We found a match
Your institution may have rights to this item. Sign in to continue.
- Title
Effect of scapular external rotation on the axillary nerve during the arthroscopic Latarjet procedure: an anatomical investigation.
- Authors
Reinares, Felipe; Werthel, Jean-David; Moraiti, Constantina; Valenti, Philippe
- Abstract
<bold>Purpose: </bold>The first purpose of this study is to measure the distance between the axillary nerve and the exit point of K-wires placed retrograde through the glenoid in the setting of an arthroscopic Latarjet procedure. The second objective is to evaluate whether manual external rotation of the scapula alters that distance.<bold>Methods: </bold>In seven fresh-frozen specimens, two 2.0-mm K-wires were drilled through the glenoid using an arthroscopic Latarjet retrograde glenoid guide. These were drilled into the glenoid at the 7- and 8-o'clock positions (right shoulders) and at the 4- and 5-o'clock positions (left). K-wires were oriented parallel to the glenoid articular surface and perpendicular to the long superoinferior axis of the glenoid, 7 mm medial to the joint surface. Two independent evaluators measured the distances between the axillary nerve and the exit point of the K-wires in the horizontal plane (AKHS for the superior K-wire and AKHI for the inferior K-wire) and in the vertical plane (AKV). Measurements were taken with the scapula left free and were repeated with the scapula placed at 15° and 30° of external rotation.<bold>Results: </bold>With the scapula left free, scapular external rotation was 34° ± 2.3°. In this position, the AKHS was 2.5 ± 1.6, 6.3 ± 1.2 mm at 15° of external rotation (ER) and 11.4 ± 1.4 mm at 30° ER. The AKHI distance was 0.37 ± 1.6, 3.4 ± 1.4 and 10.6 ± 2.1 mm, respectively, for the scapula left free, at 15° ER and 30° of ER. The AKV distances were, respectively, 0.12 ± 0.2, 4.9 ± 1.6 and 9.9 ± 1.7 mm. The increase in all distances was statistically significant (p < 0.001).<bold>Conclusion: </bold>Increasing scapular external rotation significantly increases the distance between the axillary nerve and the exit point of the K-wires, increasing the margin of safety during this procedure. Therefore, increased external rotation of the scapula could be an effective tool to decrease the risk of iatrogenic axillary nerve injury.<bold>Level Of Evidence: </bold>Cadaveric study, Level V.
- Subjects
ARTHROSCOPY; NEURODEGENERATION; NERVES; SHOULDER injuries; ENDOSCOPY; PERIPHERAL nerve injuries; SHOULDER joint surgery; SCAPULA; BRACHIAL plexus; DEAD; ROTATIONAL motion; SHOULDER; SURGERY
- Publication
Knee Surgery, Sports Traumatology, Arthroscopy, 2017, Vol 25, Issue 10, p3289
- ISSN
0942-2056
- Publication type
journal article
- DOI
10.1007/s00167-016-4224-9