2017). Nerve supply of the subscapularis during anterior shoulder surgery: definition of a potential risk area. Arch. Orthop. Trauma Surg., 137 (1). S. 135 - 141. NEW YORK: SPRINGER. ISSN 1434-3916

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Abstract

The purpose of the study was to evaluate the position of the subscapular nerves relative to surgical landmarks during exposure and to analyze the pattern of innervation of the subscapularis to avoid injury during anterior shoulder surgery. 20 embalmed human cadaveric shoulder specimens were used in the study. The muscular insertions of the subscapular nerves were marked and their closest branches to the musculotendinous junction and the coracoid process were measured in horizontal and vertical distances. In addition, the innervation pattern of each specimen was documented. 14/20 specimens showed an innervation of the subscapularis with an upper, middle and lower subscapular nerve branch. Even though the nerve branches were in average more than 2 cm medial to the musculotendinous junction, minimal distances of 1.1-1.3 cm were found. The mean vertical distance as measured from the medial base of the coracoid to the nerve innervation point into the muscle was 0.7 cm for the upper nerve branch, 2.2 cm for the middle nerve branch and 4.4 cm for the lower nerve branch. The subscapularis has a variable nerve supply, which increases the risk of muscle denervation during open shoulder surgery. Dissection or release should be avoided at the anterior aspect of the subscapularis muscle more than 1 cm medial to the musculotendinous junction. In approaches with a horizontal incision of the subscapularis, splitting should be performed at a vertical distance of 3.2-3.6 cm to the coracoid base to avoid iatrogenic subscapular nerve injuries.

Item Type:	Journal Article
Creators:	Creators Email ORCID ORCID Put Code Leschinger, Tim UNSPECIFIED orcid.org/0000-0003-1319-6949 UNSPECIFIED Hackl, Michael UNSPECIFIED UNSPECIFIED UNSPECIFIED Zeifang, Felix UNSPECIFIED UNSPECIFIED UNSPECIFIED Scaal, Martin UNSPECIFIED UNSPECIFIED UNSPECIFIED Mueller, Lars Peter UNSPECIFIED UNSPECIFIED UNSPECIFIED Wegmann, Kilian UNSPECIFIED UNSPECIFIED UNSPECIFIED
URN:	urn:nbn:de:hbz:38-247758
DOI:	10.1007/s00402-016-2585-7
Journal or Publication Title:	Arch. Orthop. Trauma Surg.
Volume:	137
Number:	1
Page Range:	S. 135 - 141
Date:	2017
Publisher:	SPRINGER
Place of Publication:	NEW YORK
ISSN:	1434-3916
Language:	English
Faculty:	Unspecified
Divisions:	Unspecified
Subjects:	no entry
Uncontrolled Keywords:	Keywords Language MUSCLE; REPAIR; RECONSTRUCTION; ARTHROPLASTY; REPLACEMENT; INNERVATION; INSTABILITY Multiple languages Orthopedics; Surgery Multiple languages
Refereed:	Yes
URI:	http://kups.ub.uni-koeln.de/id/eprint/24775